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Medical instability and growth of children and adolescents with early onset eating disorders
  1. Lee D Hudson1,2,
  2. Dasha E Nicholls2,
  3. Richard M Lynn3,4,
  4. Russell M Viner1
  1. 1Department of General and Adolescent Paediatrics, UCL Institute of Child Health, London, UK
  2. 2Department of Feeding and Eating Disorders, Great Ormond Street Hospital, London, UK
  3. 3Research Division, Royal College of Paediatrics and Child Health, London, UK
  4. 4Centre for Epidemiology, UCL Institute of Child Health, London, UK
  1. Correspondence to Lee D Hudson, UCL Institute of Child Health, General and Adolescent Paediatrics, 30 Guilford Street, London WC1N 1EH, UK; l.hudson{at}


Objective Little is known about the physical burden of early onset eating disorders (EOEDs). Most published data on physical instability and growth in malnutrition come from specialist centres, or from the developing world where aetiology differs. The authors present data on physical status at presentation from population-based surveillance systems in the UK and Ireland.

Design Prospective surveillance study.

Participants All suspected cases of EOED in children under 13 years of age reported by paediatricians and psychiatrists via the British Paediatric Surveillance System (BPSU) and Child and Adolescent Psychiatric Surveillance System (CAPSS) in the UK and Ireland from March 2005 to May 2006 (15 months).

Results 208 cases were identified (24% reported by paediatricians). Median age was 11.8 years (IQR 1.74). 171 (82%) were female (78% premenarcheal and 60% prepubertal). 74% of males were prepubertal. 35% of cases had medical instability at presentation (60% bradycardia, 54% hypotension, 34% dehydration, 26% hypothermia). 52% of cases required admission at diagnosis (73% to a paediatric ward). 41% of cases with medical instability were not underweight, that is, they had body mass index (BMI) z-scores above −2.0 (2nd centile). Sensitivities for identifying medical instability with BMI z-score <−3 or 70% median BMI were 31% and 15%, respectively. Menarcheal status did not predict risk of medical instability.

Conclusions EOEDs present with severe levels of physical instability and frequently to paediatricians. As anthropological indices alone are poor markers for medical instability, clinical assessment is essential. Doctors providing care for children have a central role in both the recognition and management of EOEDs.

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  • Contributors DN conceived the study; RL handled BPSU and CAPSS management and facilitation; DN, RV and RL undertook case selection and methodology; and LH undertook the statistical analyses and led the writing of this paper. All four authors contributed to the final manuscript.

  • Funding The Harold Hyam Wingate Foundation provided funding for this study.

  • Competing interests None.

  • Ethics approval The study was approved by the BPSU Executive and the National Research Ethics System. As BPSU studies have PIAG section 12 exemption, consent for notification was not necessary from children or families.

  • Provenance and peer review Not commissioned; externally peer reviewed.