🧒 Eating disorders in children and adolescents are serious mental health conditions characterised by disturbed eating behaviours, body image concerns, and disruption of growth, physical health, and psychosocial development. Early recognition and intervention are essential to prevent medical complications and support recovery. NICE recommends a multidisciplinary, age-appropriate approach involving paediatrics, psychiatry (CAMHS), dietetics, psychology, and family support.

📌 Common Eating Disorders (NICE / DSM-5)

🥗 Anorexia Nervosa: Restrictive eating, fear of weight gain, distorted body image → weight loss, delayed growth, failure to thrive.
🤮 Bulimia Nervosa: Recurrent binge eating with compensatory behaviours (vomiting, laxatives, excessive exercise); weight may be normal.
🍔 Binge Eating Disorder: Recurrent overeating without purging → obesity & metabolic risk.
🚫 ARFID (Avoidant/Restrictive Food Intake Disorder): Food avoidance without body image disturbance → malnutrition & growth failure.
🧩 Pica: Persistent ingestion of non-food items (chalk, dirt, paper); often associated with developmental delay or iron deficiency.

⚠️ Warning Signs / Red Flags

⚖️ Rapid weight loss / failure to gain weight
🥄 Obsessive eating rituals or avoidance of food groups
🚪 Frequent bathroom visits after meals (possible purging)
🥶 Cold intolerance, fatigue, dizziness (malnutrition)
🤕 GI symptoms: bloating, pain, constipation, reflux
😔 Mood/behaviour changes: anxiety, irritability, withdrawal, self-harm thoughts

🎯 Risk Factors (UK context)

🧬 Genetic: Family history of eating or psychiatric disorders
🧠 Psychological: Perfectionism, low self-esteem, anxiety
🌍 Environmental: Peer/media pressure, social comparison, “thin ideal” culture
💥 Trauma / Stress: Bullying, adverse childhood experiences, family disruption

💉 Medical & Psychiatric Complications

🥦 Malnutrition: Delayed growth, vitamin/mineral deficiencies
❤️ Cardiac: Bradycardia, hypotension, arrhythmias, sudden death risk
🦴 Bone: Osteoporosis, delayed puberty
🩺 Gastrointestinal: Reflux, gastritis, constipation, oesophagitis
⚖️ Endocrine: Amenorrhoea, delayed sexual maturation
🧠 Mental health: Depression, anxiety, self-harm, suicide risk

🩺 Assessment / Diagnosis (per NICE CG9 / NG69)

📖 History: Eating habits, triggers, binge/purge patterns, comorbid psychiatric symptoms
🩺 Examination: Growth chart, BMI, vitals, pubertal staging
🧪 Investigations: FBC, U&E, LFTs, ECG; bone profile if chronic malnutrition
🧠 Mental health evaluation: Mood, anxiety, risk assessment, readiness for treatment

⚕️ Management (Multidisciplinary Approach)

🥦 Nutritional rehabilitation: Gradual refeeding; hospitalisation for severe cases or medical instability
🧠 Psychotherapy: Family-Based Therapy (FBT) for children/adolescents; CBT for bulimia/binge eating
📉 Medical monitoring: Regular weight, vitals, electrolytes, ECG, growth tracking
💊 Medication: SSRIs for comorbid anxiety/depression (second-line)
👨‍👩‍👧 Family support: Structured mealtimes, psychoeducation, parental involvement

📊 Quick Reference Table – Eating Disorders in Children (UK/NICE Aligned)

Disorder	Typical Age	Key Features / Red Flags	Medical Complications	Psychological / Behavioural Complications	First-Line Management (NICE)
🥗 Anorexia Nervosa	12–18 yrs	Restriction, fear of weight gain, distorted body image, low BMI, delayed puberty	Malnutrition, bradycardia, hypotension, arrhythmia, osteoporosis, amenorrhoea	Low mood, anxiety, social withdrawal, self-harm risk	Multidisciplinary: FBT, nutritional rehabilitation, medical monitoring, psychoeducation
🤮 Bulimia Nervosa	12–18 yrs	Binge eating + compensatory behaviours (vomiting, laxatives), normal or fluctuating weight, guilt after binge	Electrolyte disturbances, dehydration, GI injury (Mallory-Weiss tear)	Depression, anxiety, shame, low self-esteem	CBT, nutritional support, medical monitoring, family involvement
🍔 Binge Eating Disorder	10–18 yrs	Recurrent binge eating without purging, distress about overeating	Obesity, metabolic syndrome, GI discomfort	Low self-esteem, depression, anxiety	CBT, nutritional counselling, behavioural therapy, support for metabolic health
🚫 ARFID	5–12 yrs (common), adolescents too	Food avoidance/restriction without body image concern, selective eating, failure to gain weight	Malnutrition, growth delay, vitamin/mineral deficiencies	Food anxiety, distress at mealtimes, social anxiety	Multidisciplinary: dietetics, CBT/therapy for food-related anxiety, gradual exposure, family support
🧩 Pica	2–8 yrs	Persistent ingestion of non-food items (chalk, dirt), developmental delay	Iron deficiency, GI obstruction, poisoning risk	Behavioural issues, attention problems	Screen for nutritional deficiencies, behavioural therapy, environmental safety, developmental support

📈 Prognosis

Early recognition and treatment are associated with the best outcomes ✅. Children who receive timely MDT care often recover fully, though relapse or chronicity is more likely with severe malnutrition, delayed diagnosis, or psychiatric comorbidity.

📚 References

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