Experts from the UCL (University College London) Institute of Child Health, who carried out the research, are calling for “urgent action” to improve both the detection of eating disorders in young children and availability of services.
The research team used the well-established British Paediatric Surveillance Unit of the Royal College of Paediatrics and Child Health and a new child and adolescent psychiatry surveillance system, to identify new cases of eating disorders in children aged between 5 and 13 years, and living in the UK and Republic of Ireland.
Over a 14 month period, 208 cases of early-onset eating disorders were confirmed. The researchers estimate that this gives an overall incidence rate of 3.01 cases in every 100,000 children. As expected, most of the 208 children with eating disorders were girls (82%), with boys accounting for 18%.
In total, 37% of the children were diagnosed with anorexia nervosa. 43% were classified as having an eating disorder not otherwise specified, because although they showed symptoms of anorexia they were not underweight.
Only 1% of the children were diagnosed with bulimia nervosa or binge eating – which the researchers believe is likely to be an underestimate. The remaining 19% had symptoms of disordered eating, such as food avoidance and being underweight, but did not have a preoccupation with their weight or shape.
104 (50%) of the children were admitted to hospital for treatment – mainly to paediatric wards. All the children were followed up after a year. At this time, 130 (73%) had improved, 11 (6%) were worse and 18 (10%) unchanged. Almost two-thirds (96) of the children were still receiving treatment, with a small number (7) in hospital for most of the year.
44% of the children had a close family member with a history of mental illness, most commonly anxiety or depression. In addition, 20% of the children had a history of early feeding problems, particularly fussy or picky eating. According to the researchers, this supports the idea that family history of mental illness and early feeding problems may be risk factors in the development of early-onset eating disorders.
Lead researcher Dr Dasha Nicholls, a consultant child and adolescent psychiatrist, said: “Our study gives the first estimate of the incidence of early-onset eating disorders in UK and Irish children. It is too early to say if there has been a rise in the numbers of children with eating disorders in recent years, but we hope our research can be used as a baseline from which to monitor future trends.”
Dr Nicholls continued: “Unfortunately, many eating disorder services are aimed specifically at adolescents. Childhood eating disorders are not quick or easy to treat. For a minority of children it may be the start of a severe and enduring illness, with death rates comparable to some forms of leukaemia. Our study shows there is an urgent need to consider the needs of children with eating disorders separately – and not simply lower the age range of existing adolescent services.”
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Nicholls DE, Lynn R and Viner RM. Childhood eating disorders: British national surveillance study. British Journal of Psychiatry 2011; 198: 295-301