Children as young as five with life threatening anorexia

New research by Australian experts has revealed that children as young as five are being treated for eating disorders - the researchers say in some cases the eating disorder has reached the stage that forced feeding becomes necessary in order to save their lives.

The national study by specialists at Westmead Children's Hospital in Sydney has found that eating disorders are possibly underdiagnosed leading to high rates of complications in children from 5 to 13.

The researchers led by Dr. Sloane Madden, a child and adolescent psychiatrist at Westmead, found that many young children are being hospitalized with eating disorders so advanced that almost half require forced feeding to save their lives and anorexia and starvation, a problem usually associated with teenage girls, is becoming rampant among children of both sexes aged 10-12 years or even younger.

The study is the first to investigate the suspicion that eating disorders were an increasing problem in younger children and examined data collected over a 3 year period by the Australian Paediatric Surveillance Unit on children who were either outpatients or were hospitalised for an eating disorder.

The information came from paediatricians and child psychiatrists treating 101 children - 74 girls and 25 boys.

Dr. Madden says the study raises interesting issues and unanswered questions about eating disorders and is cause for concern because some children are very young and become extremely sick.

Dr. Madden says demands for critical care beds at hospitals because of an Early Onset Eating Disorder (EOED), have surged in the last year and at West Mead that demand has risen by 50% and was not reflected in cases of older adolescents with eating disorders.

According to Dr. Madden, in Australia EOED affects around 1.4 in every 100,000 children aged 5 to 13 years and of those 1.1 cases need medical intervention. He believes that number will rise if measures are not adopted taken to tackle the obsession with fat and weight issues and says the study highlights that nearly two third of the cases were anorexia with body image problems usually associated with teenagers and adults, while the rest had starvation and weight loss problems.

Dr. Madden says more than 50% of the children presented with severe medical complications from malnutrition such as hypothermia (very low body temperature), hypotension (low blood pressure) and bradycardia (a very slow heart rate), which puts them at severe medical risk.

Around 80% had to be admitted to hospital admission, and of those, 50% per cent required tube feeding as a life-saving measure to manage starvation and one third required antidepressants or anti psychotic medication - treatments that may not have been required with earlier, more active intervention - and there are concerns about the effects of such powerful drugs on the developing brain and the use of antidepressant in very young people.

The researchers say the EOED was characterised by “determined food avoidance plus weight loss or a failure to gain weight during a period of growth, for no identifiable organic reason, which they say is a form of anorexia.

Dr. Madden says the children are convinced they are fat and want to be thinner, and have no insight into the fact that they are malnourished and they are literally starving themselves to death and the disease in children is more severe than teenagers and adults because it is often diagnosed later and the children are often "medically unstable''.

Dr. Madden says it is concern that such children are being misdiagnosed, or are being diagnosed late and therefore are not being referred for appropriate care and he believes the focus on weight, numbers and body fat, must be changed to one of healthy eating and exercise.

The researchers feel the study is significant because it gives information on the nature and characteristics of children who suffer early onset eating disorders and shows the need for closer integration of prevention strategies and treatments for disordered eating and obesity, such as the promotion of healthy eating patterns and foods, rather than severe dietary restriction.

They say extreme weight control behaviour and weight disorders are both important health problems in young people and an increasing problem in young children and research is imperative into understanding why such young children are developing such disorders and how effective identification and treatment can be targeted earlier.

The research is published in the latest edition of the Medical Journal of Australia.