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Premonitory symptoms of Feeding and Eating Disorders in pediatric age
Italian Journal of Pediatrics volume 41, Article number: A25 (2015)
Feed and Eating Disorders (FED), whose diagnostic criteria have recently been modified in the DSM-5 , are multifactorial diseases caused by complex interactions between biological, psychological and social factors [2, 3], whose frequency is sharply increasing in adolescence [4–6].
The diagnosis is complex, especially in early adolescence (8-12 years), because of the extreme heterogeneity of symptomatic expressions, which doesn't allow a precise nosographic assignment [3, 7–9]. The consequent diagnostic delay has a negative influence on the course of treatment and prognosis, making recoveries less and less frequent [10–12].
The role of the Family Pediatrics is, therefore, essential to intercept, through simple diagnostic tests (such as EAT 26) the first signs of these conditions because from this depends on the subsequent diagnosis, therapy and prognosis [13–18] (Table 1).
The second task is to assess the severity of the problem for both organic  and psychic aspects, in order to formulate an operational program sustainable and shareable with the family and establish the urgency of sending the patient to the specialist and the type of taking charge (outpatient or inpatient).
We propose to distinguish three steps of increasing severity, with which FED may present themselves to the observation of the family pediatrician: the suspect, the diagnosis, the emergency.
The suspect, includes those patients who have just embarked on dangerous or insane practices to lose weight without falling in any of the diagnostic categories of DMS-5 . These patients need an educational intervention that can be done by the pediatrician (Table 3).
The diagnosis, includes cases that fully meet the diagnostic criteria of DMS-5 , without showing signs of serious and immediate biological or psychological risk. Such patients can be initially helped through the motivational interviewing  and subsequently entrusted to a multidisciplinary team, which also takes care of the family, promoting inter and intra-family relationship [11, 24].
The emergency, includes patients in serious condition for which is indicated urgently indicated a taking in charge by a multi-professional team, possibly with an ICU admission, inpatient or outpatient (Table 4).
Since drop-out and relapses are frequent in the course of the FED  remains to the pediatrician to assess the progress of the disease and the outcome of care, to manage over time any residual symptoms or relapses or even new emergencies.
American Psychiatric Association: Feeding and Eating Disorders. Diagnostic and Statistical Manual of Mental Disorders. 2013, Washington: American Psychiatric Publishing, 329-354. DSM-5, 5
Brooks SJ, Rask-Andersen M, Benedict C, Schiöth HB: A debate on current eating disorders diagnoses in light of neurobiological findings: is it time for a spectrum model?. BMC Psychiatry. 2012, 12-76.
Dalla Ragione L: I disturbi del comportamento alimentare: un epidemia della modernità. In: Presidenza del Consiglio dei Ministri, Dipartimento della Gioventù. Il coraggio di guardare: prospettive ed incontri per la prevenzione dei disturbi del comportamento alimentare. Eye 03 Roma. 2012, 19-34.
Powers PS, Santana CA: Eating disorders: a guide for the primary care physician. Prim Care. 2002, 29: 81-98. 10.1016/S0095-4543(03)00075-7.
Favero A, Caregaro L, Tenconi E, Bosello R, Santonastaso P: Time trends in age at onset of anorexia nervosa and bulimia nervosa. J Clin Psychiatry. 2009, 70: 1715-21. 10.4088/JCP.09m05176blu.
Dalle Grave R: Eating disorders: progress and challenges. Eur J Int Med. 2001, 22: 153-60.
Lask B, Bryant-Waugh R, Wright F, Campbell M, Willoughby K, Waller G: Family physician consultation patterns indicate high risk for early-onset anorexia nervosa. Int J Eat Disord. 2005, 38: 269-72. 10.1002/eat.20163.
Sigel E: Eating disorders. Adolesc Med. 2008, 19: 547-72.
Centers for Disease Control and Prevention (CDC), Eaton DK, Kann L, Kinchen S, Shanklin Flint KH, Hawkins J, et al: Youth risk behavior surveillance - United States, 2011. MMWR Surveill Summ. 2012, 61: 1-162.
American Academy of Pediatrics, Committee on Adolescence: Identification and management of eating disorders in children and adolescents. Pediatrics. 2010, 126: 1240-53. 10.1542/peds.2010-2821.
Nicholls D, Hudson D, Mahomed F: Managing anorexia nervosa. Arch Dis Child. 2011, 96: 977-82. 10.1136/adc.2009.177394.
Maestro S, Baroncelli GI, Ghione S, Bertelloni S: I disturbi del comportamento alimentare in adolescenza. Prospettive in pediatria. 2013, 170: 74-83.
Martin H, Ammerman SD: Adolescents with eating disorders. Primary care screening, identification, and early intervention. Nurs Clin North Am. 2002, 37: 537-551. 10.1016/S0029-6465(02)00014-2.
Yamamoto C, Uemoto M, Shinfuku N, Maeda K: The usefulness of body image tests in the prevention of eating disorders. J Med Sci. 2007, 53: 79-91.
Johnston O, Fornai G, Cabrini S, Kendrick T: Feasibility and acceptability of screening for eating disorders in primary care. Fam Pract. 2007, 24: 511-7. 10.1093/fampra/cmm029.
Engelsen BK, Hagtvet KA: A generalizability study of the Eating Attitudes Test (EAT-12) in non clinical adolescents. Eating and Weight Disord. 1999, 4: 179-186. 10.1007/BF03339734.
Anstine D, Grinenko D: Rapid screening for disordered eating in college-aged females in the primary care setting. J Adolesc Health. 2000, 26: 338-342. 10.1016/S1054-139X(99)00120-2.
Garner DM, Olmsted MP, Bohr Y, Garfinkel PE: The eating attitudes test: psychometric features and clinical correlates. Psychol Med. 1982, 12: 871-8. 10.1017/S0033291700049163.
Winston AP, Barnard D, D'Souza G, Shad A, Sherlala K, Sidhu J, et al: Pineal germinoma presenting as anorexia nervosa: Case report and review of the literature. Int J Eat Disord. 2006, 39: 606-8. 10.1002/eat.20322.
Crawford JR, Santi MR, Vezina G, Myseros JS, Keating RF, LaFond DA, et al: CNS germ cell tumor (CNSGCT) of childhood: presentation and delayed diagnosis. Neurology. 2007, 68: 1668-73. 10.1212/01.wnl.0000261908.36803.ac.
Andreu Martínez FJ, Martínez Mateu JM: Intracranial germ cell tumor mimicking anorexia nervosa. Clin Transl Oncol. 2006, 8: 915-8. 10.1007/s12094-006-0156-z.
Cole TJ, Flegal KM, Nicholls D, Jackson AA: Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ. 2007, 28 (335): 194-
Miller W, Rollnick S: Motivational Interviewing: Helping People Change. 2012, New York: The Guilford Press, 3
Watson HJ, Bulik CM: Update on the treatment of anorexia nervosa: review of clinical trials, practice guidelines and emerging interventions. Psychol Med. 2011, 10: 1-24.
Steinhausen HC, Boyadjieva S, Griogoroiu-Serbanescu M, Neumärker KJ: The outcome of adolescent eating disorders. Eur Child Adolesc Psychiatry. 2003, 12: 91-98.
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De Luca, G., Napoletani, M. Premonitory symptoms of Feeding and Eating Disorders in pediatric age. Ital J Pediatr 41, A25 (2015) doi:10.1186/1824-7288-41-S2-A25
- Eating Disorder
- Educational Intervention
- Diagnostic Category
- Early Adolescence
- Operational Program