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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.
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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). https://doi.org/10.1186/1824-7288-41-S2-A25
- Eating Disorder
- Educational Intervention
- Diagnostic Category
- Early Adolescence
- Operational Program