Premonitory symptoms of Feeding and Eating Disorders in pediatric age
KeywordsEating Disorder Educational Intervention Diagnostic Category Early Adolescence Operational Program
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, 5, 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, 8, 9]. The consequent diagnostic delay has a negative influence on the course of treatment and prognosis, making recoveries less and less frequent [10, 11, 12].
The most significant questions in suspicion of FED among adolescent. Traits items of EAT-26 which correlate with positive total scores.
“How many diets have you begun in last year?
“Do you think, you should be on diet?”
“Do you feel dissatisfied of the weight of your body?”
“The weight influences the idea that you have of yourself?”
Differential diagnosis with other organic diseases.
Endocrine: hyperthyroidism, diabetes mellitus, Addison's disease, Simmonds syndrome
Gastrointestinal: achalasia, celiac disease, chronic inflammatory bowel disease, giardiasis and other malabsorption
Gynecological: pregnancy, other causes of amenorrhea
Infectious: AIDS, fungal infections, tuberculosis, subacute bacterial endocarditis
Neoplastic: meningiomas and any type of malignant tumor
Drugs: amphetamine, thyroid hormones, antidepressants, tricyclic, neuroleptics, lithium
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.
Educational Intervention by the family pediatrician (Heath budget for FED). Valuations/informations relative to the following items.
Balanced nutrition and health
Satisfaction of the body image
“Necessary” and “dangerous” food
Using compensation mechanisms to bingeing (vomiting, compulsive motor activity),
Use of drugs
Family, social, emotional relations
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 indications of hospitalization.
I. Biological decompensation
(includes all the serious organic conditions)
a. Serious weight loss (25-40%)
b. Rapidly evolutive weight loss
c. Total refusal of food
d. Serious complications of malnutrition as syncopations, convulsions, cardiac arrhythmias or congestive heart failure, dehydration, acrocyanosis, instability of physiological parameters (Systolic Blood Pressure ≤ 90 mmHg, Heart Rate ≤ 40 / min, body temperature ≤36 °C)
II. Psychological decompensation
(includes all high risk situations and the psychiatric comorbidities)
a. Suicide attempts
c. Abuse of drugs or other substances
d. Severe depression
f. Obsessive-compulsive personality disorder Borderline personality disorder
g. Sexual or physical abuse.
III. Other situations
a. Failure of outpatient treatment, after attempt of 2-3 months without any modifications in the clinical picture
b. Problematic family situation
c. Request from the patient or from his family
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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