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Project TEACH E-Newsletter

Eating Disorders in Primary Care, Assessment, Diagnosis & Treatment

Project TEACH has been working with pediatric practices in New York State since 2010. The project, funded by the New York State Office of Mental Health, has supported and strengthened the critical role that New York State pediatric primary care providers (PCP’s) can play in the early identification and treatment of mild-to-moderate mental health concerns for children ranging in age from 0 to 21.

One component of the Project TEACH /NYS American Academy of Pediatrics partnership in 2021 is a series of monthly newsletters touching on topics of concern to pediatricians and to parents.

And now to our topic of this Project TEACH Pediatric Newsletter: "Eating Disorders in Primary Care, Assessment, Diagnosis & Treatment”

As children grow, their sense of who they are is often influenced by their self-esteem and their acceptance of their body, particularly as it develops and changes. It is fair to say that most people express some dissatisfaction with their body shape or size. However, for many children and adolescents, this develops into a more serious disorder, often baffling the parents who were unaware of the insidious onset of the symptoms. Initially, children or adolescents may receive praise for their weight loss, only for their family to learn that it was the beginning of the eating disorder. The pediatrician is in an ideal role to identify these concerns. Of note, is that overweight or obese youth are encouraged to diet to lose weight. This needs to be done with great tact and skill in order to minimize the risk that the child or adolescent allow this to develop into a serious problem.

Eating disorders are highly prevalent, devastating illnesses that impact both the individual sufferer and those closest to him or her. There is clear evidence that children at increasingly younger ages are expressing concerns about their weight and participating in dieting behaviors. For example, the hospitalization rate for children under 12 years of age has doubled in the past twenty years. Eating Disorders, including Anorexia Nervosa, are associated with serious medical complications and a significant death rate. Eating Disorders have a peak age of onset in adolescence, just at a time in psychological development that leads to greater independence in adulthood.

Family-based approaches to the treatment of eating disorders represent important, empirically supported options for addressing the needs of adolescents with Anorexia Nervosa. Family-based weight restoration treatment for Anorexia Nervosa, in particular, has mounting evidence to support its use with children and adolescents. Family-based treatments encourage participation of the wider family network to support re-nourishment, establish independence around food and weight management, and encourage appropriate developmental gains.

Given that most adolescents remain embedded within a family structure and are dependent upon their parents, it is reasonable to expect that family involvement is viewed by many as a critical component of successful treatment of adolescent eating disorders.

Tips for the Pediatrician

  1. Be on the lookout for risk factors for the development of an eating disorder: family history of obesity, family history of anorexia nervosa; dieting behaviors and attitudes in the family; sexual abuse, obsessive compulsive disorder, trauma.
  2. Assess protective factors: supportive family, engagement in academics and after school activities
  3. If you suspect an eating disorder, ask to see the child or adolescent more often; monitor vital signs (looking for bradycardia); laboratory work (looking for hypokalemia);
  4. Refer for a nutrition consultation
  5. Request a psychiatric consultation to assess for co-occurring depression, anxiety or substance abuse.
  6. Recognize the signs or symptoms that may warrant a higher level of care; when to admit to the hospital medically (bradycardia, hypotension, rapid weight loss, failure to restore weight on an outpatient basis); when to admit to the hospital psychiatrically (suicidal ideation); when to consider a day program (not suicidal or medically fragile, but, not able to restore weight as an outpatient)
  7. Project TEACH child and adolescent psychiatrists are available to provide consultation and education on this topic and other mild-to-moderate mental health concerns for children and adolescents, ages 0 to 21.

By Victor M. Fornari, MD, Director, Division of Child & Adolescent Psychiatry, Department of Psychiatry, The Zucker Hillside Hospital & Cohen’s Children’s Medical Center, Project TEACH Consultant

Dancyger, I. & Fornari, V. (Eds.) Evidence Based Treatments for Eating Disorders: Children, Adolescents and Adults. Second Edition. Nova Science Press. New York, 2014.

Overview of Project TEACH Services

Current initiatives in Medicaid and Commercial insurance and the NYS PCMH incentive project, all create an environment that encourages pediatric practices to work toward integrating children’s behavioral healthcare into pediatric primary care. Behavioral health integration has the potential to enhance the value proposition for most practices.

Project TEACH Child and Adolescent Psychiatrists are available through the Project TEACH warm lines to provide guidance on assessment of a children’s and adolescents’ mental health symptoms and evidence-based treatment following traumatic events. You can also find the Child PTSD Symptom Scale (CPSS) on the Project TEACH website: https://projectteachny.org/rating-scales/

Project TEACH can help with a variety of behavioral health concerns presented by COVID-19, including school re-entry and self-care: https://projectteachny.org/covid/

Project TEACH direct services to pediatricians include:

Accessing the educational and supportive services of Project TEACH can help your practice contract for higher payments, while also supporting you and your team in providing more comprehensive higher quality care to your patients with mild-to-moderate mental health concerns.

Funded by a grant from the New York State Office of Mental Health’s Project TEACH.

New York State American Academy of Pediatrics (NYS AAP)

A Coalition of AAP NY Chapters 1, 2, & 3

Elie Ward, MSW | Dir. of Policy, Advocacy & External Relations | eward@aap.net

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