Atypical eating disorders in young children

Eating disorders are considered rare in young children. However, we have admitted 8 prepubertal patients with atypical eating disorders. The 6 girls and 2 boys were 5‐11 years old and had markedly abnormal eating behaviors for periods of 2 months to 10 years. Weights varied from 82% to 108% of desirable body weight. All patients refused to eat normal amounts or types of food and struggled with family and staff about eating and weight gain. Several displayed ritualistic, obsessive behaviors during meals. None had a distorted body image or fear of fatness, and none had anorexia nervosa or bulimia nervosa. Observed symptoms ranged from phobic food aversion with little weight loss or depression to very restrictive diets with bizarre eating behaviors, low weight, and significant depressive symptoms. A wide range of critical familial psychosocial problems was identified. All patients gained weight and demonstrated some improvement in eating behaviors in hospital. However, most children had significant associated psychopathology, which required treatment after discharge. Eating disorders may be more common in children than now believed, may be associated with major family conflict, and may not manifest distorted body image or fear of fatness as cardinal symptoms.