The Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
The Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Pediatrics. 2014 Sep;134(3):582-92. doi: 10.1542/peds.2014-0194.
Despite their high prevalence, associated morbidity and mortality, and available treatment options, eating disorders (EDs) continue to be underdiagnosed by pediatric professionals. Many adolescents go untreated, do not recover, or reach only partial recovery. Higher rates of EDs are seen now in younger children, boys, and minority groups; EDs are increasingly recognized in patients with previous histories of obesity. Medical complications are common in both full and subthreshold EDs and affect every organ system. No single cause of EDs has emerged, although neurobiological and genetic predispositions are emerging as important. Recent treatment paradigms acknowledge that they are not caused by families or chosen by patients. EDs present differently in pediatric populations, and providers should have a high index of suspicion using new Diagnostic and Statistical Manual, 5th edition diagnostic criteria because early intervention can affect prognosis. Outpatient family-based treatment focused on weight restoration, reducing blame, and empowering caregivers has emerged as particularly effective; cognitive behavioral therapy, individual therapy, and higher levels of care may also be appropriate. Pharmacotherapy is useful in specific contexts. Full weight restoration is critical, often involves high-calorie diets, and must allow for continued growth and development; weight maintenance is typically inappropriate in pediatric populations. Physical, nutritional, behavioral, and psychological health are all metrics of a full recovery, and pediatric EDs have a good prognosis with appropriate care. ED prevention efforts should work toward aligning with families and understanding the impact of antiobesity efforts. Primary care providers can be key players in treatment success.
尽管饮食失调（ED）的患病率高、相关发病率和死亡率高，并且有治疗选择，但儿科专业人员对其的诊断仍然不足。许多青少年未得到治疗，没有康复，或者仅部分康复。现在，儿童、男孩和少数群体中 ED 的发病率更高；在以前有肥胖病史的患者中，ED 的发病率也越来越高。无论 ED 是否完全发作或仅为阈下发作，都很常见且会影响到每个器官系统。虽然神经生物学和遗传易感性已逐渐被视为重要因素，但 ED 并没有单一的原因。最近的治疗模式承认，ED 不是由家庭引起的，也不是由患者选择的。ED 在儿科人群中的表现不同，因此，医生应使用新的《诊断与统计手册》第 5 版诊断标准，保持高度怀疑态度，因为早期干预可以影响预后。以体重恢复、减少责备和增强照顾者能力为重点的门诊家庭治疗已被证明特别有效；认知行为疗法、个体疗法和更高层次的护理也可能是合适的。在特定情况下，药物治疗可能有用。完全恢复体重至关重要，通常需要高热量饮食，并且必须允许继续生长和发育；在儿科人群中，保持体重通常是不合适的。身体、营养、行为和心理健康都是全面康复的指标，并且儿科 ED 在得到适当治疗后具有良好的预后。ED 预防工作应努力与家庭保持一致，并了解反肥胖工作的影响。初级保健提供者可以成为治疗成功的关键角色。
