More than two and a half times as many children under 10 have anorexia nervosa as previously thought, according to the first study into eating disorders among British children.
On average, 1.5 in every 200,000 British children under 10 have anorexia, according to experts from the UCL (University College London) Institute of Child Health, who carried out the research.
Direct comparison with previous UK data is limited but a general practice registry study in the early 1990s found an incidence estimate of 0.6 per 200,000 for anorexia among children aged up to nine.
The findings have shocked experts, who called for “urgent action” to help save young lives. There are no national paediatric guidelines for the care of individuals with eating disorders.
“Recognition of eating disorders in children by GPs can be poor and, unfortunately, many eating disorder services are aimed specifically at adolescents,” said Dr Dasha Nicholls, a consultant child and adolescent psychiatrist at the UCL Institute of Child Health and the study’s lead researcher.
“Childhood eating disorders are not quick or easy to treat. For a minority of children it may be the start of a severe and enduring illness, with death rates comparable to some forms of leukaemia.
“Early-onset eating disorders – defined as those starting before 13 years of age – represent a significant clinical burden to paediatric and mental health services. Efforts to improve early detection are needed but our study also shows there is an urgent need to consider the needs of children with eating disorders separately – and not simply lower the age range of existing adolescent services,” said Nicholls.
Most of the 208 patients in Nicholls’s study were girls – 82% – but boys accounted for almost one in five cases.
More than 80% of the children in the study, to be published in the British Journal of Psychiatry, had an anorexia-like illness: 37% had diagnosable symptoms while 43% were classified as having an “unspecified eating disorder” because although they showed symptoms of anorexia they were not underweight. Only 4% had bulimia.
An additional one in five children had symptoms of disordered eating, such as food avoidance and being underweight, but did not have a preoccupation with their weight or shape.
Half were admitted to hospital, over 70% of whom had anorexia. After a year, almost two thirds were still receiving treatment. 73% had improved but 6% were worse and 10% unchanged.
Almost 44% of the children had a close family member with a history of mental illness, most commonly anxiety or depression. Another fifth had a history of early feeding problems, particularly fussy or picky eating.
Studies suggest that although the incidence of eating disorders has been fairly static over the past few decades, anorexia is being diagnosed among children in increasingly younger age groups.
Data on the rate and outcome of early-onset eating disorders is sparse. The National Inpatient Child & Adolescent Psychiatric Survey found that eating disorders were the most common diagnosis among child and adolescent psychiatric in-patients in England and Wales, 9.2% of whom were under 13.
The survey, however, did not include children on paediatric wards. “Ours are the first published data on the scale of paediatric resource used by this patient group in the British Isles,” said Nicholls.
Previous research from the NHS Information Centre has found that children aged 14 to 16 account for one in every three patients treated in hospital for an eating disorder, an 11% rise on the 2,316 cases recorded for the previous 12 months.
The centre’s data, however, found only a “small number” of 10-year-olds diagnosed with conditions including anorexia and bulimia.
A 1999 Office for National Statistics study found 0.3% of 11- to 15-year-olds had an eating disorder, with no one in the five- to 10-year-old age group.
The new study found wide variation in confidence among paediatricians over how to treat children. “This study provides the baseline figures needed to determine whether increases in hospitalisation rates are real or perceived, and can aid planning of age-appropriate services,” said Nicholls.
Because the new study gives the first estimate of the incidence of early-onset eating disorders, Nicholls said she was unable to say if there has been a rise in this group. “But we hope our research can be used as a baseline from which to monitor future trends,” she added.
The findings have galvanised concern that society’s obsession with physical appearance is making children become body-conscious at an increasingly early age. Blame has been placed on everything from poor parenting to the media and websites such as Facebook.
When Miranda turned eight, her parents took her to a pizza parlour to celebrate. For any other child, it would have been a common enough treat. But for Miranda, the trip was nothing short of momentous – as it signified a return to health.
Now 11, Miranda finds it hard to remember why, at seven, she developed an eating disorder so severe that she stopped eating and drinking and ended up almost 10kg underweight, with a body mass index (BMI) of 12.5. (A BMI of under 18.5 is officially underweight.)
“I remember living in a clinic with other children. None of us could eat normally,” she said. “I was there for five months. They said I had food avoidance emotional disorder. I don’t know where it came from but in my diary, I said it was like having a pixie in my tummy. The pixie was like the devil. When I wanted to eat, the pixie would fight me. At the beginning, in my diary, I said the pixie was stronger than me. But then I got stronger than him. I remember it being like he got smaller and I got bigger. The pixie’s not in my tummy any more. I hope he never comes back.”