Early Screening for Eating Difficulties in Children: A Critical Step for Development

Rebecca Jaspan, MPH, RD, CDN, CDCES

The Prevalence of Feeding and Eating Disorders in Children

There is a growing interest in early eating difficulties in children and their impact on growth and development in later years. A number of research studies suggest that 25% to 35% of children will struggle with some type of feeding and/or growth issue at some point during the first 10 years of life.  In light of the growing prevalence of both feeding and eating disorders in children, it is important now more than ever for pediatricians to be aware of eating disorder and disordered eating symptoms and regularly screen for these life-threatening diagnoses at well child visits.

Understanding the Spectrum of Feeding Issues

While the majority of children and adolescents with eating disorders seen for treatment are underweight or normal weight, a large percentage are in larger bodies.  In a study of children with pediatric feeding disorder, 11.4% were in the <5^th percentile for BMI and 5.1% were in the >85^th percentile for BMI.¹  Population based studies of preschoolers showed that children in larger bodies have higher rates of food fussiness, picky eating, and food neophobia than their normal weight peers.²  Frequently, physicians intervene when children have delayed growth or are underweight.  However, feeding problems and eating disorders occur in children of normal and higher than normal weight as well and they are often overlooked.  This can result in malnutrition and developmental delays as the child grows.

Challenges in Detecting Eating Disorders in Diverse Body Sizes

With the rate of eating disorders in children and adolescents more than doubling since the start of the pandemic, we encourage pediatricians learn the signs and symptoms of eating disorders and routinely screen for them.  We also recognize that physicians have extremely limited time with their patients. In their 15-minute well-child visit, they likely do not have time to ask in-depth questions about feeding difficulties, body image, and disordered eating patterns on top of the long list of requirements from insurance companies.  If parents have any concerns about their child, it is recommended that they book a separate visit with the pediatrician specifically for eating disorder screening. Additionally, doctors should request a follow up appointment be booked if a patient’s weight has changed greater than a percentile in either direction on their growth chart for more in-depth screening. We recommend all patients are screened regardless of their body size.

SBIRT-ED: A Tool for Primary Care Providers

Primary care providers are in a unique position to screen, as not only have they developed a trust and rapport with their patient, but they are often the first to recognize a potential problem. Recently, an eating disorder screener specifically for primary care providers was created. The Screening, Brief Intervention, and Referral to Treament for Eating Disorders, or SBIRT-ED, is an easy to access tool for primary care providers.  The tool contains a brief questionnaire followed by next steps for doctors to recommend based on the results and degree of severity of symptoms reported.  Talking about these challenging topics with patients is not always easy, so the SBIRT-ED contains scripts to help doctors with the language to use with both patients and their parents. The SBIRT-ED also links to referral lists to help patients find a team of additional medical providers, dietitians, and therapists in their area who specialize in eating disorders.

Encouraging Comprehensive Care and Recovery

Once a patient is diagnosed with a pediatric feeding disorder or eating disorder, pediatricians can conduct a comprehensive medical assessment and help to reinforce the medical seriousness of the diagnosis. They can also emphasize the need for full weight restoration and the importance of full recovery. Along with the dietitian and therapist, doctors can support parents in what is undoubtably a challenging and emotionally taxing journey, be there to answer their questions, and remove any blame parents may be putting on themselves.

As registered dietitians specialized in feeding and eating disorders, one of our roles on the team is to support the physician and be available to help them to answer questions about what to say to eating disorder patients and their families.  Just as the physician is there to reinforce our nutrition recommendations, we are responsible for expanding on the information they may not have the time to convey to their patients. Screening and diagnosing early and working as a team is the optimal combination for best outcomes for our patients and clients.

1. Junqueira P, Dos Santos DLC, Lebl MCG, de Cesar MFC, Dos Santos Amaral CA, Alves TC. Relationship between Anthropometric Parameters and Sensory Processing in Typically Developing Brazilian Children with a Pediatric Feeding Disorder. Nutrients. 2021;13(7):2253. Published 2021 Jun 30. doi:10.3390/nu13072253
2. Finistrella V, Manco M, Ferrara A, Rustico C, Presaghi F, Morino G. Cross-sectional exploration of maternal reports of food neophobia and pickiness in preschooler-mother dyads. J Am Coll Nutr. 2012;31(3):152-159. doi:10.1080/07315724.2012.10720022