Eating Disorders in Children and Adolescents: State of the Art Review
Eating Disorders in Children and Adolescents: State of the Art Review
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DOI：
10.1542/peds.2014-0194
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发表时间：
2014-09-01
期刊：
影响因子：
8
通讯作者：
Peebles, Rebecka
中科院分区：
文献类型：
--
作者：
Campbell, Kenisha;Peebles, Rebecka
尽管他们的高患病率，相关的发病率和死亡率，以及可用的治疗方案，进食障碍（ED）继续被儿科专业人员诊断不足。许多青少年得不到治疗，没有康复，或仅部分康复。ED的发生率更高，现在在年幼的儿童，男孩和少数民族群体; ED越来越多地在有肥胖史的患者中被认识到。医学并发症在完全和阈下ED中都很常见，并影响每个器官系统。没有单一的原因ED已经出现，虽然神经生物学和遗传倾向正在成为重要的。最近的治疗范式承认，它们不是由家庭引起的或由患者选择的。ED在儿科人群中表现不同，使用新的诊断和统计手册第5版诊断标准，提供者应具有高度怀疑指数，因为早期干预可能影响预后。门诊以家庭为基础的治疗，重点是恢复体重，减少责备，并赋予照顾者权力，已成为特别有效的;认知行为疗法，个别治疗和更高水平的护理也可能是适当的。药物治疗在特定情况下是有用的。完全恢复体重至关重要，通常涉及高热量饮食，并且必须允许持续的生长和发育;体重维持通常不适合儿科人群。身体、营养、行为和心理健康都是完全康复的指标，儿科ED在适当的护理下预后良好。艾德的预防工作应该努力与家庭保持一致，并了解减肥工作的影响。初级保健提供者可以成为治疗成功的关键角色。
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.