Incidence of Eating Disorders During COVID-19: A Retrospective Review

Background The COVID-19 pandemic has had marked effects on mental health, including in pediatric populations. Pediatric patients have faced mental health concerns at increased rates including anxiety and depression. Furthermore, patients with eating disorders represent a vulnerable group who have been negatively impacted as well, as a result of lack of support, loss of in-person follow-up and increased relapse. In our centre, and nationally, clinicians have noted a trend towards increased eating disorder referrals and increased hospitalizations during the pandemic. Objectives The objective of this study was to determine the incidence, severity and triggers for eating disorders in the adolescent population during the COVID-19 pandemic and how it compares to the year prior. As well, the subset of patients who were hospitalized for medical stabilization were further analyzed to determine severity of illness. Design/Methods A retrospective chart review compared the first year of the COVID-19 pandemic (March 2020-March 2021), to the previous 12 months. Inclusion criteria included referrals to an eating disorder clinic and inpatient admissions to pediatrics or mental health services during the specified time frame. Data collected included age of onset, triggers, comorbid mental health conditions, and weight measures. Among hospitalized patients, orthostatic vital changes, need for NG feeds, length of medical stabilization and length of mental health hospitalization were included. Results Overall, 76 patients were included in the study. 44 (57.9%) were referred after COVID, which was significantly increased from the prior year (p=0.05). On average, patients presented at a younger age (14.2 ± 2.3 vs. 14.9 ± 1.9;p=0.08). Pre-COVID, approximately 44% of referrals were from family physicians and 19% from pediatrics. During COVID, approximately 39% were from family doctors and 25% from pediatricians. There was an increase in the number of patients requiring hospitalization for treatment (16 vs. 3), with 50% of the post-COVID admissions being direct from the ED Clinic on initial assessment. The reason for hospitalization was unstable vitals/ bradycardia in 68.7% of admissions;self-harm comprised the majority of the other admissions. Conclusion Our results support national and international reports that eating disorder incidence has increased during COVID-19. Patients described loss of routine, anxiety, and isolation as triggers related to the pandemic. Disruptions to daily life including school, sports, recreation, and relationships had profound effects on the mental health of children. The effect of social media on body image has also contributed. It is important for clinicians to screen for mental health conditions, including eating disorders at all available opportunities. Furthermore, this study demonstrates the need for increased services at our centre. Limitations for this study include that it is a single-centre study with a relatively small patient population. As well, it does not capture patients who may have been referred only to psychiatry.

Screening adolescents for psychosocial concerns

Psychosocial issues are cen-'tral to the care of adolescent patients. Pediatricians routinely discuss substance use, sexual health, and accident prevention with adolescents and are likely to see specific mental health concerns in about 20% of their patients. In light of rising suicide rates and the likely consequences of COVID-19, depression is an increasingly common concern. With limited access to mental health clinicians, individual pediatricians must manage patients' mental health needs by enhancing their own skills, collocating mental health personnel in their practices, and building trusted referral networks. Because psychosocial screening is now an expected part of pediatric primary care,1 this article focuses on screening adolescent patients, including choice of tools and follow-up of positive results.

Keeping patients safe from summertime illnesses

"5 However, more recent findings, such as the presentation of joint swelling without EM in Black children, are the result of research efforts to identify differences among racial and ethnic groups in presentations of disease symptoms, with the aim of greater diagnostic accuracy and reduced health care disparities.4 Treatment of Lyme disease Although most resources, such as the CDC's website,1 published articles and sites,2,3 and the Red Book,5 recommend that pediatric, adolescent, and young adult patients with Lyme disease receive an antibiotic, such as doxycycline, amoxicillin, or cefuroxime (for penicillin-allergic patients), these publications differ in recommended dosage and duration of treatment. [...]PHCPs who are unfamiliar with antibiotic treatments for Lyme disease should consult with infectious disease specialists. Children who have evidence of Lyme carditis, Lyme arthritis, cranial neuritis, Lyme meningitis, or radiculoneuritis should immediately be referred to infectious disease and the appropriate pediatric specialists.2 Respiratory infections and health care inequities Although researchers have reported studies on racial and ethnic inequities among children related to respiratory diseases over the last 20 years, few randomized controlled trials have scientifically investigated the problem or have identified and rigorously investigated evidencebased interventions. The COVID-19 pandemic brought a new focus in pediatric health care on the inequities experienced by Black, Hispanic, American Indian or Alaska Native, and Pacific Islander children living in poverty, who regularly experience a disproportionate number of respirator y illnesses and infections.6 Several studies have shown increased hospitalization rates for Blac k and H ispan ic children who contracted COVID-19.6 One team of researchers studying children from birth to 4 years old reported a hospitalization rate of 55% for Black and Hispanic children.7 For years, PHCPs have observed and treated children for asthma in all health care settings. Bhavnani et al reported that Black children had a 7-fold higher rate of emergency department visits compared with White children in 2019, 1 year before the pandemic began.8 However, the difference decreased to a 2-fold increase for Black children compared with White children in 2020, when COVID-19 measures such as masking, social distancing, and school closures were in place.8 Researchers are continuing to investigate why Black and Hispanic children are more vulnerable to upper respiratory infections with viruses such as influenza, rhinovirus, and adenovirus.8 Summertime prevention of respiratory infections Talking about prevention strategies with families is the first step toward reducing asthma episodes and exacerbations.

Managing hMPV, the "evil twin" of RSV

Preterm infants and those with underlying cardiopulmonary disease are at higher risk for complications from hMPV, just as they are with RSV or influenza. Unlike RSV, studies have shown hMPV to be biennial, occurring in an early and late pattern.2 But just as we have seen RSV appearing in the summer, not the typical seasonal pattern we have known, it seems hMPV has followed suit. Additional management is outlined in the American Academy of Pediatrics guidelines for bronchiolitis.3 Preventive care Control measures such as appropriate handwashing and cough etiquette are the primary means of preventing spread.

UNICEF highlights urgent need to resume child immunizations

UNICEF states more data collection is needed to better monitor vaccine confidence on a broader level. According to the report, lessons can be learned from the pandemic, as "vast resources can be mobilized, and new vaccines can be developed rapidly and introduced around the world," authors wrote. According to the report, a similar effort is needed now.

Ritlecitinib is effective for alopecia areata in patients 12 years and older

Ritlecitinib (Pfizer Inc) demonstrated efficacy in treating alopecia areata in patients aged 12 years and older with at least 50% scalp hair loss, according to results from a phase 2b/3 trial (NCT03732807) published in The Lancet. Of those randomly assigned, 104 patients discontinued treatment: 34 withdrew, 19 had adverse events (AEs), 12 were physician decided, 12 were discontinued due to lack of efficacy, 13 were lost to follow-up, 5 were moved to long-term study transfer, 4 discontinued due to pregnancies, 2 discontinued for protocol deviations, 1 declined follow-up due to COVID-19, 1 attended the last visit late due to COVID-19, and 1 was nonadherent. Between the placebo and the ritlecitinib 200 mg plus 50 mg group, the difference in response rate based on a SALT score of 20 or less was 29.1% (95% CI, 21.2-37.9;P < .0001). The difference in response rate based on a SALT score of 20 or less between placebo and ritlecitinib was 20.8% (95% CI, 13.7-29.2;P < .0001) for the 200 mg plus 30 mg group, 21.9% (95% CI, 14.7-30.2;P < .0001) for the 50 mg group, and 12.8% (95% CI, 6.7-20.4;P = .0002) for the 30 mg group.

Will the COVID-19 cloud change pediatric medicine forever?

With the United States still in the throes of a pandemic, nearly 400 pediatric health care providers share their struggles in getting patients back to the office, advocating for a COVID-19 vaccine, and working their way toward optimism in the face of the biggest health care challenge of their lives. [...]although the reasons around the pessimism remained the same in both 2013 and 2019 (insufficient time with patients, inadequate reimbursement, and health care reform), this year-no surprise-the top reason was concerns about adequately treating patients with COVID-19 and multisystem inflammatory syndrome in children (MIS-C). In 2019, when asked what the top 2 challenges to their practice were, 45% of health care providers said transitioning to electronic health records (EHRs) and dealing with insurance (42%) were the greatest obstacles.

What does back to school look like this year?

Contemporary Pediatrics" talked with Nathaniel Beers, MD, MPA, FAAP, executive vice president of Community and Population Health at Children's National Hospital in Washington DC, and a general and developmental behavioral pediatrician , about what this school year may look like for children and adolescents, and what pediatricians can do to help them play catch-up. There was a lot of interest in getting those activities moving quickly, because people recognize the value they had to students and their social/emotional development as well as their overall mental health. Encourage children to do reading over the summer, play some math games on the computer....These can help create structure as well, which they need once the school year begins.

Beating Burnout

Defining burnout, and why it has increased among pediatric health care providers The American Academy of Pediatrics (AAP) recently provided updated guidance on physician wellness, in which they discussed burnout among pediatricians.1 Pediatricians are not immune to burnout, according to the AAP. Approximately half of physicians in pratice experience burnout, which can lead to medical errors, higher cost, lower quality of care, and worse patient outcomes overall.2 Suicidal thoughts were also frequent, reported by 14% of physicians. "The health care system has moved to higher workloads, less autonomy, and more standardization as groups and delivery systems get larger and more automated," Jellinek said. Investigators from Pennsylvania State University recommended following a hierarchy of needs, starting with prioritizing the basic physical and mental health needs of physicians.2 Higher-order needs include connection, respect, appreciation, and changes in interactions with electronic systems.

Telehealth for pediatric well visits: sometimes the best option

During the early part of the COVID-19 pandemic, pediatricians realized that to reach families and continue to provide preventive care, including developmental, mental health, and social determinants of health screenings, they needed to embrace telehealth and meet families where they were: at home. [...]many families expressed that they were more comfortable staying on "their turf" rather than coming to a health care facility, which changes the power paradigm of who drives the visit. During the pandemic, current fee-for-service models have rapidly exposed the problems with our health care system.

Helping children grieve the loss of a caregiver due to COVID-19

The modeling study calculated COVID-19-associated or-phanhood(deathof 1 orbothparents) and deaths of custodial and coresid-ing grandparents by using mortality, fertility, and census data. The 3-pronged approach aims to: O prevent C0VID-19-associated death of caregivers through effective and equitable policies and practices that improve access and uptake of C0VID-19vaccines;O prepare families, offering support and services to help the child experiencing loss of a parent or primary caregiver;O protect children through programs that build resilience in the family, enhance parenting skills, and improve family relationships.1 Pediatric health care providers are uniquely positioned to help children grieving caregiver loss from COVID-19. Developing clinical action steps to address this pandemic-related trauma and the grief that follows is important and should incorporate the following steps: O Screen for COVID-19 related caregiver loss: "Has this child lost a parent or other caregiver to COVID-19?" Since Pediatrics published those study results, the number of children orphaned due to COVID-19 has risen to an estimated 200,000-plus.5 Health care providers play a critical role in raising awareness, protecting families, and intervening when children experience the loss of a parent or other caregiver to COVID-19.

White oral lesions in neonate with COVID-19

In the hospital nursery, a 4-week-old boy has creamy white patches on his lips, right and left buccal mucosa, palate, and tongue. He had been admitted to the nursery intensive care unit (NICU) 2 days ago. His mother brought him to the pediatric emergency department because he refused to feed and felt warm. Seven days previously, his mother received a diagnosis of COVID-19 infection. He had a sepsis work-up and was started on intravenous (IV) antibiotics.