Mother-daughter coping and disordered eating.

This study explores whether the coping style of teenage girls with and without an eating disorder is similar to that of their mothers' (biological and adoptive), and whether teens with disordered eating utilize more maladaptive coping compared with those without. Eating disorder was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria, and the Coping Inventory for Stressful Situations was administered to distinguish the coping style of the participants. Our findings suggest that daughters coped very similarly to their mothers in either group. Contrary to previous studies, our sample of teenage girls with eating disorders as well as their mothers utilized less frequently the avoidance-distraction coping compared with the girls without eating disorders and their mothers. These findings reinforce the importance for family involvement and for simultaneous focus on intrapersonal and interpersonal maintenance factors during eating disorder treatment.

Eating Disorders in Children and Adolescents: A Practical Review and Update for Pediatric Gynecologists.

Eating disorders (EDs) are common among female adolescents and young adults and can have serious and diverse health consequences. Pediatric gynecology providers have the opportunity to play a vital role in the recognition of EDs in this population. Early medical detection and referral for appropriate evidence-based treatment can lead to better health outcomes for youth. In this article we aim to increase the awareness of the pediatric gynecologist of typical and subtle presentations of EDs, provide guidance for screening, discuss common and serious medical complications, and review treatment considerations for gynecologic issues in patients with EDs.

Outcomes of an inpatient medical nutritional rehabilitation protocol in children and adolescents with eating disorders.

BACKGROUND: Medical stabilization through inpatient nutritional rehabilitation is often necessary for patients with eating disorders (EDs) but includes the inherent risk of refeeding syndrome. Here we describe our experience of implementing and sustaining an inpatient nutritional rehabilitation protocol designed to strategically prepare patients with EDs and their families for discharge to a home setting in an efficient and effective manner from a general adolescent medicine unit. We report outcomes at admission, discharge, and 4-weeks follow-up. METHODS: Protocol development, implementation, and unique features of the protocol, are described. Data were collected retrospectively as part of a continuous quality improvement (QI) initiative. Safety outcomes were the clinical need for phosphorus, potassium, and magnesium supplementation, other evidence of refeeding syndrome, and unexpected readmissions within one month of discharge. The value outcome was length of stay (LOS). Treatment outcomes were the percentage median BMI (MBMI) change from admission to discharge, and from discharge to 4-weeks follow-up visit. RESULTS: A total of 215 patients (88% F, 12% M) were included. Patients averaged 15.3 years old (5.8-23.2y); 64% had AN, 18% had atypical anorexia (AtAN), 6% bulimia nervosa (BN), 5% purging disorder (PD), 4% avoidant-restrictive food intake disorder (ARFID), and 3% had an unspecified food and eating disorder (UFED). Average LOS was 11 days. Initial mean calorie level for patients at admission was 1466 and at discharge 3800 kcals/day. Phosphorus supplementation for refeeding hypophosphatemia (RH) was needed in 14% of inpatients; full-threshold refeeding syndrome did not occur. Only 3.8% were rehospitalized in the thirty days after discharge. Patients averaged 86.1% of a median MBMI for age and gender, 91.4% MBMI at discharge, and 100.9% MBMI at 4-weeks follow-up. Mean percentage MBMI differences between time points were significantly different (admission-discharge: 5.3%, p <0.001; discharge-follow-up: 9.2%, p <0.001). CONCLUSIONS: Implementation of the CHOP inpatient nutritional rehabilitation protocol aimed at rapid, efficient, and safe weight gain and integration of caregivers in treatment of patients with diverse ED diagnoses led to excellent QI outcomes in percentage MBMI at discharge and 4-weeks follow-up, while maintaining a short LOS and low rates of RH phosphorus supplementation.

Reversibility of growth stunting in early onset anorexia nervosa: a prospective study.

PURPOSE: To evaluate the growth of premenarchal patients with anorexia nervosa. METHODS: Growth parameters were measured semi-annually in 16 subjects with anorexia nervosa until 1 year post-menarche. RESULTS: Despite the accelerated growth that followed nutritional rehabilitation, the patients did not achieve their genetic height potential.