Incidence and Age- and Sex-Specific Differences in the Clinical Presentation of Children and Adolescents With Avoidant Restrictive Food Intake Disorder.

ABSTRACT

Importance To our knowledge, this is the first pediatric surveillance study of children and adolescents with avoidant restrictive food intake disorder (ARFID). Objectives: To examine the incidence and age- and sex-specific differences in the clinical presentation of ARFID in children and adolescents in Canada. Design, Setting, and Participants: In this cross-sectional study, patients with ARFID were identified through the Canadian Paediatric Surveillance Program by surveying 2700 Canadian pediatricians monthly from January 1, 2016, to December 31, 2017. Main Outcomes and Measures: The incidence of ARFID in Canadian children (5-18 years of age) and age- and sex-specific clinical characteristics at presentation. Results: In total, 207 children and adolescents (mean [SD] age, 13.1 [3.2] years; 127 [61.4%] female) were included in this study. The incidence of ARFID in children 5 to 18 years of age was 2.02 (95% CI, 1.76-2.31) per 100 000 patients. Older children and adolescents were more likely to endorse eating too little (5-9 years of age 76.7%; 95% CI, 58%-88.6; 10-14 years of age 90.9%; 95% CI, 84.6%-94.8%; 15-18 years of age 95.6%; 95% CI, 83.6%-98.9%; P = .02), have a loss of appetite (5-9 years of age 53.3%; 95% CI, 35.4%-70.4%; 10-14 years of age 74.2%; 95% CI, 66.0%-81.0%; 15-18 years of age 80.0%; 95% CI, 65.5%-89.4%; P = .03), be medically compromised (mean body mass index z score 10-14 vs 5-9 years of age -1.31; 95% CI, -2.0 to -0.6; 15-18 vs 5-9 years of age -1.35; 95% CI, -2.2 to -0.5; 15-18 vs 10-14 years of age -0.04; 95% CI, -0.6 to 0.5; P < .001; mean percentage of treatment goal weight 10-14 vs 5-9 years of age -8.6; 95% CI, -14.3 to -2.9; 15-18 vs 5-9 years of age -9.8; 95% CI, -16.3 to -3.3; 15-18 vs 10-14 years of age -1.2; 95% CI, -5.8 to 3.4; P < .001; mean heart rate (beats per min) 10-14 vs 5-9 years of age -10; 95% CI, -21.9 to 1.9; 15-18 vs 5-9 years of age -19.7; 95% CI, -33.1 to -6.2; 15-18 vs 10-14 years of age -9.7; 95% CI, -18.7 to -0.7; P = .002), have higher rates of anxiety (5-9 years of age 26.7%; 95% CI, 13.7-45.4; 10-14 years of age 52.3%; 95% CI, 43.7%-60.7%; 15-18 years of age 53.3%; 95% CI, 38.6%-67.5%; P = .03) and depression (5-9 years of age 0%; 10-14 years of age 6.8%; 95% CI, 3.6%-12.7%; 15-18 years of age 26.7%; 95% CI, 15.7%-41.6%; P < .001), and be more likely to be hospitalized (5-9 years of age 13.3%; 95% CI, 5.0%-31.1%; 10-14 years of age 41.7%; 95% CI, 33.5%-50.3%; 15-18 years of age 55.6%; 95% CI, 40.7%-69.5%; P = .001). Younger children were more likely to endorse lack of interest in food (5-9 years of age 56.7%; 95% CI, 38.4%-73.2%; 10-14 years of age 75.0%; 95% CI, 66.8%-81.7%; 15-18 years of age 57.8%; 95% CI, 42.8%-71.4%; P = .03), avoidance of certain foods (5-9 years of age 90.0%; 95% CI, 72.6%-96.8%; 10-14 years of age 69.7%; 95% CI, 61.3%-77.0%; 15-18 years of age 62.2%; 95% CI, 47.2%-75.3%; P = .03), and refusal based on sensory characteristics (5-9 years of age 66.7%; 95% CI, 47.9%-81.3%; 10-14 years of age 38.6%; 95% CI, 30.7%-47.3%; 15-18 years of age 22.2%; 95% CI, 12.3%-36.9%; P < .001). Eating but not enough was more common in girls (75.0%; 95% CI, 64.1%-83.4%) vs boys (68.5%; 95% CI, 59.8%-76.1; P = .04), and boys had a higher rate of refusal based on sensory characteristics (51.2%; 95% CI, 40.2%-62.2%) compared with girls (31.5%; 95% CI, 23.9%-40.2%; P = .007). Conclusions and Relevance This study suggests that ARFID is a relatively common eating disorder and is associated with important age- and sex- specific clinical characteristics that may help in early recognition and timely treatment of the presenting symptoms.