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ABSTRACT. Background. Eating disorders in children and adolescents remain a serious cause of morbidity and mortality in children, adolescents, and young adults. The working knowledge of pathophysiology, recognition, and management of eating disorders continues to evolve as research in this field continues.Objectives. This article builds on previous background and position papers outlining issues relevant to the care of the adolescent patient with an eating disorder.Methods. The eating disorder special interest group from the Society for Adolescent Medicine recognized the need to update the state of the art published guidelines for the care of the adolescent patient with an eating disorder. This article was a multidisciplinary, group effort to summarize the current knowledge of best practice in the field.Results. This article summarizes newer findings on pathogenesis and etiology, prevention and screening, risk factors, nutritional issues, care from the primary care clinician's perspective, appropriate use of a multidisciplinary team, and issues of managed care and reimbursement.Conclusions. Primary prevention combined with early recognition and treatment helps decrease morbidity and mortality in adolescents with eating disorders. Pediatrics 2003;111:e98 -e108. URL: http://www. pediatrics.org/cgi/content/full/111/1/e98; adolescent, child, eating disorder, anorexia nervosa, bulimia nervosa.ABBREVIATIONS. AN, anorexia nervosa; BN, bulimia nervosa; ED-NOS, Eating disorder-not otherwise specified; BMI, body mass index. E ating disorders in children and adolescents continue to be a serious problem and may result in premature death or life-long medical and psychosocial morbidity. In 1995, the Journal of Adolescent Health published background and position papers outlining relevant issues in the care of the adolescent with an eating disorder. 1 This article provides an update on the state of the art for the child and adolescent with an eating disorder. Topics covered are pathogenesis and etiology, prevention and screening, risk factors, nutritional issues, aspects of care from a primary care clinician's perspective and goals for a multidisciplinary team, care in the inpatient and outpatient settings, use of clinical pathways, and issues of managed care and proper reimbursement. PATHOGENESIS AND ETIOLOGY OF EATING DISORDERSDespite increasing awareness of the major eating disorders, a specific etiology for the pathogenesis of anorexia nervosa (AN) and bulimia nervosa (BN) remains unclear. Rather than single factor causal theories, eating disorders are now viewed as multifactorial disorders with the symptom pattern representing a final common pathway. 2 Interest has focused variously on the contribution of environmental and social factors, psychological predisposition, and biological vulnerability, with recent familial aggregation studies renewing interest in the contribution of genetic predisposition.Dieting continues to be a common entry point in both syndromes, with the greatest risk being the group of severe dieters. 3 ...

Objective The purpose of this double-blind, placebo controlled exploratory pilot study was to evaluate the safety and efficacy of risperidone for the treatment of anorexia nervosa (AN). Method: Forty females ages 12–21 (mean 16) years, with primary AN in an eating disorders program were randomized to receive risperidone (R, N=18) or placebo (PL, N=22). Subjects completed the Eating Disorder Inventory (EDI-2), Color-A-Person Test, Body Image Software and Multidimensional Anxiety Scale for Children at baseline and regular intervals. Weight, labs, and ECG were monitored. Study medication was started at 0.5 mg daily and titrated upward weekly in 0.5 mg increments to a maximum dose of 4 mg until the subject reached a study end point. Results: Mean dose for the risperidone group was 2.5 mg and in the Placebo group 3 mg, for a mean duration of 9 weeks. R subjects had a significant decrease on the EDI-2 "Drive for Thinness" subscale over the first 7 weeks (p=0.002, effect size 0.88), but this difference was not sustained to study end (p=0.13). The EDI-2 "Interpersonal Distrust" subscale decreased significantly more in R subjects (p=0.03, effect size 0.60). R subjects had increased prolactin levels (week 7, p=0.001). There were no significant differences between groups at baseline or study end for the other rating scales, change in weight or laboratory measures. Conclusions: This study does not demonstrate a benefit for the addition of risperidone in adolescents with AN during the weight restoration phase of care.

IMPORTANCEFirearm injuries are the second leading cause of death among US children and adolescents. Because of the lack of resources allocated to firearm injury prevention during the past 25 years, research has lagged behind other areas of injury prevention. Identifying timely and important research questions regarding firearm injury prevention is a critical step for reducing pediatric mortality.OBJECTIVE The Firearm Safety Among Children and Teens (FACTS) Consortium, a National Institute for Child Health and Human Development-funded group of scientists and stakeholders, was formed in 2017 to develop research resources for the field, including a pediatric-specific research agenda for firearm injury prevention to assist future researchers and funders, as well as to inform cross-disciplinary evidence-based research on this critical injury prevention topic.EVIDENCE REVIEW A nominal group technique process was used, including 4 key steps (idea generation, round-robin, clarification, and voting and consensus). During idea generation, stakeholders and workgroups generated initial research agenda topics after conducting scoping reviews of the literature to identify existing gaps in knowledge. Agenda topics were refined through 6 rounds of discussion and survey feedback (ie, round-robin, and clarification steps). Final voting (using a 5-point Likert scale) was conducted to achieve consensus (Ն70% of consortium ranking items at 4 or 5 priority for inclusion) around key research priorities for the next 5 years of research in this field. Final agenda questions were reviewed by both the stakeholder group and an external panel of research experts not affiliated with the FACTS Consortium. Feedback was integrated and the final set of agenda items was ratified by the entire FACTS Consortium.FINDINGS Overall, 26 priority agenda items with examples of specific research questions were identified across 5 major thematic areas, including epidemiology and risk and protective factors, primary prevention, secondary prevention and sequelae, cross-cutting prevention factors, policy, and data enhancement.CONCLUSIONS AND RELEVANCE These priority agenda items, when taken together, define a comprehensive pediatric-specific firearm injury prevention research agenda that will guide research resource allocation within this field during the next 5 years.

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