Discussion | Obesity changes the association between total body weight and fat-free mass. The volume of distribution of a medication is therefore variable, according to its lipid solubility, in patients with different BMIs. While alterations in the volume of distribution in individuals with obesity are the result of more complex interactions between drugs, protein binding, and tissue perfusion, this analysis shows that current methods of calculating IBW are an inconsistent surrogate for fat-free mass in children with obesity. For an 11-year-old child with a BMI of 31.0, IBW will be calculated as between 51% and 65% of total body weight. When applied to the prescribing of gentamicin, a hydrophilic drug with a narrow therapeutic index, the starting dose will vary by 27%. Because the lower end of this range is likely to be an underestimation of the child's weight, 6 this is likely to result, at least initially, in the patient receiving subtherapeutic levels of medication. To strive to provide safe, effective dosages of medication for every child, we should seek to develop models incorporating a compartmental approach using, for example, biological impedance. This would help clinicians provide medication dosages to children with obesity ideally.

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This cross-sectional study compares the trends in incidence and hospitalization for eating disorders among children and adolescents 5 years before and in the first months of the COVID-19 pandemic.

Prophylactic oral phosphate supplementation appears safe, and no episodes of RH occurred in patients with restrictive eating disorders undergoing inpatient refeeding.

IMPORTANCETo 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.

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BACKGROUND AND OBJECTIVES: Evidence suggests that children and adolescents with avoidant/restrictive food intake disorder (ARFID) have heterogeneous clinical presentations. To use latent class analysis (LCA) and determine the frequency of various classes in pediatric patients with ARFID drawn from a 2-year surveillance study. METHODS: Cases were ascertained using the Canadian Pediatric Surveillance Program methodology from January 1, 2016, to December 31, 2017. An exploratory LCA was undertaken with latent class models ranging from 1 to 5 classes. RESULTS: Based on fit statistics and class interpretability, a 3-class model had the best fit: Acute Medical (AM), Lack of Appetite (LOA), and Sensory (S). The probability of being classified as AM, LOA, and S was 52%, 40.7%, and 6.9%, respectively. The AM class was distinct for increased likelihood of weight loss (92%), a shorter length of illness (<12 months) (66%), medical hospitalization (56%), and heart rate <60 beats per minute (31%). The LOA class was distinct for failure to gain weight (97%) and faltering growth (68%). The S class was distinct for avoiding certain foods (100%) and refusing to eat because of sensory characteristics of the food (100%). Using posterior probability assignments, a mixed group AM/LOA (n = 30; 14.5%) had characteristics of both AM and LOA classes. CONCLUSIONS: This LCA suggests that ARFID is a heterogeneous diagnosis with 3 distinct classes corresponding to the 3 subtypes described in the literature: AM, LOA, and S. The AM/LOA group had a mixed clinical presentation. Clinicians need to be aware of these different ARFID presentations because clinical and treatment needs will vary.

A hallmark of delivering quality adolescent health care services is the provision of confidential care. Key tenets when providing confidential care for adolescents include time alone with a health care provider, maintaining the privacy of health information, and securing informed consent for services without permission from a parent, guardian, or caregiver. While confidentiality is a basic principle for all health care encounters regardless of age, the unique considerations for capable adolescent patients are not always realized or appreciated. By ensuring appropriate quantity and quality of confidential care for adolescents, clinicians are better equipped to elicit a comprehensive history and physical examination, while empowering the adolescent involved to develop agency, autonomy, trust, and responsibility for their own health care decision-making and management.