Children who fear eating

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A NEW form of food disorder in children described as "fear of eating" can have even more severe effects than anorexia nervosa, psychiatrists were told yesterday.

Food Avoidance Emotional Disorder (FAED) now accounts for a quarter of cases seen by the specialist eating disorders team at Great Ormond Street Hospital. FAED children do not fear getting fat but they are physically afraid of eating.

"Common things the children say is that they are afraid of being sick, or afraid of hurting their tummy or afraid they will choke," said Dr Dasha Nicholls, clinical lecturer at the Institute of Child Health. "It is an emotional disorder but unlike anorexia nervosa where there is one very specific fear - fear of fatness - there are a variety of fears."

The Great Ormond eating disorders team compared the two types. They found that the FAED group tended to be younger than anorexics: the mean age was 11.8 years compared with 13.5 years. They were also more likely to be boys: the ratio was two girls to one boy compared with nine girls to one boy for anorexia.

"People do not recognise FAED because it is not talked about," Dr Nicholls told the Royal College of Psychiatrists Child and Adolescent Conference in Bristol. "They are quite commonly investigated for physical illnesses to explain the weight loss. Sometimes they may have physical illnesses that explain the loss of appetite but do not explain why they cannot recover [their appetite]."

The reason why FAED can have even more devastating effects is because of the earlier onset. Dr Nicholls had seen a child as young as seven suffering from the disorder, which can affect development. There was "significant stunting" in the FAED group although with treatment catch-up growth could occur. "Anorexia does not usually occur until full growth and development," Dr Nicholls said. "FAED can result in impaired growth, pubertal delay and osteoporosis." There is also a fear that FAED patients may go on later to develop anorexia.

Unlike patients with anorexia, patients with FAED want to get better and gain weight but have to overcome their fear of eating. "The basic approach is that the child needs help from their family to learn to eat again as well as individual help and management of their own anxiety." Dr Nicholls said. "We have to help them overcome their emotional disability."