5.3.2 Incidence of restrictive eating disorders among Canadian children and youth visiting paediatricians, by age group and gender, 2003 to 2004

All children aged 5 to 12 years Boys aged 5 to 9 years Girls aged 5 to 9 years Girls aged 10 to 12 years Boys aged 10 to 12 years
Incidence of restrictive eating disorders 2.6 0.6 1.3 9.4 1.3

Source; CICH graphic developed using data from Pinhas L, Morris A, Crosby RD, Katzman DK. Incidence and Age-Specific Presentation of Restrictive Eating Disorders in ChildrenA Canadian Paediatric Surveillance Program Study. Arch Pediatr Adolesc Med.2011;165(10):895–899. doi:10.1001/archpediatrics.2011.145

There is a paucity of information about restrictive eating disorders (EDs) in children and youth. This is despite the fact that eating disorders are most likely to start between 10 and 20 years of age.

A Canadian study of 2,453 paediatricians found that the incidence of early-onset restrictive eating disorders* in children aged 5 to 12 years seen by pediatricians was 2.6 cases per 100 000 person years. Girls were 6 times more likely to have an eating disorder than were boys.

The lowest incidence was among boys aged 5 to 9 years at 0.4 cases per 100 000 person-years. The incidence in girls aged 5 to 9 years was 1.3 cases per 100 000 person-years. The highest incidence was among girls aged 10 to 12 years, at 9.4 cases per 100 000 person- years. The incidence in boys aged 10 to 12 years was 1.3 cases per 100 000 person-years.

Almost half of the girls, 47% and over half of the boys, 55% had growth delay.1

Of those who had an eating disorder, 62.1% met the criteria for anorexia nervosa.1

The incidence of eating disorders was 2 to 4 times greater than that of Type 2 Diabetes in children and youth across all ages to 18 years.1

Although children with anorexia nervosa were more likely to be medically compromised, some children who did not meet criteria for anorexia nervosa were equally medically unstable.1

*Cases were defined as any child aged 5 to 12 years seen in the previous month with newly identified restrictive eating disorders symptoms.  In this study, the word restrictive refers to intentional limitation or avoidance of nutrition. A broad definition of eating disorders was used, which included any disordered eating behavior sufficient to cause a disruption, weight gain.

1Pinhas L, Morris A, Crosby RD, Katzman DK. Incidence and Age-Specific Presentation of Restrictive Eating Disorders in ChildrenA Canadian Paediatric Surveillance Program Study. Arch Pediatr Adolesc Med.2011;165(10):895–899. doi:10.1001/archpediatrics.2011.145

Implications
When young people are dissatisfied with their bodies they can have low self esteem, and sometimes it can lead to eating disorders.1 The National Eating Disorder Information Centre (NEDIC) is a Canadian non-profit organization providing resources on eating disorders and weight preoccupation. They have a number of ideas for families to help prevent eating disorders among children and youth. For example, they recommend that it is important to teach children that their self-worth is not related to how they look and to emphasize their talents and qualities rather than their physical appearance. It is important to involve children in planning meals, shopping and cooking and to give them healthy choices. They recommend stressing the positive aspects of healthy eating – rather than the negative effects of unhealthy eating. It is important to not use food as a reward or punishment. It is also important to remind children and youth to eat when they are hungry and stop when they are full. There are many other suggestions at http://nedic.ca.

1Freeman JG, King M and Pickett W. Health Behaviour in School-aged Children (HBSC) in Canada: Focus on Relationships. 2016. http://healthycanadians.gc.ca/publications/science-research-sciences-recherches/health-behaviour-children-canada-2015-comportements-sante-jeunes/index-eng.php