Children with eating disorders more than triple during lockdown

Children’s hospitals deal with acute cases - some as young as 10

EATING disorders among children have more than tripled in one of the country’s leading children’s hospitals during the pandemic.

Clinicians started seeing the sharp increases in presentations to Irish hospitals in the wake of Covid19 restrictions last year – with children losing more than a fifth of their body weight in many cases.

Professor Fiona McNicholas, consultant child and adolescent psychiatrist at Crumlin Children’s Hospital, said both community and hospital presentations of young people with different types of eating disorders increased immediately after lockdown.

She said: ‘In Crumlin presentations increased three to four times in one year from 2019 to 2020, such that 16% of all our work was related to an eating disorder.

‘Similar increases have also been noted by our colleagues in Temple Street, Tallaght, and Child and Adolescent Mental Health Services.’

Eating disorders typically start in adolescence, but clinicians have seen presentations in children as young as nine or 10, and cases in lockdown have tended to be severe.

‘There has also been a sense that presentations are more acute, with significant weight loss, in many cases above 20% of original body weight’, said the child psychiatrist. ‘They might be on cardiac monitoring because their heart rate has gone so low. They might have electrolyte abnormalities. It is a medical emergency when their weight goes very low.’

The paediatric psychiatrist added: ‘We’re seeing a general increase in eating disorders in the community; we’re seeing relapses in cases and new-onset cases, and what we’re finding is it is starting very quickly and they’re losing a lot of weight.’

Parents and children are linking the onset of the disorder with the pandemic. ‘One mother described new behaviour the very next day after lockdown where the young child engaged in what started off as a healthy focus on structure and exercise the day after but got out of hand,’ said Prof. McNicholas.

‘Many parents have reported, and indeed the young people themselves, a link between the onset of problematic eating or exercise to be linked with Covid. The reason why it is so crucial to be focusing on kids is they get ill very quickly; they don’t have a lot of spare capacity to lose weight, unlike adults.’

Children presenting to hospital are more likely to have anorexia nervosa as they become medically compromised but disorders like bulimia are more likely to be seen in the community. An examination of hospital and community records would be needed to discover how the pandemic has affected different eating disorders.

Anorexia nervosa, bulimia nervosa, and binge eating disorder are commonly known while a more recent disorder called Avoidant Restrictive Food Intake Disorder, is more typical in younger children and individuals with autism or learning difficulties.

Before lockdown, studies were already pointing to a rise in eating disorders, with cases presenting at younger ages and more presentation in boys, although females still predominated. ‘Even though numbers were going up it was milder cases but with Covid the increased numbers, it’s not just mild cases – it’s actually more severe cases as well,’ said Prof. McNicholas.

She said she was unsure of the cause of the increase but points out

‘It is an emergency when their weight is very low’

‘They don’t have spare capacity to lose weight’

that the pandemic added to the stress of daily life. The professor added that the necessary public health measures such as school closures, and restricted gatherings, have affected young people in removing positive support networks like sport and school.

The national clinical eating disorder program was set up by the HSE in 2018 in combination with the college of psychiatrists and Bodywhys to address the growing numbers. n The Bodywhys helpline number is: 01-210 7906.