Hudson LD et al. – Early onset eating disorders (EOEDs) present with severe levels of physical instability and frequently to paediatricians. As anthropological indices alone are poor markers for medical instability, clinical assessment is essential. Doctors providing care for children have a central role in both the recognition and management of EOEDs.

• All suspected cases of EOED in children under 13 years of age reported by paediatricians and psychiatrists via the British Paediatric Surveillance System (BPSU) and Child and Adolescent Psychiatric Surveillance System (CAPSS) in the UK and Ireland from March 2005 to May 2006 (15 months).

• 208 cases were identified (24% reported by paediatricians).
• Median age was 11.8 years (IQR 1.74). 171 (82%) were female (78% premenarcheal and 60% prepubertal). 74% of males were prepubertal.
• 35% of cases had medical instability at presentation (60% bradycardia, 54% hypotension, 34% dehydration, 26% hypothermia).
• 52% of cases required admission at diagnosis (73% to a paediatric ward).
• 41% of cases with medical instability were not underweight, that is, they had body mass index (BMI) z-scores above -2.0 (2nd centile).
• Sensitivities for identifying medical instability with BMI z-score