Greetings, and thank you for your interest in our work!

We’re excited to share some preliminary findings from ongoing research we’re doing to develop and validate a pediatric eating disorder (ED) screener or use in primary care settings.

Why do we need a screener for eating disorders in youth?
Despite common misconceptions, DSM-5 ED’s do occur in young children, the most common of which is avoidant/restrictive food intake disorder (ARFID). Various professional organizations call for routine ED screening in primary care, and while there are numerous ED screening instruments validated for use in adults, none have been validated in youth populations. Pediatricians are well positioned to administer screenings due to frequency of visits, prolonged engagement with families over time, current routine screening practices for mental health disorders during annual visits, and regular collection of anthropometric measurements.

Why is it critical to capture symptoms reflecting ARFID in children?

• Malnutrition in children with ARFID is often severe and longstanding
• The physical and psychological symptoms are all-encompassing (such as significant delays growth and development), and if untreated, the individual may suffer lifelong consequences
• Timely recognition intervention is associated with improved rates of remission

How are we working to address this shortcoming?
The process of the pediatric screener development consisted of 3 distinct study phases:

Phase 1
In phase one, we convened a group of multidisciplinary experts to develop an initial set of screening questions that would (1) represent all ED diagnoses (2) address unique needs of children ages 6-12 and (3) be tailored to caregivers.

Phase 2
We asked approximately 600 caregivers of children ages 6-12 questions about their eating behaviors and growth/development. The purpose of phase II was to identify a minimal set of questions that could correctly classify individuals with/without an ED.

Phase 3
With the goal of validating the predictive accuracy of the screening questions, diagnostic interviews were being performed on 144 caregivers of children ages 6-12 to determine presence/absence of an ED. Next steps for Phase 3 are in progress, and include validation of the screener in adolescents ages 13-17.

Preliminary Findings in 6-12 year olds
We’re excited to share what we’ve learned from our caregivers so far through the in depth live diagnostic interviews:

• 144 caregivers completed the live diagnostic interviews
• 54% were cisgender boys
• 69% were White
• Children as young as 6 years old had ED’s- primarily ARFID and OSFED
• Approximately ⅓ of our sample population had an ED (2-3x higher than existing literature on prevalence in this age group).
• 37% of the children had an ED (n=53), of which:
  • 55% had ARFID
  • 40% had OSFED
  • 5% had bulimia nervosa or binge eating disorder
• 70% of the children diagnosed with ARFID were cisgender boys
• Some of the more common ED behaviors/symptoms are
  • neglecting to eat meals/snacks without prompting,
  • skipping meals/snacks at school,
  • significant picky eating that is stable over time,
  • persistent refusal to eat foods from all food groups and avoidance of foods due to fears of weight gain.
• Some of the most common comorbidities in this sample have been ADHD and ASD.
• ED’s in children are easily missed if we rely on weight loss as a symptom, as lack of weight gain over time can also be a common symptom.
• Parental accommodation for ED behaviors is common, especially for ARFID. This may look like parents making separate meals consisting of only safe food for the child, or packing safe foods for children unwilling/able foods they encounter outside of the home.
• Caregivers often struggled to recognize the seriousness of their child’s ED symptoms

What is the take-home message at this point in the study?
Early results suggest that this screener is accurately capturing ED symptoms in children, including newer DSM 5 diagnoses such as ARFID and OSFED. Existing tools are likely failing to capture the true prevalence of ED’s in children, and boys may be disproportionately affected.

Please feel free to reach out via email (research@equip.health) with any questions about our work, or if you’re interested in connecting. We’d love to connect with you at IPFDC 2025 or beyond!

In collaboration,

Dori Steinberg, VP of Research
Jessica Baker, Senior Research Manager
Kelly Cai, Data Scientist
Megan Hellner, Head of Nutrition and Exercise Research
Megan Whelen, Postdoctoral Research Associate
Nicky Jones, Data Scientist
Dave Freestone, Data Scientist