This is in response to a letter to the editor regarding our article, ‘Eating disorders in children and adolescents’. Children and adolescents can present with weight loss or inadequate weight gain due to a number of medical, physical, environmental and psychological factors. We agree that it is important to consider a broad range of differentials when reviewing a child/adolescent presenting with significant weight loss and restrictive eating patterns and recommend a systems-based approach to exclude important medical conditions such as a brain tumour, as described in Case 1 of the letter. A thorough history, physical examination and review of systems is important in the workup of any child or adolescent with weight loss. Targeted investigations may be required in ruling out more sinister causes, but are not necessary in all cases of eating disorders. The American Academy of Pediatrics (AAP) has a helpful reference on weight loss in the paediatric population, which takes into consideration a broad approach.
Diagnosing eating disorders and exclusion of important medical causes for weight loss commonly require specialised care and can be challenging in primary care practice. For such cases, we recommend referral to a specialist, who can determine the need for a more thorough workup for other medical causes of weight loss based on initial assessment and clinical progression across time, while promptly starting treatment for an eating disorder.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
1. Lee AC, Tan N, Tang KK, Ng I Comments on: Eating disorders in children and adolescents. Singapore Med J 2022; 63: 632.
2. Tan JS, Tan LE, Davis C, Chew CS Eating disorders in children and adolescents. Singapore Med J 2022; 63: 294–8.
3. American Academy of Pediatrics. Weight Loss. Point-of-Care Quick Reference. 6 Nov 2020 Available from: https://publications.aap.org/pediatriccare/article/
doi/10.1542/aap.ppcqr 396125/1520/Weight-Loss Last accessed on 2022 Oct 11.