From the Guidelines
The appropriate workup for a 15-year-old with lack of appetite should begin with a comprehensive medical and psychological evaluation, as recommended by the American Psychiatric Association 1. This evaluation should include a detailed history and physical examination to identify potential underlying causes, which may include physical illness, medication side effects, psychological factors like depression or anxiety, or eating disorders. Some key points to consider in the workup include:
- Laboratory tests, such as complete blood count, comprehensive metabolic panel, thyroid function tests, and inflammatory markers, to rule out underlying medical conditions 1.
- Screening for depression and anxiety using validated tools like the PHQ-9 or GAD-7, as these conditions can contribute to lack of appetite 1.
- Assessment of eating habits and behaviors to identify potential eating disorders, such as anorexia nervosa or bulimia nervosa, which require specialized treatment 1. Management depends on the underlying cause but generally includes:
- Addressing any identified medical conditions, such as treating underlying infections or managing chronic illnesses.
- Nutritional support, which may include small, frequent meals with nutrient-dense foods and possibly liquid supplements like Ensure or Boost if weight loss is significant.
- Psychological intervention, such as cognitive behavioral therapy, which can help address underlying psychological factors contributing to lack of appetite. For suspected eating disorders, a multidisciplinary approach involving a pediatrician, nutritionist, and mental health professional is essential, as recommended by the American Psychiatric Association 1. Family involvement is also crucial in the management plan, as they can help monitor eating habits and provide emotional support. Regular follow-up appointments are necessary to track progress and adjust the treatment plan as needed. It's also important to note that, according to the American Psychiatric Association, patients with eating disorders should have a documented, comprehensive, culturally appropriate, and person-centered treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise, commonly via a coordinated multidisciplinary team 1.
From the Research
Initial Evaluation
- A 15-year-old with a lack of appetite should undergo a comprehensive evaluation to determine the underlying cause of their condition.
- This evaluation may include a physical examination, laboratory tests, and a psychological assessment 2, 3.
Laboratory Tests
- A complete blood count (CBC) may be ordered to check for anemia, leukopenia, and thrombocytopenia, which are common complications of anorexia nervosa 3.
- Other laboratory tests, such as electrolyte panels and liver function tests, may also be necessary to rule out other potential causes of appetite loss.
Psychological Assessment
- A psychological assessment is crucial to evaluate for comorbid mental health conditions, such as depression and anxiety, which are common in individuals with eating disorders 2, 4.
- The assessment may include standardized questionnaires and interviews to evaluate the individual's mental health status.
Treatment Options
- Treatment for a 15-year-old with a lack of appetite will depend on the underlying cause of their condition.
- If anorexia nervosa is diagnosed, treatment may involve a combination of psychotherapy, nutrition counseling, and medication 2, 4.
- Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, may be considered for the treatment of comorbid depression and anxiety 2, 5.
Monitoring and Follow-up
- Regular monitoring and follow-up are essential to assess the individual's response to treatment and adjust the treatment plan as needed.
- Laboratory tests, such as CBC and electrolyte panels, may need to be repeated periodically to monitor for potential complications 3.
- A multidisciplinary team, including a psychiatrist, psychologist, and nutritionist, may be involved in the individual's care to ensure comprehensive treatment 2, 4.