Does anorexia nervosa occur in the prepubertal years?

A nine-year-old girl, an only child, immigrated to Canada with her parents three months ago and adapted quite well to the move. In the past month, she mentioned that many children in her school were fat and expressed a fear that eating would make her fat, too. As a result, she started to cut back on her food intake and eventually was eating very little. Her parents could not convince her to eat more and took her to the family doctor. On physical examination, she was pale and fraillooking, with a height of 133 cm (50th percentile) and a weight of 22 kg (below the 10th percentile), which was significantly decreased from her previous weight of 29 kg three months earlier. Her blood pressure was normal, but she had bradycardia (heart rate of 45 beats/min) and hypothermia (temperature of 35.9°C). Her family doctor was concerned about her presentation. Although the girl was not a typical case, her doctor wondered if she had anorexia nervosa and referred her to a child and adolescent eating disorder program. Because her clinical signs and symptoms were consistent with an early-onset eating disorder (EOED), she was admitted to hospital. As part of her workup, medical and psychiatric causes of weight loss were ruled out. Her treatment lasted 18 months and included outpatient care and a second inpatient admission. As with most children and young adolescents, she made a full recovery.