7 Signs Of Eating Disorders In Children, Types And Treatment

Eating disorders are behavioral conditions characterized by disordered eating patterns that often go hand-in-hand with distressing emotions. There are several contributing factors ranging from social to psychological issues. If left untreated, an eating disorder could cause malnutrition, affecting a child’s physical and mental development (1).

Although common in adolescents, eating disorders can be observed even in younger children. Read this post to learn more about the types, symptoms, causes, and treatment for a child with an eating disorder.

Types Of Eating Disorders

Based on the eating pattern observed and the actions that follow, eating disorders are primarily of the following types (1) (2) (3) (4).

1. Anorexia nervosa: It is a serious disorder where a child typically has low body weight and self-perception of a distorted body image. These children are constantly worried about gaining weight and may show discontent with their body size. As a result, they may starve themselves or decrease their calorie intake to meet their hypothesized physical parameters. If a child is of normal body weight and shows similar symptoms, they may have atypical anorexia nervosa.

2. Bulimia nervosa: A child with bulimia nervosa would show episodes of binge eating followed by purging to get rid of excess calories. Excessive fasting and increased use of laxatives, enemas, or diuretics, and induced vomiting occur alongside decreased control over food intake.

3. Binge eating disorder: Children with binge eating disorder take food in high amounts, followed by episodes of guilt and depression. They also show disinterest in getting rid of the excess calories, increasing the risk of obesity. There is no purging or induced vomiting usually.

4. Avoidant/restrictive food intake disorder: In avoidant/restrictive food intake disorder, a child refuses to eat foods based on their sensory characteristics such as taste, color, temperature, texture, or aroma. They may also show decreased appetite towards this entire group. This selective disinterest may cause nutritional deficiencies.

5. Pica and rumination disorders: Pica and rumination disorders also fall under eating disorders. In pica, a child shows interest in consuming items with no nutritional value such as paint chips, coal, cloth, soap, chalk, metal, pebbles, clay, or other food items. This may put the child at risk of toxicity. In rumination disorder, regurgitation and re-chewing of the food are observed.

Causes And Risk Factors Of Eating Disorders

There isn’t a particular reason that may lead to eating disorders. It could be due to the amalgamation of social, psychological, or biological issues. The following could manifest themselves through an eating disorder (5) (6).

• Anxiety
• Depression
• Decreased self-esteem
• Misconception about body images
• Negative influence of media on weight stigma
• Stress and trauma
• Behavioral inflexibility
• Mood disorders

According to a few studies, eating disorders could be due to genetic background as well (7). Having a parent or a close relative with an eating disorder could put a child at risk. Similarly, a child brought up in a body-conscious and diet-focused environment may develop an eating disorder.

Symptoms Of Eating Disorders

Increased concern over their physical appearance is a common eating disorder feature. The other symptoms may vary depending on the causative factor and the eating disorder (8) (9) (10) (11) (12) (13).

1. Common symptoms of eating disorders

• Severe weight loss or obesity
• Gastrointestinal issues such as constipation, nausea, and lack of hunger
• Fatigue

2. Symptoms of anorexia nervosa

• Low BMI
• Decreased caloric intake
• Loss of weight
• Fatigue
• Constipation
• Bloating after food consumption
• Decreased thermoregulatory ability
• Dry skin
• Irregular or decreased period flow in girls
• Body image dissatisfaction
• Reluctance to eat food, despite feeling hungry
• Intense fear of gaining weight
• Increased physical activity
• Denial of hunger cramps
• Excessive exercise as a compensatory behavior

3. Symptoms of bulimia nervosa

• Episodes of excessive eating, mostly in secrecy
• Social isolation
• Fear of lack of self-control over binge eating
• Scars on the back of fingers due to self-induced vomiting
• Constant weight fluctuations and upset stomach
• Self-induced vomiting
• Fasting after an episode of excess eating
• Constipation
• Substance abuse, which may include unregulated usage of laxatives, diuretics, enema, or cathartics
• Heart-burn
• Increased intense exercise patterns

4. Symptoms of binge eating disorder

• Episodes of binge eating followed by guilt
• Lack of control on eating patterns
• Forced eating despite lack of hunger
• Preoccupied with thoughts of food and eating
• Sudden excessive weight gain
• Lack of interest in losing weight

5. Symptoms of avoidant/restrictive food intake disorder

• Sudden disinterest in eating a particular type of food
• No fear of weight gain and no body-consciousness
• Progressive picky-eating
• Fear of choking or vomiting
• Nutritional deficiencies usually indicative of brittle nails, dry skin, and poor wound healing

6. Symptoms of pica

• Constant upset stomach
• Bloody stools due to ulcers in the stomach
• Injured teeth
• Typical history of consuming inedible objects

7. Symptoms of rumination disorder

• Frequent regurgitation and re-chewing of food
• Chapped lips
• Bad breath

Complications Of Eating Disorders

Since eating disorders affect a child’s nutritional status, they could cause several complications if left unidentified or untreated. These complications may include (8) (9) (10) (11) (12) (13):

• Anemia
• Heart issues such as bradycardia (decreased heartbeat), arrhythmia (irregular heartbeat), or altered blood pressure
• Delayed growth
• Altered hormonal levels
• Tooth decay
• Leukopenia (decreased white blood cells count)
• Gastrointestinal issues
• Obesity
• Type 2 diabetes
• Polyuria (increased urine production)
• Compromised bone health
• Electrolyte imbalances
• Muscle weakness
• Lead poisoning (in case of pica if the child consumes lead)
• Choking and aspiration (in case of rumination disorder due to entry of food into the windpipe)

Diagnosis Of Eating Disorders

Your healthcare provider and mental health professional would conduct a physical and psychological evaluation to diagnose an eating disorder. A few standardized questionnaires may also help in the eating disorders diagnoses (14) (15).

1. Physical exam: Medical professionals would consider your child’s height and weight and compare them to their previous growth charts or standardized growth charts simultaneously.

2. Psychological exam: A doctor would ask about your child’s eating patterns, behaviors, history, symptoms, and psychological is sues, if any.

3. Other exams: If the child seems malnourished, blood tests to check for anemia electrolytes or hormonal levels in the body could be conducted.

After completing the test, the healthcare provider may use the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) to identify the diagnostic criteria. It can help determine the specific eating disorder affecting the child.

Treatment For Eating Disorders

A combined approach is deemed most suitable to cure eating disorders. These therapies may include the following (14) (15).

1. Nutrition counseling: A registered dietitian would plan a diet based on your child’s nutritional status. They may even guide your child in choosing the right food patterns. 

2. Psychotherapy: As eating disorders also fall in the psychological spectrum, a counseling session with a psychiatrist or a psychologist would be suggested by your physician. This behavioral therapy would focus on identifying any underlying mental health disorders and counseling the patients accordingly during the sessions.

3. Medications: Vitamin and mineral supplementation may be suggested based on the nutritional status of the child. If the child is depressed, antidepressants may also be prescribed. 

4. Maudsley approach: In this parent-focused intervention therapy, parents are trained to have a positive approach and eventually hand over the control of the eating patterns to their children (16).

Prevention Of Eating Disorders In Children

There could be a few strategies that may prevent eating disorders among children. As children tend to learn by observing, parents and teachers should focus on healthy eating patterns. Focusing less on body shape and more on right eating patterns and body positivity could passively avoid any eating disorders.

Here are a few tips you could follow to create a positive food environment at home (6) (17).

• Do not enforce any strict dietary changes on the child
• Avoid rewarding any activities with food
• Do not label foods as “good” and “bad” as this may prompt them to choose the bad foods
• Encourage them to eat only when they’re hungry and limit their portions based on their hunger level
• Do not inculcate eating habits to lose weight, and eating should be only for good health

Many hospitals in the US offer eating disorder treatment programs to assist children in falling back to the right eating patterns. You may also contact local support groups to help the child during the early stages of an eating disorder.

Care For Those With Eating Disorders

A suitable approach towards a child with an eating disorder is to initiate a non-judgmental conversation. Expose the child to positive personality traits and success stories of those who survived eating disorders. Stay calm, focused and ensure your child that they can rely on you for assistance. If needed, encourage your child and your whole family for a counseling visit.

Here are a few tips you could try to approach your child (18).

• Choose the right time to initiate a non-judgmental conversation
• Avoid giving them any ultimatums
• Try not to focus much on their body image during the conversation
• Explain your cause for concern
• Listen to their side of the story patiently
• Expect resistance from their side
• Stay humble and patient
• Note that the process towards recovery takes time
• Understand that recovery wouldn’t happen in a fortnight
• Encourage them to seek help
• Maintain a healthy relationship with your child

If you suspect that your child may have an eating disorder, it is better to consult a physician for a diagnosis. A better approach to helping a child with an eating disorder is to be consistent with the visits to a clinic and cohesive, optimistic involvement of the entire family in their treatment. Assist your child in whatever way you can and be patient throughout their recovery process.

References

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Dr. Shaon MitraMD

 

Dr. Shaon Mitra is a consultant pediatrician and neonatologist with 17 years of experience. She is attached to several hospitals in Kolkata, West Bengal, including Bellevue Clinic, ILS Hospitals Salt Lake, and Park View Superspeciality Hospital.

Read full bio of Dr. Shaon Mitra