Anorexia Nervosa in Children

What is anorexia nervosa in children?

Anorexia nervosa is an eating disorder. It is a form of self-starvation. Children and teens with this health problem have a distorted body image. They think they weigh too much. This leads them to severely restrict how much food they eat. It also leads to other behavior that stops them from gaining weight. Anorexia nervosa is sometimes called anorexia.

There are 2 types of anorexia:

• Restrictor type. Children with this type severely limit how much food they eat. This often includes foods high in carbohydrates and fat.
• Bulimic (binging and purging) type. Children with bulimia eat too much food (binge) and then make themselves throw up. They may also take large amounts of laxatives or other medicines that clear out the intestines.

What causes anorexia nervosa in a child?

Researchers don’t know what causes anorexia nervosa. It most often starts as regular dieting. But it slowly changes to extreme and unhealthy weight loss.

Other things that may play a role in anorexia are:

• Social attitudes toward body appearance
• Family influences
• Genetics
• Brain chemical imbalances
• Developmental issues

Children with anorexia are more likely to come from families with a history of:

• Weight problems
• Physical illness
• Other mental health problems, such as depression or substance abuse

Children with anorexia often come from families that are very rigid and critical. Parents may be intrusive and overprotective. Children with anorexia may be dependent and emotionally immature. They are also likely to cut themselves off from others. They may have other mental health problems, such as an anxiety disorder.

Which children are at risk for anorexia nervosa?

Most children with anorexia are girls. But that is changing. More boys are now getting it. The disorder was first seen in upper-class and middle-class families. But it is now found in all socioeconomic groups and in many ethnic and racial groups.

What are the symptoms of anorexia nervosa in a child?

Each child’s symptoms may vary. He or she may:

• Have low body weight
• Fear becoming obese, even as he or she is losing weight
• Have a distorted view of his or her body weight, size, or shape. For example, the child sees his or her own body as too fat, even when very underweight.
• Refuse to stay at the minimum normal body weight
• In girls, miss 3 menstrual periods without some other cause
• Do a lot of physical activity to help speed up weight loss
• Deny feeling hungry
• Be obsessed with food preparation
• Have strange eating behaviors
• Be socially withdrawn, irritable, moody, or depressed

Many physical symptoms linked to anorexia are often because of starvation and malnourishment. They may include:

• Dry skin that when pinched and let go, stays pinched
• Fluid loss (dehydration)
• Belly pain
• Constipation
• Lethargy
• Dizziness
• Extreme tiredness (fatigue)
• Sensitivity to cold temperatures
• Being abnormally thin (emaciated)
• Growth of fine, downy body hair (lanugo)
• Yellowing of the skin

These symptoms may seem like other health problems. Make sure your child sees his or her healthcare provider for a diagnosis. Early diagnosis and treatment are vital. They can help prevent future problems.

How is anorexia nervosa diagnosed in a child?

Parents, teachers, and coaches may be able to spot a child or teen with anorexia. But many children with it first keep their illness very private and hidden.

A child psychiatrist or a mental health expert can diagnose anorexia. He or she will talk with parents and teachers about the child’s behavior. In some cases, your child may need mental health testing.

How is anorexia nervosa treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment often involves a mix of the following:

• Individual therapy
• Family therapy
• Behavior changes
• Nutritional rehabilitation
• Antidepressant medicines, if your child is also depressed

Anorexia causes frequent health problems. It’s also possible for a child with this disorder to die during treatment. Because of this, both your child’s healthcare provider and a nutritionist must be active members of the care team. Parents play a vital role in any treatment. Your child may need to go to the hospital for problems linked to weight loss and malnutrition.

What are the possible complications of anorexia nervosa in a child?

Anorexia and the malnutrition that results can harm nearly every organ system in the body. It can be fatal. It may lead to health problems with the:

• Heart. Damage to the heart can happen because of malnutrition or repeated vomiting. A child may have a slow, fast, or irregular heartbeat. He or she may also have low blood pressure.
• Blood. About 1 in 3 children with anorexia have a low red blood cell count (mild anemia). About half of children with this health problem have a low white blood cell count (leukopenia).
• Digestive tract. Normal movement in the intestinal tract often slows down with very restricted eating and severe weight loss. Gaining weight and taking some medicines can help fix it.
• Kidneys. Dehydration from anorexia may lead to highly concentrated urine. Your child may also make more urine. This may happen when the kidneys’ ability to concentrate urine drops. Kidney changes often return to normal when your child is back to normal weight.
• Endocrine system. In girls, a lack of menstrual periods is one of the hallmark symptoms of anorexia. It often happens before severe weight loss. It may continue after normal weight is restored. Lower levels of growth hormones are also sometimes found in teens with anorexia. This may explain the delayed growth sometimes seen in children with anorexia. Normal eating habits often restore normal growth.
• Bones. Children with anorexia are at a greater risk for broken bones. When anorexic symptoms start before peak bone formation has been reached (most often mid to late teens), there is a greater risk for decreased bone tissue or bone loss. Bone density is often found to be low in girls with anorexia. They may not get enough calcium in their diet or absorb enough of it.

How can I help prevent anorexia nervosa in my child?

Experts don’t know how to prevent anorexia. But spotting and treating it early can lessen symptoms. It can enhance your child’s normal development. It can also improve his or her quality of life. Encouraging your child to have healthy eating habits and realistic attitudes toward weight and diet may also help.

How can I help my child live with anorexia nervosa?

If you are worried your child has an eating disorder, talk with your child’s provider right away. Here are things you can do to help your child:

• Keep all appointments with your child’s healthcare provider.
• Talk with your child’s healthcare provider about other providers who will be involved in your child’s care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, psychiatrists, and registered dietitian nutritionists. Your child’s care team will depend on your child’s needs and how serious the anorexia is.
• Tell others about your child’s anorexia. Work with your child’s healthcare provider and school to develop a treatment plan.
• Reach out for support from local community services. Being in touch with other parents who have a child with an eating disorder may be helpful.

Key points about anorexia nervosa in children

• Anorexia nervosa is an eating disorder. It is a form of self-starvation.
• Many things may play a role in anorexia, such as social attitudes toward body appearance and family influences.
• A child with anorexia has low body weight. He or she often has a distorted view of his or her body.
• Physical symptoms may include very dry skin, belly pain, and constipation.
• A mental health expert can diagnose anorexia.
• Treatment may involve therapy and nutritional rehab.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.