Eating Disorders in Children

An eating disorder may be described as an extremely persistent habit of irregular eating associated with severe distress, despite the individual’s awareness of one’s body weight and shape. It includes both inadequate and excessive intake of food.

Eating disorders are psychiatric illnesses especially common in children and which inhibit their growth. The effects of this disorder may include malnutrition, stunting of normal growth, extremely low body weight, and long-term consequences such diseases of the heart, the digestive system, and the bones.

Image Credit: Marcos Mesa Sam Wordley / Shutterstock

Spectrum of Eating Disorders

Anorexia Nervosa (AN)

Children with AN are commonly underweight. They have a phobia regarding weight gain. This condition is mostly seen in girls. AN is associated with mood and anxiety disorders.

There are two types, namely:

• Binge-eating/Purging: Here, the sufferers go on periodic binges of eating anything and everything, but immediately feel guilty for eating too much, as well as having fears of becoming overweight. As a result of this they forcefully induce vomiting or use enemas to get rid of the food just ingested.
• Restrictive: In this condition, the child refuses to eat adequately for the age and metabolism level.

Bulimia Nervosa (BN)

BN is an eating disorder characterized by periods of overeating and gobbling. The people affected may be of average weight, extremely overweight, or obese. They may have associated mental disorders such as depression, sadness, stress, and anger.

Avoidant or Restrictive Food Intake Disorder (ARFID)

Here, the sufferers refuse to have certain foods based on their structure, taste, color, and other similar traits. This leads to loss of weight, insufficient nutrition, and growth restriction and psychological effects such as a lack of interest in food or refusal of food whenever they feel out of sorts.

Emotional Overeating

This refers to the overconsumption of food as a response to negative emotions like depression and anxiety.

Eating Disorder Not Otherwise Specified (EDNOS)

EDNOS is an umbrella term to include all illnesses which present in children in a less serious manner, not sufficient to meet criteria for AN and BN. The sufferers do, however, have a deep reluctance to or fear of gaining weight.

Pica

Children with this disorder consume non-eatable materials like chalk, plaster, paint, rubber, etc., which have no nutritional value. This is linked with mineral deficiencies like iron or zinc. It is associated with family disorders, psychological disturbances, and the absence or delay of mental growth.

Prader-Willi Syndrome (PWS)

This is a genetic disorder in which infants have hypotonia, difficulty in feeding, and slow growth. Children affected by this disorder eat excessively and become obese. The syndrome includes hypogonadism, growth delay, and specific behaviors like obsession, a bad temper, and adamant behavior.

Night Eating Syndrome

This is a syndrome in which excessive foods are taken at the wrong times, in the evening or night. The children are overweight but have episodes of anorexia and insomnia, in rare cases accompanied by joint pain. This syndrome consists of morning anorexia and hyperphagia in the evening, and the children are characteristically obese.

Causes and Symptoms

Eating disorders are complex conditions, and different from other disorders. The exact causes are unknown, but a combination of the following factors may operate behind their etiology.  

• Biological Factors: There may be an unbalanced relationship between hormone function, genetic factors, and lack of nutrition, precipitating these conditions.
• Psychological Factors: Negative thoughts regarding body and loss of self-confidence may lead to the development of an eating disorder as a form of wresting control over one’s life.
• Environmental Factors: Severe trauma and childhood abuse, and cultural pressure from friends and peers, may result in a distorted attempt to meet artificial and incorrect expectations regarding body shape and weight.

Eating disorders are associated with the following emotional, postural, and behavioral symptoms:

• Refusal to eat
• Worried about external appearance
• Finding and hoarding food
• Loss of weight or excessive weight gain
• Slowing of growth and development
• Hyperactivity or excessive exercising
• Thinning of hair on head
• Abnormal menstruation
• Getting angry or displaying severe anxiety when offered food
• Avoiding social occasions like feasts
• Abnormal eating behavior
• Avoid eating by making excuses

Rehabilitation

1. Treatment of underlying mental health disorders

Treatments include ensuring adequate nutritional intake and proper management of the child’s development and behavior, with a supportive environment.

• Family-Based Treatment (FBT): FBT is necessary for children suffering from AN, EDNOS, and BN. The parents are taught how to manage the weight of the children. The main aim of this treatment is to control the disorder with the involvement and support of the whole family.
• Psychological Treatment: Cognitive Behavioral Therapy (CBT) is also often effective in the treatment of BN. This therapy is aimed at producing deliberate changes in the abnormal thoughts and images associated with eating and food. The patient is monitored regularly at frequent intervals to assess the rate and quality of change in their thoughts and actions.

2. Nutritional Services

Nutrition specialists must be consulted for advice on achieving a balanced and healthy diet. Lack of nutrition leads to insufficiency and irregularity of menstruation, which in turn can cause slow development, low bone density, and changes in the brain both structurally and functionally.

3. Medication

There is no specific medication for this disorder, but drugs such as fluoxetine have been used in BN if there are co-occurring conditions such as anxiety, depression, and OCD.

4. Parental Role in Preventing Eating Disorders

When a child refuses to take certain non-optional foods on a habitual basis, the parent should consult a doctor to check for psychological problems.

Children should never be allowed to skip meals. It is also crucial that parents spend time at an early stage with children who show such disturbances to understand their hidden concerns and reassure them of their parents’ support.

Comparisons should be avoided at all costs, especially regarding the child’s shape, weight and appearance. It is highly recommended to encourage and help the child to overcome any fears or anxieties they may have about their body image or acceptance.

References

• https://www.nationaleatingdisorders.org/types-symptoms-eating-disorders
• http://www.rch.org.au/kidsinfo/fact_sheets/Eating_disorders_types_and_treatment/
• http://nyulangone.org/conditions/eating-disorders-in-children-adolescents/types
• https://www.b-eat.co.uk/about-eating-disorders/types-of-eating-disorder
• https://rarediseases.info.nih.gov/diseases/5575/prader-willi-syndrome
• http://www.something-fishy.org/whatarethey/other.php
• https://www.waldeneatingdisorders.com/popular-searches/night-eating-syndrome-nes/
• http://www.mirror-mirror.org/child.htm
• https://www.eatingdisorders.org.au/eating-disorders/eating-disorders-children-teens-and-older-adults/eating-disorders-a-children
• https://www.eatingdisorderhope.com/treatment-for-eating-disorders/family-role/eating-disorders-in-children-12-and-under
• https://treatingeatingdisorders.com/youngchildren.aspx