Pediatric Anorexia Nervosa

Anorexia nervosa is also called anorexia. It is a serious medical illness that affects a child's eating behavior. It's not a lifestyle choice.

Anorexia 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 can lead them to severely limit how much food they eat. It can also leads to other behavior that stops them from gaining weight.

There are two 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.

Anorexia 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.

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's now found in all socioeconomic groups and in many ethnic and racial groups.

Risk may rise with a combination of factors. These include genetic, biological, environmental, behavioral, psychological and social factors.

Each child’s symptoms may vary. They may:

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• Be socially withdrawn, grouchy, moody or depressed

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

• Very dry skin (when pinched and let go, it 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. Have your child see their healthcare provider for a diagnosis. Early diagnosis and treatment are vital. They can help prevent future problems.

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

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

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:

• Individual therapy
• Family therapy
• Behavior changes
• Nutritional rehab
• Antidepressant medicines, if your child is also depressed
• Hospital stay to treat malnutrition

Anorexia is a serious condition that causes frequent health problems. It can be severe enough that it leads to death. 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.

Anorexia and the malnutrition that results can harm nearly every organ system in the body. It can be fatal. Anorexia has one of the highest death rates of any mental illness. Most deaths are associated with medical complications.

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 one in three 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. Fluid loss (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 is impaired. 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.

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

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

• Talk to your child about your concerns and listen to their perspective on the situation.
• Seek care as soon as you notice symptoms. Keep all appointments with your child’s healthcare provider.
• Take part in family therapy when suggested.
• Have a supportive and compassionate attitude toward your child. Remember that anorexia is an illness, not a lifestyle choice. Get individual counseling for yourself if you are struggling.
• Take action right away if you child talks of self-harm or suicide. Call 911 if your child is in immediate danger. If you need help right away, call the 988 Suicide and Crisis Lifeline (formerly the National Suicide Prevention Lifeline): Call or text 988, available 24 hours a day, 7 days a week
• Talk with your child’s healthcare provider about other providers who will be included 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. Who is on the team will depend on your child’s needs and how serious the anorexia is.
• Tell others about your child’s anorexia. Work with their healthcare provider and school to create a treatment plan.
• Check on school resources for your child. Anorexia may interfere with their ability to succeed in school. The Americans with Disabilities Act (ADA) and Section 504 of the Civil Rights Act can help your child get an appropriate education. Talk with their teachers and principal to find out about these protections.
• 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.