Pediatric Bulimia Nervosa

Bulimia nervosa is an eating disorder. It’s also called bulimia. A child with bulimia overeats or binges uncontrollably. This overeating may be followed by self-induced throwing up (purging).

A child who binges eats much larger amounts of food than would normally be eaten in a short period of time (often less than two hours). The binges happen at least twice a week for three months. They may happen as often as several times a day.

Bulimia has two types:

• Purging type. A child with this type regularly binges and then causes himself or herself to throw up. Or the child may misuse laxatives, diuretics, enemas or other medicines that clear the bowels.
• Nonpurging type. Instead of purging after binging, a child with this type uses other inappropriate behaviors to control weight. He or she may fast or exercise too much.

Researchers don’t know what causes bulimia. Some things that may lead to it are:

• Cultural ideals and social attitudes about body appearance
• Self-evaluation based on body weight and shape
• Family problems

Most children with bulimia are girls in their teens. They tend to be from a high socioeconomic group. They may have other mental health problems, such as anxiety or mood disorders.

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

• Eating disorders
• Physical illness
• Other mental health problems, such as mood disorders or substance abuse

Each child may have different symptoms. But the most common symptoms of bulimia are:

• Often has a normal or low body weight but sees him or herself as weighing too much
• Repeated episodes of binge eating, often in secret
• Fear of not being able to stop eating while bingeing
• Self-induced throwing up, often in secret
• Extremely excessive exercise
• Excessive fasting
• Strange eating habits or rituals
• Misuse of laxatives, diuretics or other medicines to clear the bowels
• In girls, irregular periods or no period at all
• Severe anxiety
• Discouragement because he or she is not satisfied with his or her appearance
• Depression
• Obsession with food, weight and body shape
• Scarring on the back of the fingers from self-induced throwing up
• Overachieving behaviors

The symptoms of bulimia nervosa may look like other health problems. Make your child sees his or her healthcare provider for a diagnosis.

Parents, teachers and coaches may be able to spot a child with bulimia. But many children with it first keep their illness hidden. If you notice symptoms of bulimia in your child, you can help by getting a diagnosis and treatment early. Early treatment can often prevent future problems.

A child psychiatrist or a mental health expert can diagnose bulimia. They will talk with you, your partner and teachers about your child’s behavior. Your child may need psychological 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 includes a mix of the following:

• Individual therapy
• Family therapy
• Behavior changes
• Nutritional rehabilitation
• Medicine for depression or anxiety, if needed

Bulimia can lead to malnutrition. It can harm nearly every organ system in the body. That’s why early diagnosis and treatment is important. Some health problems it may cause are:

• Damage to the throat, stomach and bowels
• Dehydration
• Tooth decay

Health complications may happen during treatment. Because of this, both your child’s healthcare provider and a registered dietitian nutritionist (RDN) must be part of the care team. You as a parent play a vital role in treatment.

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 RDNs. Your child’s care team will depend on your child’s needs and how serious the bulimia is.
• Tell others about your child’s bulimia. Work with your child’s healthcare provider and schools to create a treatment plan.
• Reach out for support from local community services. Being in touch with other parents who have a child with bulimia may be helpful.

Call your child’s healthcare provider if your child has:

• Symptoms that don’t get better or get worse
• New symptoms