Bulimia in Children

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KEY POINTS

• Bulimia is an eating disorder that causes your child to binge, and then purge, cut back on eating, or exercise too much to make up for binging.
• Treatment involves learning healthy eating habits, therapy, and possibly hospitalization if your child’s condition is severe and life threatening.
• Contact your healthcare provider or therapist if you have any questions or if your child’s symptoms seem to be getting worse.

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What is bulimia?

Bulimia is an eating disorder that causes your child to binge, which means eating a large amount of food in a short time without being able to stop. The amount of food is much more than most people would eat at one time. Your child may then purge, which is getting rid of the food and fluids by making himself or herself vomit or using laxatives, water pills or enemas. Your child may fast by not eating at all for a period of time, cut back on eating, or exercise too much to make up for binging.

Most people with bulimia have a normal weight but feel they cannot control their eating. Once a binge starts, your child may feel as if he or she can’t stop eating.

Although the disorder can affect males, most people with bulimia are girls.

What is the cause?

The exact cause of bulimia is not known. It may be caused by a mix of physical, mental, and social factors, and traits that are inherited from parents. It may be related to problems with the chemicals in the brain that control mood and appetite.

Your child may be at risk of developing bulimia if your child:

• Has a family history of bulimia or other eating disorders
• Has a personal or family history of obesity
• Has a family or personal history of depression, bipolar disorder, anxiety disorders, or obsessive-compulsive personality disorder
• Has a history of physical or sexual abuse

What are the symptoms?

In addition to binging and purging, the signs and symptoms of bulimia include:

• Strict dieting, trying fad diets, or going long periods without eating in between binges
• Ritualistic eating such as never eating in front of other people
• Exercising too much
• Having heartburn, throat pain, damaged teeth, or swollen cheeks caused by the stomach acid in your child's vomit
• Having scratches or scars on the back of your child's hands caused by scraping fingers on the teeth when your child makes himself or herself vomit
• Feeling weak, depressed, or guilty after binge eating
• Frequently going to the bathroom after meals
• Smelling of vomit
• Constantly thinking about food, being thin, and feeling that weight is tied to self-esteem

Bulimia may cause other health problems including:

• For females, if your child’s weight gets very low, she may not have monthly periods. Hormone changes result from low weight and low levels of body fat. This can happen if your child exercises a lot also.
• For males, low amount of the hormone testosterone
• Weakening of the bones called osteoporosis
• Low amount of red blood cells called anemia
• An imbalance of minerals called electrolytes in your child’s body
• Heart and blood vessel problems such as low blood pressure, abnormal heart rhythms, and heart failure
• Kidney and bowel problems
• Death

The risk of suicide is much greater if your child has bulimia.

How is it diagnosed?

Your healthcare provider will ask about your child’s symptoms and medical history and examine your child. Your child’s provider will ask about your child’s eating habits and other behaviors. Your child may have blood tests, X-rays, or other tests.

How is it treated?

Your child may have a hard time seeing that he or she has a problem and needs treatment. Bulimia does not go away or get better on its own. Treatment involves learning healthy eating habits, getting to and keeping a healthy weight, and learning to think about weight differently. Your child’s healthcare provider may suggest that you and your child meet with a dietitian to create a healthy meal plan. Your child may need therapy to help change how he or she thinks about self and food.

Cognitive behavior therapy (CBT) is a good way to help your child identify and change views your child has of self, the world, and the future. CBT can make your child aware of unhealthy ways of thinking. It can also help your child learn new thought and behavior patterns even after your child stops going to therapy. It can help your child learn to manage stress and improve self-esteem.

Family therapy may be helpful. Family therapy treats all members of the family rather than working with one person alone. It helps the whole family to make changes.

Your child’s healthcare provider may prescribe medicine to help reduce constant thoughts about food. Medicine may be prescribed if your child has anxiety or depression.

You child may need to go for treatment every day or be hospitalized if your child’s condition is severe and life threatening.

• If your child has bulimia, your child may think constantly about weight and food for many years. Even after your child reaches a healthy weight, your child may need to continue treatment for many months. Being under a lot of stress can cause the symptoms to get worse. The earlier you seek treatment for your child, the more successful it is likely to be.

How can I take care of my child?

• Support your child. Encourage your child to talk about whatever your child wants to talk about. Be a good listener. This helps your child realize that feelings and thoughts really do matter, that you truly care about your child, and that you never stopped caring. If your child shuts you out, don't walk away. Let your child know that you are there whenever your child needs you. Remind your child of this often. Even children raised in a loving and nurturing home need to hear it a lot because they may feel unworthy of love and attention for other reasons.
• Don’t criticize your child’s weight or tease your child about the way your child looks. Praise your child for all efforts. Also point out to your child that you appreciate other people for what they do rather than how they look.
• Help your child learn to manage stress. Teach children to practice deep breathing or other relaxation techniques when feeling stressed. Help your child find ways to relax such as taking up a hobby, listening to music, watching movies, or taking walks.
• Take care of your child’s health. Make sure your child, along with you and the family, eats a variety of healthy foods and gets the right amount of sleep and physical activity every day. Offer healthy food choices and be careful not to label some foods as “bad.” Talk to your child about the risks of smoking, using e-cigarettes, drinking alcohol, and using drugs.
• Check your child’s medicines. Tell all healthcare providers who treat your child about all the medicines, natural remedies, vitamins, and other supplements your child takes.
• Contact your healthcare provider or therapist if you have any questions or your child’s symptoms seem to be getting worse.

Ask if your child is feeling suicidal or has done anything to hurt himself or herself. Get emergency care if your child has thoughts of suicide or self-harm, violence, or harming others.

What can be done to help prevent bulimia?

• Learn all you can about bulimia. Help your child avoid TV programs, movies, magazines, or websites that emphasize being thin instead of being healthy. Teach your older child to question advertisements or articles that make her feel bad about her body shape or size. Are they are trying to sell something? Is what they say and show true? Or, have the pictures been air-brushed or computer generated to make the person look so perfect?
• Remind your child to eat a variety of foods in healthy amounts. No single food is always bad or always good.
• Teach your child that body fat and weight gain are not shameful, and do not mean that your child is lazy, worthless, or a bad person. Also avoid judging other people based on their weight or shape. Never say to your child or others, “I will like you better if you lose weight, don’t eat so much, or change your body shape.”
• Be a model of healthy self-esteem and body image. Teach your child to accept his or her body’s unique shape and size. It is much more important to be healthy than to be skinny.
• Teach your child to value self and others based on goals, accomplishments, talents, and character.

For more information, contact:

• National Eating Disorders Association
  800-931-2237
  https://www.nationaleatingdisorders.org
• National Association of Anorexia and Associated Disorders
  630-577-1330
  https://anad.org/our-services/eating-disorders-helpline/