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Anorexia Nervosa in Children

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KEY POINTS

  • Anorexia nervosa is an eating disorder. If your child has anorexia, she sees herself as being overweight when she is not. Your child is so afraid of becoming overweight that she eats as little as possible.
  • 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 anorexia nervosa?

Anorexia nervosa is an eating disorder. If your child has anorexia, she sees herself as being overweight when she is not. Your child is so afraid of becoming overweight that she eats as little as possible.

Anorexia can be a very severe physical and mental illness. Your child could die from starvation or suicide.

What is the cause?

The exact cause of anorexia is not known. It may be caused by a mix of physical, mental, and social factors, and traits that are inherited from parents. Part of the cause in many cultures is thinking that being thin means being beautiful. This illness is most common in teens and young women but can start in girls as young as 4. Young athletes, dancers, models, and actors who focus on low weight to perform better may also develop anorexia.

Your child may be at risk of developing anorexia if she:

  • Has a family history of anorexia or other eating disorders
  • 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?

Signs and symptoms may include:

  • Not eating for long periods, eating very little, or eating only food that is very low in calories
  • Binge eating, which means eating large amounts of food in a short period of time, and purging, which means making yourself throw up or using laxatives or water pills
  • Ritualistic eating, such as cutting food into tiny pieces or never eating in front of other people
  • Exercising too much
  • Losing a lot of weight such as being more than 15% below a healthy body weight
  • Feeling weak, dizzy, and cold all the time
  • Feeling depressed or anxious about weight
  • Having trouble sleeping
  • Constipation
  • Thinking about dieting and losing weight all the time
  • Fearing weight gain even though she is underweight
  • Denying that she is seriously underweight or that she has an eating disorder
  • If your child has diabetes, skipping insulin doses to lose weight
  • Withdrawing from friends and usual activities

Anorexia may cause other health problems including:

  • For girls, 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 boys, 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 anorexia.

How is it diagnosed?

Your child’s 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 she has a problem and needs treatment. Anorexia 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 eating plan for your child. Your child may need therapy to help change how she thinks about herself and food.

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

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.

There are no medicines known to treat anorexia nervosa. Medicine may be prescribed if your child has problems with anxiety or depression.

Your child may need to be in treatment every day or be hospitalized if her condition is severe and life threatening.

If your child has anorexia, she may think constantly about weight and food for many years. Even after your child reaches a healthy weight, she 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 her to talk about whatever she wants to talk about. Be a good listener. This helps your child realize that her feelings and thoughts really do matter, that you truly care about her, and that you never stopped caring. If your child shuts you out, don't walk away. Let your child know that you are there for her whenever she needs you. Remind your child of this over and over again. She may need to hear it a lot because she feels unworthy of love and attention. Don’t criticize your child’s weight or tease your child about the way she looks. Praise your child for her 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, for example take up a hobby, listen to music, watch movies, or take walks.
  • Take care of your child’s physical health. Make sure your child, along with you and the family, eats a healthy diet and gets the right amount of sleep and exercise every day. Offer healthy food choices and be careful not to label some foods as “bad.” Teach children to avoid alcohol, caffeine, nicotine, and drugs.
  • Check your child’s medicines. Tell all healthcare providers who treat your child about all medicines the child takes.
  • Contact your healthcare provider or therapist if you have any questions or your child’s symptoms seem to be getting worse.

Ask your child if she is feeling suicidal or has done anything to hurt herself. Get emergency care if your child has ideas of suicide or harming others or harming herself.

What can be done to help prevent anorexia?

  • Learn all you can about anorexia. 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 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 her body’s unique shape and size. It is much more important to be healthy than to be skinny.
  • Teach your child to value herself and others based on goals, accomplishments, talents, and character.

For more information, contact:

Developed by Change Healthcare.
Pediatric Advisor 2019.4 published by Change Healthcare.
Last modified: 2019-08-12
Last reviewed: 2019-05-22
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2018 Change Healthcare LLC and/or one of its subsidiaries
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