EATING DISORDERS IN CHILDREN

Introduction

Eating disorders are unique medical conditions, having both physical and psychological effects on children and young adults. It is often underestimated as it affects not just the patient, but their family as well. Fortunately, studies show that about 70% of adolescents who are promptly identified with eating disorders can recover from the condition.

What are eating disorders?

Eating disorders affect an average of 9% of the whole population. Around 20% of females and 0.5% of males have been diagnosed with an eating disorder. There is an increase in cases of eating disorders among young adults who are aged 16-20 years old and patients who come from low socioeconomic status. In recent years, there have been more cases affecting preadolescents. In the United States, most cases are anorexia nervosa (including atypical) at a total of 62% of all eating disorders, followed by avoidant/restrictive food intake disorder at 19%.

Classic signs and symptoms of eating disorders are seen in most female patients. On the other hand, males typically cope with eating disorders through weight control, the use of supplements to increase muscle bulk, and substance abuse.

In this group of disorders, the younger the onset, the higher the chances of developing other mental disorders, such as anxiety or depression. Adolescents diagnosed with other medical conditions, such as inflammatory bowel disease and diabetes, may be at risk of developing eating disorders.

Peer pressure and social media, which are easily accessed by teens and young adults, are the most common channels for discrimination.

What causes eating disorders to develop?

There has been no clear cause for eating disorders. Research points to emotional distress, media influence, and cultural norms. Some psychiatric or neurodevelopmental conditions have also been diagnosed in patients with eating disorders.

Studies also note that the type of eating disorder in a patient may develop into another type as symptoms continue or progress.

Signs and Symptoms

Patients with eating disorders may have a wide range of medical signs and symptoms, but others may only have minimal symptoms and are easily overlooked by healthcare providers unfamiliar with this set of conditions.

Preadolescents and teenagers may experience any of the following symptoms:

• weakness or fatigue
• dizziness or pallor
• feeling very thirsty or frequently urinating
• muscle or joint pains
• constipation or diarrhea
• abdominal pain, bloatedness, or heartburn
• chest pain or palpitations

Teenagers who start menstruation later than expected (or not at all) might also be evaluated for eating disorders.

Other behaviors that may or may not point to an eating disorder are:

• afraid of gaining weight
• refusing to eat meals or attending events associated with food
• angry during meals
• increased bathroom visits
• intense exercise habits
• heightened anxiety or social withdrawal
• depression or suicidal thoughts

Diagnosis

Since eating disorders are also considered mental disorders, the diagnosis depends on criteria found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Note that your healthcare provider will take into consideration the child’s physical exam and other factors in making a diagnosis. The following paragraphs are summarized, simplified, and based on the DSM-5 criteria for eating disorders.

For anorexia nervosa, the following are some of the criteria that healthcare providers take into account:

1.  decreased food intake that leads to a lower-than-expected body weight
2.  fear of gaining weight
3.  placing one’s self-worth or value on their body weight
4.  unrealistic perception of body weight

In atypical anorexia nervosa, teens may have weight loss and decreased sense of self-worth while having normal or even increased body weight.

For bulimia nervosa, teens typically experience multiple, uncontrollable binge-eating episodes. This consists of eating a large amount of food for a certain time or in a certain situation. Teenagers cope afterward by exercising too much, drinking laxatives, or inducing vomiting.

Binge-eating disorder (BED) also involves impulsively taking in a huge amount of food associated with unusual behavior, like eating too quickly or even when not hungry, or experiencing depression or disgust at oneself after eating.

In avoidant or restrictive food intake disorder (ARFID), children may have weight loss or inability to gain weight, nutritional deficiencies, or no interest in food (especially in food texture or smell). Sometimes, an unnatural fear of vomiting or choking may contribute to the development of ARFID.

One closely associated condition not included in the DSM-5 criteria is orthorexia. There is less motivation to eat because of the source and quality of the food that is available to the child. Teens who are highly motivated to consume only organic foods or other similar nutritional restrictions may be placed under this category.

Depending on a case-to-case basis, laboratory evaluation might be needed. This can include a complete blood count, electrolytes, liver function, thyroid function, vitamin or mineral levels, and a urinalysis. Your healthcare provider will determine which laboratory exams will be needed.

Treatment

Some of the main objectives of treating eating disorders are to:

1.  Regain the lost weight (or gain enough weight for the child’s age)
2.  Improve or normalize eating patterns and behaviors

Changes in eating patterns may be introduced. Usually, this involves 3 meals and 2-4 snacks per day. Multivitamins and supplements may be included. A dietitian or nutritionist may be called to provide nutritional advice that is tailored to the patient’s needs.

Behavioral therapy is also important. The most commonly used is the Maudsley approach (family-based treatment), wherein the patient and family frequently meet with a therapist.

For moderate to severe cases, your healthcare provider might advise referrals to specialists or hospital admission for more in-depth treatment. Children may be required to have regular follow-up consults to monitor for optimal growth, including weight and height.

One important aspect of treatment is patient (and family) education. Informing patients and their caregivers about the psychological effects of eating disorders and the positive impact of family and community support will, in the long run, make the treatment process more effective and encouraging for the patient.

Complications

Most children with eating disorders are prone to develop chronic malnutrition, with vitamin or mineral deficiencies. If untreated, this can affect bone development and cognitive function. Dehydration is another frequent concern, especially in patients who frequently vomit.

Patients are often exposed to bullying and increased emotional stress, which can lead to anxiety, depression, and suicidal thoughts.

Screening

Most adolescents can be screened for eating disorders during yearly preventive health checkups. Sometimes, the eating disorder is discovered while undergoing medical clearance for sports participation.

In general, screening may include questions related to eating preferences, perceptions of body image, emotions related to meals or food, medication use, exercise, and other related medical symptoms, as well as monitoring of the teenager’s height and weight over a certain time.

Summary

Eating disorders are conditions of unusual eating patterns and behaviors, leading to changes in weight, self-image, or medical complications. While seen in adults, these disorders may also develop in children and adolescents. Families play a big role in observing for signs and symptoms of eating disorders, while both family and community support are highly encouraging for effective treatment.

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Sources

• Hornberger, LL, et al. Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics January 2021; 147 (1): e2020040279. 10.1542/peds.2020-040279
• Agnieszka, R, et al. Adolescents With Eating Disorders in Pediatric Practice – The European Academy of Paediatrics Recommendations. Frontiers in Pediatrics 2022(10): 10.3389/fped.2022.806399. Taken from: https://www.frontiersin.org/articles/10.3389/fped.2022.806399
• NYU Langone Hospitals (n.d.) Types of Eating Disorders in Children & Adolescents. Taken from: https://nyulangone.org/conditions/eating-disorders-in-children-adolescents/types
• The Royal Children's Hospital Centre for Adolescent Health (2021). Eating disorders. The Royal Children’s Hospital Melbourne. Taken from: https://www.rch.org.au/kidsinfo/fact_sheets/Eating_disorders/
• Johns Hopkins All Children’s Hospital (2020). Eating Disorders in Children and Adolescents. Taken from: https://www.hopkinsallchildrens.org/ACH-News/General-News/Eating-Disorders-in-Children-and-Adolescents

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