Anorexia in Children
(Anorexia Nervosa in Children)
Anorexia is an eating disorder characterized by severe restraint in food intake and/or excess physical activity. It is often linked to negative feelings toward body image. Over time, anorexia can cause severe symptoms, such as stunted growth, bone loss, damage to major organs such as the heart, and even death.
The cause of anorexia in children is not known. It appears that genetics and environment play a role.
Anorexia can occur in both girls and boys, but is much more common in girls. Factors that increase your child’s risk of anorexia include:
- Family history of eating disorders
- Low self-esteem
- Fear of becoming overweight
- Pressure to be thin
- Employment or activities in which body image concerns dominate, such as gymnastics and fashion modeling
- Mood disorders, such as anxiety, or or obsessional traits
- History of emotional or sexual child abuse
Behavioral signs may appear before physical symptoms. They may include:
- Distorted self-image of being overweight despite evidence of the opposite
- Obsession with food
- Restricting food or certain food groups even when thin
- Fear of becoming overweight even if the child is losing weight
- Excessive exercising to promote weight loss
- Self-induced vomiting
- Laxative abuse
- Denying feelings of hunger
Physical symptoms may include:
- Changes in weight, such as slow weight gain or weight loss
- Loss of menstrual periods or delay in the beginning of periods
- Feeling cold, especially in the hands and feet
- Changes is body temperature
- Hair loss and/or growth of fine hair on the body
- Fainting or severe lightheadedness
- Fatigue and muscle weakness
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You will be asked about your child’s symptoms and medical history. A physical exam and a psychological evaluation will be done. The diagnosis will be based on information from you and your child and the examination.
If anorexia is suspected or diagnosed, then your child’s doctor may order further tests to determine what effect the anorexia has had on your child’s overall health. Tests may include:
- Blood tests—to look for changes in electrolytes, vitamins, and other important nutrients.
- Electrocardiogram (EKG)—to look for any effects on the heart.
- Bone density test—to test the health of your child’s bones, especially in girls whose menstrual periods are absent.
Management of anorexia will include:
- Assuring adequate nutrition
- Addressing the feelings and distorted thoughts causing the condition
- Identifying and managing any physical problems caused by poor food intake
The length and intensity of treatment will depend on the individual child. Regular supervision by health care specialist will help to make sure that hydration and nutrient levels have not dropped to dangerous levels during recovery. It may take many years to fully manage anorexia. Treatment should include more than one approach but may include:
You may be referred to a dietitian who will talk to you and your child about practical weight goals and calorie goals. A dietitian will also assure proper weight gain and help your child develop good eating habits.
Severe malnutrition may require the delivery of nutrients through a tube that is passed through the nose and into the stomach.
Therapy can help address factors that may be linked to your child’s anorexia including harmful thought patterns, anxiety, and poor self-esteem. It can also help your child develop a more positive attitude about food and their body image.
Work with your child’s doctor and therapists to determine which therapy may be best for your child. Your child may use more than one type of therapy or try different therapies before the right one is found. Some therapy options include:
- Family therapy—Recovery is often more successful if family members take part in therapy. All family members need to understand the disorder to provide the proper support.
- Cognitive behavioral therapy—To help your child develop a healthier and more realistic self-image. The therapist will help your child find new ways to think about his or her body and diet.
- Interpersonal therapy—To help your child understand and cope with concerns about relationships.
If your child is depressed, antidepressant medication may be used
Hospitalization may be needed to provide critical nutrition or to monitor problems caused by the anorexia such as heart disorder.
An inpatient eating disorder program may help children who have not found success with outpatient programs.
Early detection and treatment is the best option. The following parenting tips may help prevent anorexia in children:
- Compliment your child on his or her inner qualities instead of his or her outward appearance.
- Send positive messages about eating. For example, avoid making negative comments about your own body in front of your child.
- Do not diet at home. Instead, focus on eating a healthy diet that includes plenty of whole grains, fruits, and vegetables.
- Eating breakfast is especially important. When possible, try to eat meals as a family.
- Discuss media images of bodies with your children so they do not get harmful messages about body size.
Healthy Children—American Academy of Pediatrics
Kids Health—Nemours Foundation
Caring for Kids—Canadian
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Anorexia nervosa in children. Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/conditions/pediatrics/anorexia%5Fnervosa%5Fin%5Fchildren%5F90,P02554/. Accessed August 23, 2017.
Campbell K, Peebles R. Eating disorders in children and adolescents: state of the art review. Pediatrics. 2014 Sep;134(3):582-592. Available at: http://pediatrics.aappublications.org/content/134/3/582.long#content-block.
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- Reviewer: EBSCO Medical Review Board Michael Woods, MD, FAAP
- Review Date: 09/2017
- Update Date: 04/07/2015