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Eating Disorders in Children

American culture places a premium on being physically attractive and having the "perfect" body. This has led to almost a societal obsession with losing weight, being thin, and dieting. Concerns about being overweight begin as early as preschool age, and the drive for thinness intensifies with age. The results can have both physical and psychological repercussions, including potentially serious disor­dered eating.

Disordered eating is an unhealthy pre­occupation with food and one's body. It is "emotional" eating and includes compulsive-obsessive eating, anorexia ner­vosa, bulimia, and most commonly, dieting and restrictive eating. There has been an increased incidence of eating problems during the past two decades. During the middle years, children ages ten to twelve are at greatest risk. More girls and women seem to be affected by eating disorders than males.

In some families, adults use a variety of activities to help them cope with their feel­ings. They may smoke, use alcohol, work feverishly, exercise intensively, or choose other ways to help them feel better. Many use food and thus become emotional eaters. Most children have ready access to food and so learn to "stuff" their feelings. Whether it is done when they are feeling very high or very low emotionally, it is easy to use food to cope with emotions.

Anorexia nervosa is characterized by self-induced starvation, a troubling degree of weight loss, and a seriously distorted body image fueled by an intense fear of be­ing fat. Anorexia is more common in girls than in boys, but can occur in either sex. The child's body image is so unrealistic and distorted that she complains of look­ing fat, even when it is obvious to others that she is severely underweight and con­spicuously gaunt. Generally, children with anorexia nervosa consume only a few hun­dred calories each day, while they may en­gage in rituals of sneaking and hiding food or getting rid of it. They may abuse laxa­tives and diuretics (drugs that increase uri­nation). They are also preoccupied with exercise to burn off as many calories as possible, by jogging for miles, doing aero­bic dancing several times a day, or running up and down stairs constantly in the pur­suit of thinness. Girls with anorexia ner­vosa who have begun menstruating may miss their periods, or stop having periods completely, and pre-adolescent girls who have anorexia nervosa may experience a delay in the onset of menstruation. Anorexia nervosa is relatively rare during the middle years, ages five to twelve.

Bulimia is a different condition but is characterized by some of the same activi­ties. It is often referred to as the binge/ purge syndrome. A binge is a period of vo­racious eating, with an urgency and a need to stuff food, while at the same time having a fear of not being able to stop. Typically the foods that are chosen are high-calorie junk foods, but bingeing can occur with any type of food. Binge eating is out-of-control emotional eating. At times the amount of food eaten is not necessarily excessive; for example, if a girl has been di­eting and restricting food intake and then begins to eat, she may binge and feel very out of control, regardless of the actual amount of food she consumes.

Following a binge, purging is common. Girls try to rid their bodies of food, either by self-induced vomiting (sticking a finger or an object like a toothbrush down the throat) or abusing laxatives or diuretics. They may engage in abusive exercise, diet pills, fasting, or dieting, all in an attempt to lose weight. Most girls with bulimia feel quite ashamed of their bingeing and purg­ing, and they become highly skilled at keeping it a secret from friends and family. The strong emotional compulsion to maintain the binge/purge cycle, as well as their success at disguising their problem, makes bulimia difficult to detect and treat. Full-fledged bulimia is also relatively uncom­mon during the middle years. However, particularly as they enter puberty, children are more commonly engaging in purging without bingeing.

Dieting and restrictive eating are charac­terized by a disturbing preoccupation with the need to lose weight. These children weigh themselves frequently, engage in fad diets, and are unreasonably restrictive about food intake. This behavior pattern is unrelated to whether the child is over, un­der, or at a healthy body weight. Being on a diet is the common theme for everyone suf­fering from disordered eating and can lead to serious problems.

The restrictive-eating child may initially appear only to be a picky eater, cutting out certain foods—maybe refusing to eat any bread—or perhaps becoming a vegetarian. Since these children still have normal ap­petites, their eating behavior is a way of exerting control in one area of their lives. Because eating is often an important issue in their families, these children find it easy to use their diets to manipulate their par­ents. Frequently, their disordered eating leads to emotional struggles with their par­ents. Unfortunately, because of the societal pressure to be thin, parents and other adults sometimes succumb to the control­ling eating behavior of their children.

Last Updated
Caring for Your School-Age Child: Ages 5 to 12 (Copyright © 2004 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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