Anorexia Nervosa in Children
What is anorexia nervosa?
Anorexia nervosa is an eating disorder. It is a form of self-starvation. Children
and teens with this disorder have a distorted body image. They think they are overweight.
This leads them to severely restrict how much food they eat. It also leads to other
behavior that prevents them from gaining weight. Anorexia nervosa is sometimes called
What causes anorexia nervosa?
The cause of anorexia nervosa is not known. It usually begins as regular dieting.
But it slowly changes to extreme and unhealthy weight loss.
Other things that may play a role in anorexia are:
Teens who develop anorexia are more likely to come from families with a history of:
Teens with the disorder come from families that are challenged by appropriate problem
solving, being too rigid, overly critical, intrusive, and overprotective. These teens
may also be dependent and emotionally immature. They are also likely to isolate themselves
from others. Teens with anorexia often have other mental health problems such as anxiety
disorders or affective disorders.
Who is affected by anorexia nervosa?
About 90% to 95% of those with anorexia are female. But those numbers are changing
as more males are now becoming affected. The disorder was first seen in upper- and
middle-class families. But anorexia is now found in all socioeconomic groups and in
many ethnic and racial groups.
What are the different types of anorexia?
Anorexia has 2 subgroups:
Restrictor type. People with this type of anorexia severely limit how much food they eat. This usually
includes foods high in carbohydrates and fat.
Bulimic (binging and purging) type. People with bulimia eat too much food (binge) and then make themselves throw up. They
may also take large amounts of laxatives or other medicines that clear out the intestines.
What are the symptoms of anorexia nervosa?
Each child’s symptoms may vary. Symptoms may include:
Low body weight
Intense fear of becoming obese, even as the child is losing weight
Distorted view of his or her body weight, size, or shape. Sees his or her own
body as too fat, even when very underweight. Says he or she feels fat, even when
Refuses to maintain minimum normal body weight
In girls, missing 3 menstrual periods without another cause
Doing too much physical activity to help speed up weight loss
Denies feeling hungry
Preoccupation with food preparation
Strange eating behaviors
Many physical symptoms linked to anorexia are often due to starvation and malnourishment.
However, each child’s symptoms may vary. Physical symptoms may include:
Dry skin that when pinched and let go, stays pinched
Fluid loss (dehydration)
Can’t handle cold temperatures
Abnormally thin (emaciated)
Development fine, downy body hair (lanugo)
Yellowing of the skin
People with anorexia may also be socially withdrawn, irritable, moody, or depressed.
The symptoms of anorexia nervosa may seem like other health problems or psychiatric
conditions. Always see your child's healthcare provider for a diagnosis.
How is anorexia nervosa diagnosed?
Parents, teachers, coaches, or instructors may be able to identify a child or teen
with anorexia, although many people with the disorder first keep their illness very
private and hidden. However, a child psychiatrist or a qualified mental health professional
usually diagnoses this condition in children and teens. A detailed history of the
child's behavior from parents and teachers, clinical observations of the child's behavior,
and in some cases, psychological testing contribute to the diagnosis. If you see symptoms
of anorexia in your child, get an evaluation and treatment early. Early treatment
can often prevent future problems.
Anorexia, and the malnutrition that results, can harm nearly every organ system in
the body. This makes early diagnosis and treatment even more important. Anorexia can
be fatal. Talk with your child's healthcare provider for more information.
How is anorexia nervosa treated?
Your child's healthcare provider will figure out the best treatment plan for your
child based on:
How old your child is
Your child’s overall health and medical history
How sick your child is
How well your child handles certain medicines, treatments, or therapies
If your child’s condition is expected to get worse
The opinion of the healthcare providers involved in your child's care
Your opinion and preference
Anorexia is usually treated with a mix of individual therapy, family therapy, behavior
modification, and nutritional rehabilitation. Treatment should always be based on
a full evaluation of the teen and the family. Individual therapy usually includes
both cognitive and behavioral techniques. Medicine (usually antidepressants) may be
helpful if your child is also depressed.
Anorexia causes frequent medical problems. It’s also possible for a child or teen
with this disorder to die during the course of treatment. Because of this, both your
child's healthcare provider and a nutritionist must be active members of the management
team. Parents play a vital supportive role in any treatment process. Your child may
need to be hospitalized for medical problems linked to weight loss and malnutrition.
What are the complications of anorexia nervosa?
Medical problems that may result from anorexia include:
Heart (cardiovascular). Most anorexic patients who are hospitalized have low heart rates. Heart muscle damage
that can occur because of malnutrition or repeated vomiting may be life threatening.
Common heart problems that may occur include the following:
Fast, slow, or irregular heartbeat (arrhythmias)
Slow heartbeat (bradycardia)
Low blood pressure (hypotension)
Blood (hematological). About 1/3 of people with anorexia have a low red blood cell count (mild anemia). About
50% of people with this disorder have a low white blood cell count (leukopenia).
GI (gastrointestinal). Normal movement in the intestinal tract often slows down with very restricted eating
and severe weight loss. Gaining weight and taking some medicines can help to restore
normal intestinal movement.
Kidney (renal). Dehydration often linked to anorexia leads to highly concentrated urine. Your child
may also have increased urine production (polyuria). This may happen when the kidneys'
ability to concentrate urine decreases. Kidney changes usually return to normal when
your child is back to normal weight.
Endocrine (hormones). In girls, an abnormal absence of menstrual periods (amenorrhea) is one of the hallmark
symptoms of anorexia. This often happens before severe weight loss and continues after
normal weight is restored. Reduced levels of growth hormones are sometimes found in
teens with anorexia. This may explain the delayed growth sometimes seen in people
with anorexia. Normal nutrition usually restores normal growth.
Bones. People with anorexia are at a greater risk for broken bones. When anorexic symptoms
start before peak bone formation has been reached (usually mid to late teens), there
is a greater risk of decreased bone tissue (osteopenia) or bone loss (osteoporosis).
Bone density is often found to be low in girls with anorexia, and low calcium intake
and absorption is common.
Can anorexia nervosa be prevented?
There is no known way to prevent anorexia. But early detection and intervention are
important. They can reduce the severity of symptoms, enhance normal growth and development,
and improve the quality of life for children and teens with this condition. Encouraging
your child to have healthy eating habits and realistic attitudes toward weight and
diet may also be helpful.