Eating disorders
Eating disorders in children cause serious changes in eating habits that can lead to major, even life
threatening health problems. The three main types of eating disorders are as follows:
1. Anorexia: A condition in which a child refuses to eat adequate calories because of an intense and
irrational fear of becoming fat.
2. Bulimia: A condition in which a child grossly overeats (binging) and then purges the food by
vomiting or using laxatives to prevent weight gain.
3. Binge eating: A condition in which a child may eat food rapidly, but without purging.
Causes
Adolescents who develop anorexia are more likely to come from families with a history of
weight problems, physical illness, and mental health problems, such as depression or
substance abuse.
Families with high levels of stress, poor patterns of communication, unrealistically high
expectations, and underdeveloped problem-solving skills.
Sports or activities in which leanness is emphasized (e.g., ballet, running or wrestling)
Adolescents with anorexia often have other mental health problems, such as anxiety
disorders, obsessive-compulsive disorder, affective mood disorders, and problems with
substance abuse.
Genetic factors: Both disorders (anorexia and bulimia) tend to run in families, and twin
studies support the role of genetics in the actual disorders.
Sociocultural standards, which favor a thinner shape as the ideal for women.
Psychological level: Psychodynamic theories of eating disorders emphasize parent-child
relationships and personality characteristics.
Cognitive behavioral theories: Cognitive behavioral theories of eating disorders propose that
fear of being fat and body image distortion make weight loss a powerful reinforcer
Anorexia Nervosa
Anorexia nervosa is a form of self-starvation. Children with this health problem have a
distorted body image
Signs of Anorexia
Low body weight (under 85% of the normal weight for the child's height and age)
Intense fear of weight gain, even as they are losing weight
Distorted view of body weight, size, or shape; see themselves as too fat or normal sized,
even when very underweight.
Refusal to maintain normal body weight
In females, absence of three consecutive menstrual cycles without another cause
Excessive physical activity
Denies feelings of hunger
Preoccupation with food preparation
Bizarre eating behaviors, (e.g., using a fork to eat raisins or cutting food into very small
pieces)
Physical Changes in Anorexia Nervosa
Hypotension, bradycardia
Kidney and gastrointestinal problems
Bone mass declines
Skin dries out, nails become brittle
Hormone levels change
Mild anemia may occur
EEG abnormalities and neurological impairments
Structural brain changes
Emotional Symptoms
Withdrawal from social situations
Irritability
Mood changes
Depression
Diagnostic Criteria
Refusal to maintain body weight at or above a minimally normal weight for age and height,
(e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or
failure to make expected weight gain during period of growth, leading to body weight less
than 85% of that expected).
Intense fear of gaining weight or becoming fat, even though underweight.
Disturbance in the way in which one's body weight or shape is experienced, undue influence
of body weight or shape on self-evaluation, or denial of the seriousness of the current low
body weight.
In postmenarcheal females, amenorrhea, Le, the absence of at least three consecutive
menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only
following hormone, e.g., estrogen, administration).
Medical Management
Individual therapy
Family therapy
Behavior changes
Nutritional rehabilitation
Antidepressant medicines, if child is depressed
Complication of Anorexia Nervosa
Anemia
Heart problems (arrhythmias, slow heart rate, heart failure, and mitral valve prolapse)
Low blood pressure
Kidney problems
Electrolyte imbalance
Lack of menstruation in women
Low testosterone in men
Bone loss
Death
Bulimia Nervosa
Bulimia Nervosa is an eating disorder in which one starts to consume large amounts of food at once
and then is followed by purging, using laxatives, or overexercising to rid themselves of the food they
ate.
Diagnostic Criteria
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of
the following:
Eating, in a discrete period of time, (e.g., within any 2-hour period), an amount of food that
is definitely larger than most people would eat during a similar period of time and under
similar circumstances.
A sense of lack of control overeating during the episode, (eg., a feeling that one cannot stop
eating or control what or how much one is eating).
Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-
induced vomiting misuse of laxatives, diuretics, enemas, or other medications; fasting, or
excessive exercise.
The binge eating and inappropriate compensatory behaviors both occur, on average, at least
twice a week for 3 months.
Self-evaluation is unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Two Types of Bulimia Nervosa
1. Purging type: The person has regularly engaged in self-induced vomiting or the misuse of
laxatives , diuretics or enemas
2. Nonpurging type: The person has used other inappropriate compensatory behaviors, such as
fasting or excesive exercise, but has not regularly engaged in self induced Vomiting or the misuse
of laxatives, diuretics, or enemas
Binge Eating Disorder -Warning Signs
Wrappers/containers indicating consumption of large amounts of food
Overweight for age and height
Long history of repeated efforts to diet, feel desperate about their difficulty to control
food intake
Eat throughout the day with no planned mealtimes
Signs and Symptoms
Physical changes like:
Menstrual irregularities, including amenorrhea
Potassium depletion due to frequent purging
Electrolyte imbalance and diarrhea due to heavy use of laxatives
Recurrent vomiting may lead to tearing of tissue in the stomach and throat and the loss of
dental enamel
Salivary glands may become swollen
Medical Management
Psychological treatment of bulimia nervosa: Cognitive behavior therapy is the best validated
and most current standard for the treatment. It focuses on questioning society's standard for
physical attractiveness, challenging beliefs that encourage severe food restriction, and
developing normal eating patterns.
Family therapy
Behavior changes
Nutritional rehabilitation
Antidepressants
Binge Eating in Children
Binge eating is similar to bulimia. It includes chronic, out-of-control eating of large amounts in a
short time, even to the point of discomfort. However, binge eaters do not purge the food
through vomiting or other means. As a result, they tend to become overweight or obese.
Complications
Heart disease
High blood pressure
High Cholesterol
Type 2 diabetes
Treatment
Behavioral therapy
Medications, including antidepressants
Psychotherapy
Nursing Diagnosis
Imbalanced nutrition (less or more) than body requirements related to refusal to eat or
excess food or excessive exercise
Risk for fluid and electrolyte imbalance related to fluid shift, laxative/diuretic overuse
Ineffective adolescent eating dynamics
Impaired bowel pattern related to altered gastric motility
Disturbed thought process related to disease condition
Disturbed body image, chronic low self-esteem related to anorexia/bulimia
Risk for impaired skin integrity related to malnutrition
Deficient knowledge related to disease condition
Nursing Interventions
Assess the child's daily weight and eating patterns.
Supervise the child during mealtimes and for a specified period after meals (usually one
hour).
Identify the child's elimination patterns to prevent self-induced vomiting.
Explain the risks of laxative, emetic or diuretic abuse.
If edema or bloating occurs after the child has returned to normal eating behavior,
reassure her that this phenomenon is temporary.
Establish a minimum weight goal and daily nutritional requirements.
Provide smaller meals and supplemental snacks, as appropriate.
Make a selective menu available, and allow the child to control choices as much as
possible.
Provide nutritional therapy within a hospital treatment program as indicated when the
condition is life-threatening.
Administer supplemental nutrition as appropriate.
Adhere strictly to the nutritional regimen.
Promote self-concept without moral judgment
Encourage child to take charge of their own life in a more healthful way by making their
own decisions and accepting self as she or he is at this moment
Educate parents about various sources of protein, carbohydrate, and fats. Inform about
the advantages of a balanced diet.
