What is bulimia nervosa in children?

Bulimia nervosa is an eating disorder. It’s also called bulimia. A child with bulimia overeats or binges uncontrollably. This overeating may be followed by self-induced throwing up (purging).

A child who binges eats much larger amounts of food than would normally be eaten in a short period of time (often less than 2 hours). The binges happen at least twice a week for 3 months. They may happen as often as several times a day.

Bulimia has two types:

• Purging type. A child with this type regularly binges and then causes themselves to throw up. Or the child may misuse laxatives, diuretics, enemas, or other medicines that clear the bowels.

• Nonpurging type. Instead of purging after binging, a child with this type uses other inappropriate behaviors to control weight. They may fast or exercise too much.

What causes bulimia nervosa in a child?

Researchers don’t know what causes bulimia. Some things that may lead to it are:

• Cultural ideals and social attitudes about body appearance

• Self-evaluation based on body weight and shape

• Family problems

Which children are at risk for bulimia nervosa?

Most children with bulimia are girls in their teens. They tend to be from a high socioeconomic group. They may have other mental health problems, such as anxiety or mood disorders.

Children with bulimia are more likely to come from families with a history of:

• Eating disorders

• Physical illness

• Other mental health problems, such as mood disorders or substance abuse

What are the symptoms of bulimia nervosa in a child?

Each child may have different symptoms. But the most common symptoms of bulimia are:

• Often has a normal or low body weight but sees themselves as weighing too much

• Repeated episodes of binge eating, often in secret

• Fear of not being able to stop eating while bingeing

• Self-induced throwing up, often in secret

• Extremely excessive exercise

• Excessive fasting

• Strange eating habits or rituals

• Misuse of laxatives, diuretics, or other medicines to clear the bowels

• In girls, experiencing irregular periods, or no period at all

• Severe anxiety

• Discouragement because they are not satisfied with their appearance

• Depression

• Obsession with food, weight, and body shape

• Scarring on the back of the fingers from self-induced throwing up

• Overachieving behaviors

The symptoms of bulimia nervosa may look like other health problems. Make sure your child sees their healthcare provider for a diagnosis.

How is bulimia nervosa diagnosed in a child?

Parents, teachers, and coaches may be able to spot a child with bulimia. But many children with it first keep their illness hidden. If you notice symptoms of bulimia in your child, you can help by getting a diagnosis and treatment early. Early treatment can often prevent future problems.

A child psychiatrist or a mental health expert can diagnose bulimia. They will talk with you, your partner, and teachers about your child’s behavior. Your child may need psychological testing.

How is bulimia nervosa treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment often includes a mix of the following:

• Individual therapy

• Family therapy

• Behavior changes

• Nutritional rehabilitation

• Medicine for depression or anxiety, if needed

What are possible complications of bulimia nervosa in a child?

Bulimia can lead to malnutrition. It can harm nearly every organ system in the body. That’s why early diagnosis and treatment are important. Some health problems it may cause are:

• Damage to the throat, stomach, and bowels

• Dehydration

• Tooth decay

Health complications may happen during treatment. Because of this, both your child’s healthcare provider and a registered dietitian nutritionist (RDN) must be part of the care team. You as a parent play a vital role in treatment.

How can I help prevent bulimia nervosa in my child?

Experts don’t know how to prevent bulimia. But early detection and treatment can lessen symptoms. They can also help your child’s normal development and improve their quality of life. Encouraging your child to have healthy eating habits and realistic attitudes toward weight and diet may also help.

How can I help my child live with bulimia nervosa?

Here are things you can do to help your child:

• Keep all appointments with your child’s healthcare provider.

• Support your child in a nonjudgmental manner. Binge-eating or other behavioral slips may occur. Your child needs to feel safe confiding in you when extra support or additional help is needed.

• Comply with family therapy if it is recommended.

• Talk with your child’s healthcare provider about other providers who will be involved in your child’s care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, psychiatrists, and RDNs. Your child’s care team will depend on your child’s needs and how serious the bulimia is.

• Tell others about your child’s bulimia. Work with your child’s healthcare provider and schools to create a treatment plan. In an age-appropriate manner, include your child in this process.

• Educate siblings on your child's condition and help them understand how to support their brother or sister.

• Reach out for support from local community services. Being in touch with other parents who have a child with bulimia may be helpful.

When should I call my child’s healthcare provider?

Call your child’s healthcare provider if your child has:

• Symptoms that don’t get better, or get worse

• New symptoms

Key points about bulimia nervosa in children

• Bulimia nervosa is an eating disorder.

• A child with this eating problem overeats or binges uncontrollably. They may also engage in other activities to control weight. They may exercise too much or cause themself to throw up.

• Social attitudes toward body appearance and family problems may lead to bulimia.

• A mental health expert can diagnose this eating problem.

• A child may need therapy and nutritional rehab.

• Family therapy may be part of the treatment plan

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.