Pediatric eating disorders

Avoidant Restrictive Food Intake Disorder (ARFID) is an eating disorder where food restriction occurs without concern about influencing body shape and/or size. Unlike other eating disorders, individuals who have ARFID limit their food types and/or volume in response to one of three concerns:

• sensory aversions to certain tastes, textures, smells
• previous aversive experience (e.g., choking, vomiting) 
• general lack of appetite and fear of feeling overly full

This pattern of food avoidance may become chronic, resulting in health complications and social interruptions. Treatment is aimed at halting these avoidant behaviors and reversing any associated medical complications.

Patients with anorexia may be unable to maintain an appropriate body weight, have a fear of weight gain or engage in behaviors that interfere with weight gain. They tend to not see their bodies accurately or may not recognize the seriousness of being underweight.

Physical warning symptoms:

• Dramatic weight loss or in young children or failure to gain appropriate weight
• Menstrual irregularities or loss of period in females
• Dizziness and/or fainting episodes
• Feeling cold all the time
• Fine hair on the body
• Thinning of hair on the head
• Abnormal lab findings, such as slowed heart rate, low blood cell counts or low hormone levels

Psychological warning symptoms:

• Preoccupation with food or calories
• Refusal to eat certain foods or food groups
• Refusal to eat in public settings or at mealtimes
• Frequent comments about “feeling fat”
• Food rituals
• Body image rituals
• Driven to exercise or excessive workouts
• Withdrawal from friends, family and activities
• Anxiety, depression, irritability or limited emotional expression

Patients with bulimia go through repeated cycles of binge eating, followed by inappropriate purging or laxative abuse to prevent weight gain. Their body shape and weight often negatively effects how they view themselves as a person.

Physical warning symptoms:

• Noticeable fluctuations in weight (some may maintain a normal body weight or be overweight)
• Dizziness and/or fainting episodes
• Cuts or calluses on fingers
• Dental problems
• Swelling of cheeks
• Abnormal lab findings, such as low potassium levels

Psychological warning symptoms:

• Preoccupation with food or calories
• Disappearance of large amounts of food from the household
• Hoarding of food
• Frequent trips to the bathroom after meals
• Evidence of laxative use
• Difficulties eating in public
• Food rituals
• Body image rituals
• Driven to exercise or excessive workouts
• Withdrawal from friends, family and activities
• Anxiety, depression, irritability or limited emotional expression

While there is not one specific factor that has been identified as the cause for eating disorders, research suggests that biology could play a role. Differences in the brain have been found in patients who develop anorexia or bulimia versus those who do not. What’s more, certain personality traits, such as perfectionism, may make individuals more susceptible to eating disorders. These traits are usually noticeable in childhood and tend to persist even after recovery.

It is not uncommon for parents to feel guilt or blame when they discover that their child has an eating disorder. However, research has proven that parents do not cause eating disorders, and although they were often excluded from treatment in the past, parents today are a vital part of the child’s recovery process.