Eating Disorders(ED) in children

The term “Eating Disorders” may sound unfamiliar to the general population in India, as what people know is only fussy eating or picky eating problems in children.
In India, there is a remarkable increase of Eating disorders by 41.2% in girls and 28.7% in boys. The lack of awareness and acceptability of abnormal eating due to psychiatric disorders like ED in India manifests into malnutrition in children at various stages of growth.
To ensure healthy growth in children, a complete understanding of eating disorders is needed to evaluate its treatment solutions.

WHAT IS AN EATING DISORDER?

Understanding the term:
Eating disorder is a serious psychiatric disorder highly prevalent in young adolescents characterized by abnormal eating pattern. The distorted body image and low self-esteem causes emotional and physical complications in the body, restricting daily life activities of a child.

Types of Eating Disorders:

1.Anorexia Nervosa (AN):
Anorexics usually perceive themselves as “FAT” when they are clearly thin or underweight.
Obsessive behavior of achieving a thin body type by eating small quantities of food, compulsive exercising and crash dieting is seen in anorexic children. In most extreme cases, purposeful vomiting and laxative abuse is also seen to expel food consumed out of the body.
Repetitive measurement of body weight, portioning and eating very small quantities of food is a psychological problem seen in eating disorders.

2.Bulimia Nervosa (BN):
Quite opposite to anorexia nervosa, children with bulimia have normal to excessive body weight due to lack of control in eating food.
They engage in eating exorbitant quantity of food at a time known as “binge eating” accompanied by a feeling of lack of control on over-eating episodes.
Bulimic children are always in a state of disgust or shame and are usually unhappy with their body shape and type.
They characterize surreptitious behavior of hiding food in the bathroom, closet and excessive eating. Guilt associated with loss of control makes them practice starvation for days together as a compensatory method.

3. Binge eating disorder (BED):
Slightly different from AN and BN, binge eating disorder is usually seen in obese children who are seeking weight management measures. During the weight loss dieting plans, they suddenly give in to their urges and do a binge eating session which essentially derails the whole weight loss regimen. Statistically BED is seen in 8-19% of obese children and 70% of overeaters.
Frustration associated to losing weight, distorted cognitions, and crash dietary measures for weight loss causes a compulsive attitude towards eating. This causes excessive consumption of food intake without involvement of compensatory methods to lose excess fat.

4. Avoidant restrictive food intake disorder:
This type is classified as Eating disorder not otherwise specified (EDNOS).
It is typically characterized by restrictive eating behavior which involves aversions to certain textures of food, swallowing phobia, fear of choking etc.
This does not involve a fear of weight gain or loss but causes emotional and physical impairment to a significant level.

General Causes of Eating disorders:
A specific known cause of ED is still unknown. Factors like genetic, biological, environmental, socio-cultural and also inter-relationship of children with parents may influence development of ED.
Obsessive parental influence on children to lose weight or look attractive can hold a negative impact on a child’s psychology.
Obese children and adolescents with Juvenile Diabetes Mellitus are at a risk of undiagnosed ED.

Signs for early diagnosis of ED in children:
A dramatic shift of weight in children with obsessive engagement in food and body weight.
Refusal to foods once liked, persistent denial for meal time with family and friends along with rigid patterns of exercise or starvation.
Delay in pubertal milestones in young boys and girls. Delay in menstrual cycles or no menses at all in girls is a typical sign of poor linear growth due to eating disorders.
Constant dehydration, fatigue and loss of interest in daily activities can be a sign of ED.

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