EATING DISORDERS IN CHILDREN AND ADOLESCENTS - ECONOMÍA - 2024

The most common eating disorders in children and adolescents are anorexia, bulimia, binge eating disorder, pica, selective eating and rumination. Although food is a basic function of the human being, from the moment of birth, people choose how and when to eat food, so it becomes a mode of communication, socialization, etc.

These types of disorders have a genetic component, but also an environmental component based on eating habits and culture, which can be changed. Therefore, it is important to give a good nutritional education to children from a young age.

Most common eating disorders in children and adolescents

-Anorexia nervosa

Both anorexia nervosa and bulimia nervosa are eating disorders that have developed in younger and younger ages. Currently, there is great interest in this type of disorder, since, in addition to the severity of the disease itself, it becomes chronic in 25% of cases, culminating in death in one in 10 patients.

In addition, during the course of the disorder, both the quality of life of the affected minor and that of his / her family members is greatly deteriorated. From 7-8 years, the first signs of bodily concern begin, performing some dieting behaviors between 8-11 years.

Approximately 1% of the child-adolescent population has anorexia nervosa. As in the adult population, it occurs more frequently among girls.

These girls learn to attach importance to the physique through the influence of the media, their parents, and classmates. Teasing and criticism for being overweight are a fundamental factor for girls to start engaging in maladaptive behaviors in relation to food.

The onset of the disorder usually begins with food restriction, which is produced by the fear of gaining weight and is maintained by the cognitive distortion that they develop.

These children are forbidden to eat highly caloric foods, which they combine with physical exercise - in the restrictive subtype of anorexia nervosa - and some maladaptive behaviors such as using laxatives and causing vomiting - when it comes to purgative anorexia nervosa.

Little by little, they become more demanding with the weight they originally intended to reach, so that they eat less and less food.

A necessary criterion to diagnose anorexia nervosa is that children lose 15% of their body weight, or that they fail to reach the expected weight based on their age and height.

Physical consequences

Organic damage is serious and numerous, among which are:

1. Vital signs - hypothermia, hypotension and bradycardia - are reduced.
2. Hollow eyes.
3. Dry Skin.
4. Amenorrhea –or non-appearance of menstruation in prepubertal girls- and vaginal dryness in girls.
5. Constipation.
6. Low levels of estrogens -in girls- or testosterone -in boys-.

Psychological characteristics

With regard to psychological characteristics, parents often describe the minors as highly responsible, intelligent and with great concern for pleasing others.

As the disorder progresses, they tend to become more withdrawn, spend less time with their friends, and show changes in their behavior - they become more irascible, anxious, impulsive, and their self-esteem decreases.

All of this negatively affects the relationship these girls have with their parents and siblings.

-Bulimia nervosa

In the case of bulimia nervosa, children and adolescents also pretend to lose weight through inappropriate behaviors. It is estimated that between 1-3% of preadolescents and adolescents have this disorder, whose age of onset is usually slightly higher than that of anorexia nervosa.

In this disorder, binge-eating episodes are typical - the child or adolescent ingests a large amount of food, usually with hypercaloric content.

Binge eating occurs after a period of time in which the girl / or has tried to carry out a restrictive diet, which means that she feels a great desire to eat and loses control during the intake.

After binge eating, children feel guilty and may carry out behaviors such as intense physical exercise, use laxatives, self-induce vomiting - in the case of purgative-type bulimia nervosa - or simply resort to new diets and exercise - in the Non-purgative subtype of bulimia nervosa.

Once the disorder is established, girls and adolescents do not binge only when they are hungry, but in the face of intense emotions that they cannot manage.

In this case, unlike anorexia nervosa, girls have a normative weight or slightly higher than indicated depending on their age and height.

Physical consequences

Some of the physical damages that girls with bulimia nervosa usually suffer are:

• Hypertrophy of salivary glands.
• Swollen face.
• Arrhythmias
• Abdominal distension.
• Erosion of tooth enamel and cavities.
• Epigastric pain.

As this disorder occurs at a higher age than anorexia nervosa and, in many cases, girls have already left their homes of origin, there are fewer studies of family characteristics.

However, it seems to be common in these families that there is a greater number of conflicts, a high incidence of affective disorders, alcohol abuse among relatives, etc.

-Pica

Pica is a disorder in which children ingest non-nutritive substances continuously, without feeling aversion or disgust. These substances vary depending on the age of the child:

• Young children often ingest paint, string, plaster, etc.
• In adolescents, however, it is more common for them to eat animal droppings, leaves, sand, or insects.

The most frequent age to present pica is usually between 2-3 years, also influencing living in an area with little environmental stimulation. It appears to be more common in children with delay, the higher the level of mental retardation being more likely.

It also seems that there is a relationship between this disorder and some characteristics of the parents, such as having a severe psychopathological disorder - the higher the level of psychopathology, the greater the likelihood of the child developing pica.

Despite the fact that this disorder can cause problems in the body (such as infections or intestinal obstructions), it usually has a good prognosis, remitting in most cases naturally.

At other times, parents are required to attend a specialist for guidelines on how to correct this maladaptive behavior.

-Rumination

Rumination is another of the eating disorders characteristic of childhood ages.

Children who present it regurgitate the ingested food while carrying out specific body movements: arching their back, throwing their head back and, sometimes, initiating the episode by inserting their fingers into their mouth.

This behavior seems to cause pleasure in the child and great discomfort in the parents. The causes of this disorder are not exactly known, since there are several hypotheses:

• Insufficient attention from the mother, so the child seeks another type of stimulation.
• It can also be explained with theories of behavior, according to which, the behavior is maintained by the attention that the mother pays when it carries out this behavior.
• Finally, physiological theories have also been found, which state that there are organic causes that cause the disorder.

Rumination occurs to a greater extent in boys who have some type of mental retardation, as is the case with pica. Although in most cases a spontaneous remission occurs as age increases, on many occasions it becomes chronic.

In fact, it is estimated that the mortality rate can reach 25% of cases, due to malnutrition, esophageal tear and other organic causes.

-Selective intake

It is a new disorder in which the child shows a permanent refusal to eat certain foods. Although few studies have been done so far, it appears to be more prevalent among the male population.

This disorder tends to become chronic, with few cases in which it remits spontaneously over the years. Due to the lack of certain nutrients, the child will present a lack of energy that will negatively influence their school performance.

However, unlike anorexia and bulimia nervosa, the minor does not usually suffer alterations in his mood.

With regard to selective eating disorder (or selective eaters), a profile that collects the most important psychological characteristics has not yet been described.

However, it seems that some of them may present anxiety, some obsessive-compulsive traits, social avoidance or difficulty adapting to the changes around them.

These traits will be perpetuated in the minor, forming part of his future personality.

References

1. De Gracia, M., Marcó, M., & Trujano, P. (2007). Factors associated with eating behavior in preadolescents. Psicothema, 19

   (4), 646-653.

2. Del Carmen Guirado, M., & Arnal, RB (2003). Detection of risky eating behaviors in children aged 11 to 14 years. Psicothema, 15 (4), 556-562.
3. Osorio, E., Weisstaub, N., & Castillo, D. (2002). Development of eating behavior in childhood and its alterations. Chilean Nutrition Magazine, 29 (3), 280-285.
4. Rodríguez S., J. (2009). Basic Child Psychopathology.