Eating Disorders in Children and Adolescents

Anorexia is a serious condition characterized by significantly low weight for age and sex and an enormous fear of gaining weight or becoming fat. They see themselves as fat and may have severe body image issues. They may restrict their food intake, exercise excessively, abuse laxatives or enemas and or purge to keep their weight as low as possible.

Common presentation of Anorexia in Adolescents

• Weight loss
• Restrictive food intake 
• Secretive around food times including longer time to eat meals and not finishing their food
• Reluctant or refuse to eat in front of others
• Bingeing and / or purging behaviour
• Feeling tired or very energetic
• Exercising more or discretely
• Cold intolerance 
• Growth of fine downy body hair, hair loss
• Stomach aches 
• Amenorrhea or Delayed Onset of Periods
• Inspecting themself in mirror
• Wearing baggy clothes 
• Becoming socially withdrawn

Bulimia Nervosa commonly known as Bulimia involves eating large quantities of food (bingeing) with inappropriate compensatory behaviours such as self-induced vomiting, misuse of laxatives, diuretics or enemas, excessive exercise or fasting. Binge eating and compensatory behaviours both are recurrent.

Common presentation of Bulimia in Adolescents

• Preoccupation with body weight and shape
• Lack of control overeating 
• Secretive around food times including longer time to eat meals and not finishing their food
• Reluctant or refuse to eat in front of others
• Going to the bathroom immediately after a meal
• Bingeing and / or purging behaviour
• Exercising more or, you suspect, in secret
• Feeling tired
• Stomach aches 
• Marks on the back of knuckles from inducing vomiting
• Dental issues, such as enamel erosion
• Enlarged salivary glands
• Checking themselves in mirror
• Wearing baggy clothes 
• Becoming socially withdrawn

ARFID is a type of eating disorder in which the young people restrict their eating based on sensory characteristics of food such as smell, colour, appearance, texture etc or perhaps lack of interest in food which results in weight loss or secondary to a traumatic event such as choking during eating. Weight loss is not the main reason for dietary restriction. Although the presentation may mimic Anorexia, but it is not the same as Anorexia. However, if untreated it may develop into Anorexia.

Common presentation of ARFID 

• Reluctant or refuse to eat in front of others
• Selective dietary habits
• Fearful of eating in front of others
• Distressed during mealtimes 
• Secretive around food times including longer time to eat meals and not finishing their food
• Irritable or angry around mealtimes
• Weight loss
• Poor growth
• Physical difficulties due to poor nutrition

Eating disorders are very complex and may have a combination of biological, psychological and social causes. Often genetic and environmental factors in combination have been associated with increased vulnerability to the development of eating disorders. 

1. Biological
   Increased risk in adolescents with anxiety disorders or obsessional traits. Increased risk in first degree relatives with the disorder. Hormonal changes around puberty may increase the risks. There are strong links observed in children and adolescents with Autism, ADHD, anxiety, OCD or learning disabilities and ARFID.
    
2. Social 
   Increased risk in adolescents in cultures where thinness is cherished. 
   Also increased risk in occupations where thinness is encouraged such as modelling and athletics. Social media leading to a low self-esteem, increased dissatisfaction with their body image.
    
3. Psychological
   Choking, vomiting or difficulty in swallowing can be associated with ARFID. Comfort eating to manage emotions could lead to Bulimia.