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Bulimia nervosa in children
Children with bulimia (bu·lim·ia) nervosa tend to eat large amounts of food at once (called “binge eating”) and then do something to avoid gaining weight, such as make themselves vomit. At Children's Health℠, we help them develop healthy habits around food and self-image by addressing the personal, medical and social issues that drive their bulimia behavior.
What is bulimia nervosa in children?
Bulimia is an eating disorder. Eating disorders are conditions where people have abnormal and unhealthy eating habits because they want to have a certain body type or appearance. Differences in a child’s brain affect their thoughts, urges and behaviors about food.
Bulimia leads people to have frequent episodes of binge eating followed by “purging” or attempting to stop gaining weight. Children often “purge” by making themselves vomit. They may also take laxatives to promote a bowel movement or do excessive amounts of exercise.
People of all different backgrounds, ethnicities, religions and cultures can experience bulimia.
Risk factors
Bulimia is most common among teen girls and young women, but it affects boys and men too.
What are the signs and symptoms of bulimia nervosa in children?
Bulimia can be hard to recognize, because children with bulimia are usually average weight for their age. But they often have particular habits and behaviors. They may also have health problems as a result of frequently binging on food and vomiting or using laxatives to empty their stomach.
Behavioral signs of bulimia:
- Spending long amounts of time in the restroom with the water running (to cover the sound of vomiting), especially right after meals
- Constant talk or concern about food and weight
- Stealing, hiding or hoarding food
- Consuming very large amounts of food
- Anxiety about eating in public
- Not wanting to join family meals
- Using pills such as laxatives and diuretics
- Constant exercise
- Depression or isolation
Medical or physical signs of bulimia:
Over time, bulimic behavior damages a child’s body. Talk to your doctor right away if your child’s weight changes dramatically (either gaining or losing weight), if your child’s face or glands swell, or if you notice hair loss, tremors or extreme thirst or cold.
Other signs include:
- Tooth and gum decay
- Ongoing red, inflamed or sore throat
- Swollen salivary glands in the neck and jaw
- Burst blood vessels in the face
- Calluses on the fingers or knuckles that were used to induce vomiting
- Abdominal pain and intestinal problems
- Acid reflux disease (GERD)
- Dehydration
- Dizziness and weakness
- Heart attack
How is bulimia nervosa in children diagnosed?
Only medical professionals can properly diagnose bulimia. They do this by gathering information about your child’s health and behavior through interviews, tests and exams.
These may include:
- A physical exam, to note problems such as dry mouth or changes to the cheeks
- A dental exam, to see whether the teeth and gums show damage from stomach acid
- Blood tests to look for low levels of minerals like potassium and sodium, which the body loses from frequent vomiting and use of laxatives and diuretics
What are the causes of bulimia nervosa in children?
Children do not choose to be bulimic. And they don’t become bulimic because of your parenting choices.
A child is bulimic because of the way their brain reacts to urges and messages about food, health and body image. Many factors play a role in making this happen. These include genetics, stress and social and cultural pressures to have a particular weight or appearance.
How is bulimia nervosa in children treated?
Most children we treat for bulimia come into the clinic for regular therapy and check-ups. Some children benefit from staying in the hospital until the eating disorder is under control. This is usually because they also have other health problems, such as malnutrition or depression.
We create a treatment plan based on each child’s individual needs.
Treatment may include:
- A combination of individual, group and family therapy
- Nutritional counseling with a dietitian, who can help you and your child develop plans for healthy eating
- Medical treatment of complications from bulimia, such as low potassium or heart problems
- Dental care for damaged teeth and gums
- Use of medications such as antidepressants to help reduce your child’s binging and purging behavior
Bulimia nervosa doctors and providers
Our team specializes in treating eating disorders in children and teens, including boys and children under age 12. We work with you and other family members as one team, dedicated to giving your child the care they need.
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Urszula Kelley, MD Pediatric Psychiatrist -
Mohanika Gowda, MD Pediatric Psychiatrist -
Medha Iyer, MD Pediatric Psychiatrist -
M Elizabeth Weidmer-Mikhail, MD Pediatric Psychiatrist
Frequently Asked Questions
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What age does bulimia usually start?
Bulimia in children most often appears between ages 10 and 15. It can also impact older and younger kids.
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What do I do if my child is bulimic?
If you think your child might be bulimic, you should seek help from professionals who specialize in childhood eating disorders. Only they can provide the different resources and therapies that are necessary to help your child manage their condition.
At home, the most important thing for you to do is treat your child with love and compassion. Many children feel shame about their bulimia. Let them know you care and don’t blame them. Make meals a time for the whole family to enjoy being together.
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What’s the difference between bulimia and anorexia?
Bulimia is a pattern of binge eating and then doing something like vomiting to prevent weight gain. Children with bulimia are usually average weight.
Children with anorexia are also concerned with weight gain, but usually they prevent it by eating limited amounts and exercising excessively. They are almost always underweight.
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Can you have bulimia and anorexia at the same time?
Many children who have anorexia also have bulimia at some point. They may vomit because they missed exercise or because they’re worried they ate too much.
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Will my child outgrow bulimia?
Eating disorders often emerge when people are young. But they are not a “phase” that a child passes through and leaves behind. They are medical conditions that can last into adulthood and cause serious problems if they aren’t treated.
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Why didn’t I notice my child’s bulimia earlier?
Children with bulimia are usually normal weight. They often feel ashamed of their behaviors and become very good at hiding them.
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If my child isn’t losing weight, why is bulimia a problem?
Children with bulimia do not eat a balanced diet or allow nutrients to be absorbed by their bodies. Frequent vomiting and other purging behaviors can cause dehydration and damage a child’s organs. If bulimia isn’t treated, it can be fatal because of serious health problems or depression that leads to suicide.
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Is there any medication for bulimia?
An antidepressant called fluoxetine has been approved for treatment of bulimia. It works by increasing the body’s level of serotonin, a chemical that affects your mood and appetite. Many people with bulimia have less serotonin than average.
Be sure to carefully discuss antidepressants with your child’s doctor. Some antidepressants can cause unwanted side effects in children and teens.
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How does the family help with bulimia treatment?
Families are essential to helping children with bulimia get better. Have compassion for your child and the fears and struggles that come with their disorder. Help them understand their disorder and how it changes the way they think and act around food. Bring the whole family together for regular, relaxed and healthy meals. Actions like these help kids with bulimia feel safe and supported as they create healthier eating habits.