Pediatric Bulimia Nervosa

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. Bulimia is most common among teen girls and young women, but it affects boys and men too.

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

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

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