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Bulimia Nervosa In Children

AMBULATORY CARE:

Bulimia

is an eating disorder. Your child eats large amounts of food in a short period of time. This is called binging. She or he then vomits, uses laxatives, starves, or exercises for hours to prevent weight gain. This is called purging. Your child does this at least 1 time each week for several months.

Common signs and symptoms:

  • Not being able to stop eating, usually secretly or when she or he is alone
  • Spending a long time in the bathroom, especially with water running to cover the sound of vomiting
  • Saying she or he is too fat even if her or his weight is healthy or too low, or weight that goes up and down often
  • Often being bloated and having constipation or diarrhea
  • A sore throat and tooth decay caused by vomiting
  • A puffy face and throat, dehydration, or thinning hair
  • Calluses or cuts on your child's knuckles if she or he uses her or his hand to make herself or himself vomit
  • In adolescent girls, monthly periods that are irregular or stop completely
  • Feeling cold all the time, or tired, weak, dizzy, or lightheaded
  • Being moody and depressed, believing self-worth is tied to weight, or talking about food and weight all the time

Call 911 for any of the following:

  • Your child says she or he wants to harm or kill herself or himself.
  • Your child has pain when she or he swallows, or very bad pain in her or his chest or abdomen.
  • Your child's heart is beating very fast or fluttering, or she or he feels dizzy or faint.

Seek care immediately if:

  • Your child's muscles feel weak, and she or he has pain and stiffness.
  • Your child cannot stop vomiting.
  • Your child vomits blood or sees blood in her or his bowel movements.

Contact your child's healthcare provider if:

  • Your child is constipated.
  • Your child's hands or feet tingle.
  • Your child has pain in her or his teeth, mouth, or gums.
  • Your child has new abdominal pain.
  • Your female child's monthly period is very light or has stopped completely.
  • You have questions or concerns about your child's condition or care.

Follow up with your child's healthcare provider as directed:

Your child may need blood tests to make sure treatment is working. Write down your questions so you remember to ask them during your visits.

Medicines:

Your child may need any of the following:

  • Antidepressants called SSRIs are usually used to treat bulimia. Your child may need this medicine even if she or he is not depressed. An SSRI gives your child's brain more of a chemical called serotonin. Serotonin may help your child focus on other things and think less about weight and food.
  • Anticonvulsants may help control your child's mood swings and decrease aggression or irritability.
  • Antinausea medicine may be given to calm your child's stomach and prevent vomiting.
  • Laxatives may be used to treat constipation. Give your child laxatives that contain polyethylene glycol 3350, or use glycerin suppositories. Do not use stimulant laxatives, because they can damage your child's bowels.
  • Vitamin or mineral supplements may be needed if your child's nutrient levels are low because of bulimia.
  • Give your child's medicine as directed. Contact your child's healthcare provider if you think the medicine is not working as expected. Tell him or her if your child is allergic to any medicine. Keep a current list of the medicines, vitamins, and herbs your child takes. Include the amounts, and when, how, and why they are taken. Bring the list or the medicines in their containers to follow-up visits. Carry your child's medicine list with you in case of an emergency.

Care for your child:

  • Take your child to counseling sessions. Counseling is an important part of treatment for bulimia. Your child may work with healthcare providers alone or in a group. Group counseling is a way for your child to talk with others who have bulimia. Counseling may center on helping your child replace negative thoughts with positive thoughts. Family sessions can help everyone in the family understand bulimia and what to do to help your child.
  • Work with your child's dietitian. Your child will meet with a dietitian to talk about nutrition and develop a healthy meal plan. It is important for your child to eat 3 to 5 structured meals a day to reduce the urge to binge. Your child might need to learn how to prepare healthy food. She or he might also need to relearn what it feels like to be hungry and full. You or your child may be asked to keep a food diary and bring it to future visits.
  • Care for your child's mouth. Have your child brush her or his teeth or rinse with fluoride mouthwash or baking soda after vomiting. This will help prevent tooth damage. Choose toothpaste made for sensitive teeth if your child's tooth enamel has been damaged by vomiting. Have your child suck on tart candies to relieve swollen salivary glands.
  • Help your child manage stress. Help your child take a break and rest for 30 minutes every day. Try different ways to reduce stress, such as yoga, meditation, journaling, or spiritual development.

What you can do to help your child:

  • Be patient and supportive. Recovery from bulimia is a process that takes time. Your child may have a binging and purging episode after a long period of healthy eating. This is common. Help your child get back on track with healthy eating and healthy exercise. Do not punish your child for the episode. Be available if your child wants to talk about her or his feelings.
  • Help your child develop healthy self-esteem. Your child's self-esteem may be tied to her or his weight or appearance. Ask your child what she or he likes about herself or himself. For example, your child may be a talented artist, or may write well. Encourage your child to focus on those skills or talents instead of on appearance. Do not comment on your child's weight or shape. Your child's healthcare provider can tell you healthy weight ranges for your child.
  • Have regular family meals. Your child may be able to help you plan and cook meals. At mealtime, do not focus on your child's choices. For example, do not tell your child to take a larger portion or to go for another helping. Do not criticize your child's choices. It may take time before your child is ready to eat like others at the table.
  • Set a healthy example. Let your child see you eat healthy foods in correct portions. Do not tell your child you are on a diet or say that you need to lose weight. Tell your child what you like about your own body and what you do to stay healthy.
  • Spend time doing things your child enjoys. Make family time about being together, not about meals. Try to go to places other than restaurants, movies, and other places that feature food.

For support and more information:

  • National Institute of Mental Health (NIMH), Public Information & Communication Branch
    6001 Executive Boulevard, Room 8184, MSC 9663
    Bethesda , MD 20892-9663
    Phone: 1- 301 - 443-4513
    Phone: 1- 866 - 615-6464
    Web Address: http://www.nimh.nih.gov/
  • The National Women's Health Information Center
    8270 Willow Oaks Corporate Drive
    Fairfax , VA 22031
    Phone: 1- 800 - 994-9662
    Web Address: http://www.womenshealth.gov

© 2016 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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