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Bulimia Nervosa in Children


What is bulimia nervosa?

Bulimia nervosa is an eating disorder. Your child eats a large amount 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.

What increases my child's risk for bulimia nervosa?

Bulimia is more common in girls, and in adolescents. The following may increase your child's risk:

  • Being overweight or thinking she or he is too heavy
  • Not feeling good about her or his body
  • A need to be perfect, or setting high goals
  • Participation in a sport or activity that values thinness, such as gymnastics, wrestling, or modeling
  • A history of anxiety, depression, or obsessive-compulsive thoughts
  • A family history of an eating disorder, obesity, or problems with substance abuse
  • Not having good relationships with family members, or stress or trauma

What are the signs and symptoms of bulimia nervosa?

  • 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 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

How is bulimia nervosa diagnosed?

Your child's healthcare provider will examine your child and check her or his height and weight. Blood tests will show if your child is getting enough iron, calcium, glucose, and other nutrients. Urine tests may be used to check for signs of dehydration. The provider will ask your child how she or he feels about her or his body, and how she or he controls weight. The provider may ask your older child to fill out several forms about feelings and eating habits. Tell your child's provider anything you have noticed about your child's behavior and eating habits. The provider may want to talk to your child alone. Your child may have a hard time talking about bulimia or asking for help while a parent is in the room.

How is bulimia nervosa treated?

Bulimia is a life-threatening medical condition. Treatment may need to take place in a hospital or clinic. Treatment will be more effective if your child understands the seriousness of the condition and truly wants to get better.

  • Counseling is an important part of treatment. 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.
  • Nutrition therapy means you and your child will meet with a dietitian. Together you will 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.
  • Medicines are sometimes used to help treat bulimia or the health problems it causes. Your child may get medicine to help improve mood, control mood swings, and decrease obsessive thoughts or irritability. Vitamin or mineral supplements may also be needed if your child's nutrient levels are low because of bulimia.

What can I do to help my 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.

Where can I find support and more information?

  • National Institute of Mental Health (NIMH), Office of Science Policy, Planning, and Communications
    6001 Executive Boulevard, Room 6200, MSC 9663
    Bethesda , MD 20892-9663
    Phone: 1- 301 - 443-4513
    Phone: 1- 866 - 615-6464
    Web Address:
  • The National Women's Health Information Center
    8270 Willow Oaks Corporate Drive
    Fairfax , VA 22031
    Phone: 1- 800 - 994-9662
    Web Address:

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.

When should I seek immediate care?

  • 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.

When should I contact my child's healthcare provider?

  • 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.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's healthcare providers to decide what care you want for your child. 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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