Anorexia Nervosa in Children: A Guide for Parents and Caregivers

Anorexia nervosa is a serious eating disorder characterized by restrictive eating, intense fear of weight gain, and distorted body image. It can affect children as young as 8–10, with peak onset in adolescence.

Risk Factors

• Genetic: Heritability ~50–60%; family history of eating disorders, anxiety, OCD.
• Psychological: Perfectionism, high achievement orientation, low self-esteem, anxiety, need for control.
• Environmental: Weight-related teasing, dieting culture, sports emphasizing leanness (ballet, gymnastics, wrestling), trauma.
• Biological: Puberty-related hormonal changes, neurotransmitter dysregulation (serotonin, dopamine).

Warning Signs

• Rapid weight loss or failure to gain expected weight/height.
• Preoccupation with calories, "clean eating," food rules, body checking.
• Avoiding meals, social eating; rituals (cutting food, excessive chewing).
• Excessive exercise, even when injured/ill.
• Cold intolerance, lanugo, hair loss, dry skin, constipation, fatigue, dizziness.
• Mood changes: irritability, withdrawal, depression, anxiety.

Medical Complications

• Cardiac: bradycardia, hypotension, arrhythmia, QT prolongation, sudden death risk.
• Endocrine: amenorrhea, bone loss (osteopenia/osteoporosis), growth retardation.
• GI: gastroparesis, constipation, reflux, hepatic steatosis.
• Electrolytes: hypokalemia, hyponatremia, hypophosphatemia (refeeding syndrome risk).
• Neurocognitive: impaired concentration, memory, executive function.

Treatment

Early intervention improves outcomes. Multidisciplinary approach:

1. Medical stabilization (inpatient if medically unstable).
2. Nutritional rehabilitation (family-based treatment/FBT is gold standard for adolescents).
3. Psychotherapy: CBT-E, FBT, adolescent-focused therapy.
4. Medication: SSRIs for comorbid anxiety/depression (after weight restoration); olanzapine for severe agitation/rigidity.

Parents: express concern without blame, avoid food battles, seek specialized eating disorder team immediately. Recovery is possible with proper treatment.