Eating disorders in children are a serious illness that negatively affects children's health, emotions, behaviors, and important areas of life. Eating disorders can be observed very frequently in childhood. The causes of eating disorders in children can occur due to the combination of genetic, psychological, and social factors. Eating disorders seen in children are a treatable condition. When this condition progresses, it can cause health problems that negatively affect life.
What is Eating Disorder in Children?
Eating disorders in children are defined as the regurgitation of food back into the mouth and chewing it again without nausea, some time after the food is swallowed and partially digested. Attention should be paid to this condition, which is observed in this manner for at least 1 month. It can be seen that children are relieved and happy with this situation.
Eating disorders in children and infants ensure the establishment of a relationship in which verbal and non-verbal cues between the infant and the parent are received and interpreted for healthy nutrition. This mutual relationship process forms the basis of emotional bonding between the infant and the parent.
After the 6th month, the infant's motor and cognitive development enables him to act more independently physically and emotionally. With the infant transitioning to the spoon and starting to feed himself, an 'independence-dependence struggle' begins between the infant and the parent. In other words, a conflict arises regarding who will bring the spoon to the infant's mouth at each meal. In such cases, meal times turn into a 'battlefield' instead of an environment where the infant and the parent communicate socially.
Eating disorders in children and infants are a treatable condition. Parents should not harbor negative emotions during this period. The fact that children eat very little or are picky eaters does not mean that it is unhealthy. However, some nutritional and eating disorders can cause health problems in children over time. Accurate detection of these and diagnosis of other underlying diseases gain importance. With treatment in children, healthier nutritional habits can be acquired, and dermatological, cardiovascular, and stomach-related problems caused by the eating disorder can be prevented.
The development of nutrition in children: It is a process involving the active participation of the child and the parent. The parent determines "where" and "when" to offer which food to the child, and the child determines "how much" to eat. As the child grows and matures, this division of labor becomes more complicated.
According to feeding skills and food varieties, a child goes through certain stages from birth. These stages can be listed as follows;
- The first 6 months, breast milk is the main source of nutrition. No complementary foods, including water, are recommended. Infant formula may be preferred in certain special situations, but the general diet consists of liquid foods.
- The 6-8 months is the period when fruit juices and semi-solids in puree consistency are added to the infant's meals. This transition may occur in the 4th month in infants who cannot receive breast milk or those who are fed more complexly (breast milk + formula).
- 8-10 months, soft and lumpy foods are introduced. During the transition to foods with different tastes, fewer problems are experienced in those fed with breast milk in the first 6 months compared to infants using a baby bottle.
- After the 12th month, the transition is made from the baby bottle to the spoon and self-feeding. The child can eat at the same table and the same foods as family members. Food preferences begin to emerge. Therefore, it is the period when feeding problems occur most frequently.
Eating disorders sometimes occur very frequently. High rates of feeding problems can be seen in 40-70% of premature children. Eating disorders in children are divided into two within themselves;
Pica: Pica, an eating disorder in children and infants, is the persistent eating of substances that do not have nutritional properties and are not edible. This behavior, seen at 12-24 months in normal development, leads to various medical problems. Most frequently, it can lead to malnutrition, anemia, diarrhea, constipation, infection, iron and zinc deficiency, lead poisoning, and intestinal obstruction due to bezoar. It has been detected 5 times more often in individuals with mental retardation under institutional care compared to the general population. Male gender, young age, mental retardation, autism, and schizophrenia have been identified as potential risk factors. The severity of the disease is directly proportional to the severity of mental retardation. There are studies finding a strong relationship between childhood PICA and adult bulimia nervosa.
Rumination: Rumination, an eating disorder in children and infants, is the repetitive and voluntary regurgitation of stomach contents into the mouth and re-chewing. It is seen more frequently in males than females. It can rarely be seen between the ages of 3 - 12 in typically developing individuals. In those with mental retardation, it can occur at any age. It can occur in adults without mental retardation along with other eating disorders. It may appear in the presence of an inappropriate psychosocial environment or in cases of inadequacy, limitation, reciprocity, lack of stimulation, and neglect in child-mother relationships in the early years of life. It can also be done due to self-soothing, gaining pleasure, and attracting the mother's attention. Rumination is thought to stimulate the endogenous opiate system and thus provide relief. In this respect, it resembles stereotypic movements. High coexistence with reflux disease is observed. It follows a more chronic course in older children and adults. The main medical problems it causes are malnutrition, mouth sores, tooth decay, esophagitis, aspiration, electrolyte loss, dehydration, weight loss, and death. Death rates have been reported as 25%.
What are the Causes of Eating Disorders in Children?
The causes of eating disorders seen in children can vary. Eating disorders feeding problems in children, which are usually seen in infancy and early childhood, occur. Some of these eating disorders are as follows;
- Food refusal (eating little / not eating at all)
- Picky eating (eating only a few types of food)
- Lack of expected development in food consistency (failure to transition to semi-solid / solid foods)
- Lack of self-feeding
- Frequent vomiting, inappropriate behavior during meal times (irritability, crying, temper tantrums)
- It can be summarized as swallowing or chewing problems.
In studies conducted, data were obtained that feeding problems are more frequent in girls, children with feeding problems have more siblings, these children are less able to focus their attention, the rate of working mothers is higher in children with feeding problems, and there is a history of eating problems in these families previously.
Eating disorders in children can occur due to many reasons. Reflection of problems in the mother-infant relationship; in the presence of severe psychiatric illness or eating disorder in the mother, after the death of the mother
Post-traumatic feeding disorder: It develops after a traumatic event affecting the mouth, pharynx, or esophagus (such as a surgical procedure or food entering the respiratory tract). Fear during feeding is typical. Specifically, fear of swallowing and choking can be observed.
Food refusal due to sensory reasons: It is against foods with a specific taste, smell, appearance, or consistency. In these children, a rejecting attitude towards new foods and picky eating behavior are also common.
Accompanied medical condition: It can frequently be seen that feeding disorders associated with reflux, heart, or lung diseases are experienced.
Organic failure to thrive: Growth retardation caused by direct effects on growth hormones or genetic reasons can be seen.
How are Eating Disorders in Children Treated?
Eating disorders in children occur due to stomach problems and some systemic diseases. It is observed that this condition is based on psychological problems.
Children's need for love and attention must be met by their parents. Especially in infancy periods, it has been observed that children do not accept feeding. It is necessary to take precautions against eating disorders for children to develop healthily.
