Eating disorders in children are serious illnesses that negatively affect children's health, emotions, behavior and important areas of life. Eating disorders can be observed very frequently in childhood. The causes of eating disorders in children can be a combination of genetic, psychological and social factors. Eating disorders in children are treatable. When this disorder progresses, it can cause health problems that negatively affect life.
What is an eating disorder in children?
Eating disorders in children are defined as bringing food back to the mouth and chewing it again without nausea, some time after the food has been swallowed and partially digested. This should be observed for at least 1 month. It can be seen that children are relieved and happy with this situation.
Eating disorders in children and infants, healthy nutrition enables the establishment of a relationship between the infant and the parent in which verbal and non-verbal cues are received and interpreted. This reciprocal relationship process forms the basis of emotional attachment between the baby and its parent.
After the 6th month, the baby's motor and cognitive development enables the baby to behave more independently physically and emotionally. When the baby switches to a spoon and starts eating on its own, the 'independence-dependence struggle' between the baby and the parent begins. In other words, a conflict arises over who takes the spoon to the baby's mouth at each meal. In these cases, mealtimes turn into a 'battlefield' instead of an environment where the baby and the parent interact socially.
Eating disorders in children and infants are treatable. Parents should not get caught up in negative emotions during this period. The fact that children eat very small amounts of food or are picky eaters does not mean that they are unhealthy. However, some feeding and eating disorders can cause health problems in children over time. It is important to correctly identify these and diagnose other underlying diseases. With treatment, children can gain healthier eating habits and dermatologic, cardiovascular and gastrointestinal problems caused by eating disorders can be prevented.
Development of nutrition in children: It is a process in which the child and parent are actively involved. The parent determines "where" and "when" to offer the child what food to eat and the child determines "how much" to eat. As the child grows and matures, this division of tasks becomes more complex.
According to feeding skills and food types, the child goes through some stages from birth. These stages can be listed as follows;
- Breast milk is the main source of nutrition for the first 6 months. No additional food including water is recommended. In some special cases, formula may be preferred, but the general diet is liquid foods.
- 6-8 months is the period when fruit juices and pureed semi-solids are added to the baby's meals. In babies who cannot receive breast milk or those who are fed more mixed (breast milk + formula milk), this transition may occur in the 4th month.
- At 8-10 months, soft and lumpy foods are introduced. Babies who are breastfed for the first 6 months have fewer problems during the transition to different tasting foods than babies who use bottles.
- After the 12th month, the transition from bottle to spoon and self-feeding begins. The child can eat the same foods at the same table with family members. Food preferences begin to emerge. Therefore, this is the period when feeding problems occur most frequently.
Eating disorders occur very frequently at certain times. A high rate of eating problems can be seen in 40-70% of children born prematurely. Eating disorders in children are divided into two types;
Pica: Eating disorders in children and infants, pica is the persistent eating of substances that do not have nutritional properties and are not edible. This behavior, which is seen in 12-24 months in normal development, leads to various medical problems. Most commonly, it may lead to malnutrition, anemia, diarrhea, constipation, infection, iron and zinc deficiency, lead poisoning, and intestinal obstruction due to bezoar. The prevalence of mental retardation in institutionalized individuals is 5 times higher than in the general population. Male gender, young age, mental retardation, autism and schizophrenia have been identified as possible risk factors. The severity of the disease is directly proportional to the severity of mental retardation. There are studies finding a strong correlation between Pica in childhood and bulimia nervosa in adulthood.
Rumination In eating disorders in children and infants, rumination is the repetitive and voluntary bringing of stomach contents into the mouth and re-chewing. It is more common in boys than girls. It can rarely be seen between the ages of 3 and 12 in normally developing children. In those with mental retardation, it can occur at any age. It may be seen together with other eating disorders in adults without mental retardation. It may occur in the presence of an inappropriate psychosocial environment or in the first years of life in cases of inadequacy, limitation, lack of reciprocity, lack of stimuli and neglect in child-mother relationships. It may also be due to self-soothing, pleasure seeking and attracting the mother's attention. It is thought that rumination stimulates the endogenous opiate system and provides relief in this way. In this respect, it is similar to stereotypical movements. There is a high association with reflux disease. It follows a more chronic course in older children and adults. The main medical problems it causes are malnutrition, mouth sores, dental caries, esophagitis, aspiration, electrolyte loss, dehydration, weight loss and death. Mortality rates have been reported as 25%.
What are the Causes of Eating Disorders in Children?
The causes of eating disorders in children may vary. Eating disorders in children, which are usually seen in infancy and young childhood, cause nutritional problems. Some of these eating disorders are as follows;
- Eating refusal (eating less / not eating at all)
- Food selection (eating only a few types of food)
- Lack of expected improvement in food consistency (inability to switch to semi-solid/solid foods)
- Lack of self-feeding
- Frequent vomiting, inappropriate behavior at mealtimes (irritability, crying, outbursts of anger)
- It can be summarized as swallowing or chewing problems.
Studies have shown that eating problems are more common in girls, children with eating problems have more siblings, these children are less able to focus their attention, children with eating problems have more working mothers and these families have a history of eating problems.
Eating disorders in children can occur for many reasons. Reflection of problems in the mother-infant relationship; in the presence of serious psychiatric illness or eating disorder in the mother, after the death of the mother
Post-traumatic malnutrition: Develops after a traumatic event affecting the mouth, pharynx or esophagus (such as a surgical procedure or food getting into the airway). Fear during feeding is typical. In particular, fear of swallowing and choking may be observed.
Refusal to eat due to sensory reasons: It is against foods with a specific taste, smell, appearance or consistency. Rejection of new foods and picky eating behavior are also common in these children.
Concomitant medical condition: It is common to experience malnutrition associated with reflux, heart or lung diseases.
Organic growth retardation: Growth retardation may occur due to direct effects of hormones affecting growth or genetic reasons.
How are Eating Disorders in Children Treated?
Eating disorders in children are caused by stomach problems and some systemic diseases. It is observed that this situation is based on psychological problems.
Children's need for love and attention should be met by their parents. It has been observed that children do not accept nutrition, especially during infancy. It is necessary to take measures against eating disorders for children to develop in a healthy way.
