What are the effects of recurrent binge eating (Bulimia Nervosa) followed by self-induced vomiting in a child?

From the Guidelines

A child exhibiting recurrent binge eating followed by self-induced vomiting should be evaluated by a healthcare professional immediately, as this pattern may indicate bulimia nervosa, a severe eating disorder that can lead to numerous health complications, including electrolyte imbalances, dehydration, tooth decay, and damage to the esophagus and digestive system 1. This behavior is concerning and could have severe physical and psychological consequences, particularly in children, whose developing bodies are vulnerable to the effects of malnutrition and electrolyte imbalances caused by frequent vomiting.

Key Considerations

• The American Psychiatric Association recommends a comprehensive evaluation, including weighing the patient, quantifying eating and weight control behaviors, and identifying co-occurring health conditions, including co-occurring psychiatric disorders 1.
• The initial physical examination should include assessment of vital signs, height, weight, and BMI, as well as physical appearance, including signs of malnutrition or purging behaviors 1.
• Laboratory assessment should include a complete blood count and a comprehensive metabolic panel, including electrolytes, liver enzymes, and renal function tests 1.

Immediate Steps to Take

• Consult a pediatrician or eating disorder specialist for a thorough evaluation.
• Keep a food and behavior diary to track eating patterns and symptoms.
• Encourage regular, balanced meals and avoid restrictive dieting.
• Promote open communication about feelings and body image concerns.

Treatment Approach

• Cognitive-behavioral therapy (CBT) to address underlying thought patterns.
• Family-based therapy, especially for younger children.
• Nutritional counseling to establish healthy eating habits.
• Possible medication (e.g., fluoxetine) if prescribed by a doctor. It's crucial to address this behavior early, as prolonged binge-purge cycles can have severe physical and psychological consequences, and the developing bodies of children are particularly vulnerable to the effects of malnutrition and electrolyte imbalances caused by frequent vomiting 1.

From the Research

Physical Health Complications

• There is no direct evidence in the provided studies to specifically address the effects of recurrent binge eating (Bulimia Nervosa) followed by self-induced vomiting in a child.
• However, studies have shown that eating disorders can cause malnutrition, which can have significant effects on every organ system in the body 2.
• Cardiovascular complications are particularly dangerous and cause eating disorders to have the highest mortality rate of all mental illnesses 2.

Gastrointestinal Complications

• Gastroesophageal reflux disease (GERD) can occur in children and may be a chronic, potentially life-long condition that begins in childhood 3.
• Children with GERD may be at risk for long-term severe disease sequelae, such as strictures, Barrett's esophagus, and/or esophageal adenocarcinoma 3.
• Nausea and vomiting are common symptoms encountered in medicine, and chronic unexplained nausea and vomiting can be difficult to control, leading to a significant decline in the patient's quality of life 4.

Other Complications

• Avoidant restrictive food intake disorder (ARFID) is a feeding and eating disorder that can have physical health complications, including low weight, nutritional deficiencies, and low bone mineral density 5.
• Children with ARFID can present across the weight spectrum, and many are not underweight yet still have complications 5.
• Chronic nausea in children can be associated with comorbid conditions, such as migraines, autonomic disturbances, sleep problems, fatigue, and anxiety 6.