Eating disorders in young children. Food psychology

The psychological parameters of eating behavior and its disorders to a greater extent determine the personal attitude to eating and its methods. These include various factors:
- violations of the relationship in the "mother-child" system in early childhood;
- unacceptable for a child in early childhood ways of eating;
- stress, frustration situations;
- personal problems of the child and adolescent;
- conflict families;
- problems in interpersonal relationships in the family, children's institutions, with peers and other people around.

Family doctors deal with the issues of proper nutrition, and the problem of eating behavior, until recently, occupied medical psychologists. Apparently, such consideration of the functioning of the same system is unjustified, since the physiological and psychological parameters of the vital activity of the human body are inextricably linked and should be considered as a whole.

Depending on age, eating behavior and its disorders are distinguished according to the causes of its occurrence, the characteristics of the personal response of the child and adolescent, the structure of symptoms and the mechanism of their occurrence.
In an infant and young child, eating disorders are often combined with a violation of appetite. Most often, they, especially those suffering from a neuropathic constitution, have hyporexia and anorexia.

Symptoms of anorexia and hyporexia

Symptoms of anorexia and hyporexia can manifest as follows:
- complete or partial refusal of food;
- preference for a certain consistency of food (liquid, solid);
- slowing down the feeding process;
- eating only certain foods (cereals, fruits, sweets);
- Refusal of various foods (dairy products, meat);
- protest against changing the menu, demanding only the same dishes;
- protest against the stereotype of the feeding process.

The psychological reasons for this eating disorder can be different:
- Wrong way to feed the baby;
- insufficient patience on the part of the nursing;
- the inability of the mother or another person to find the right approach to the child during feeding;
- a mechanical approach to the feeding process (“if only the child swallowed food”);
- increased excitability or lethargy of the child during feeding;
- endless prodding him to eat food, the taste of which the child often does not fully feel or the dish is unpleasant to him;
- the initial violation of the relationship in the "mother-child" system:
- force-feeding, which usually ends in vomiting and can lead to habitual vomiting in response to any psychogenic stimulus (psychosomatic disorder);
- family conflict situations, especially during the feeding of the child;
- when breastfeeding, the mother should be occupied with all her thoughts and feelings only with the baby, and not with her own problems;
- a change in the habitual stereotype of a child's life, which is a stressful situation for him (moving to another apartment, separation from his mother, attending a kindergarten, etc.). Also, many other reasons that violate the "psychological homeostasis" of the child.

Often, for a child with anorexia, the very process of eating, its unusual smell and taste, or even preparation for eating is unpleasant. The child shows anxiety at the sight of a chair and a table at which he is fed, bowls and spoons.
Parents and persons involved in feeding the baby come up with a lot of tricks in order to feed him.
Cases from practice come to mind. Zhanna, 3.5 years old, was fed by her father, putting her on his shoulder so that she could sort out the pendants of the chandelier during feeding.
Until the age of 2, Irochka took food from her mother's hands, while throwing cutlery out of the table drawer.
Misha, 4 years old, when moving to another city for several months preferred to drink lemonade and eat pieces of cookies, refused other dishes, and was force-fed.

How to defeat hyporexia and anorexia if it is not associated with somatic diseases?

First of all, the child should be examined for the absence of organic disorders from the digestive system.
Then it is necessary to understand the psychological reasons for such eating behavior, the presence of neuropathic features of the child's constitution.
Advice that parents can give on coping with this type of eating disorder might include the following:
- to understand the correctness of their behavior in relationships with a small child in general;
- change the stereotype of feeding a child;
- feed at a common table in the presence of other people and do not fix attention on the process of feeding the child, but rather on the consumption of food by other family members;
- enable the child to eat on his own (pour some of the food into the bowl and help him eat);
- allow him to eat from the common table even with his hands the food he likes.
There can be many tips and options for changing feeding methods, but the main thing is that the child likes it. It is advisable to conduct sessions of play therapy on a plot related to eating behavior.

Case from practice: Zhenya, 10 months old, with hyporexia, was put right on the dining table surrounded by people close to him and allowed him to choose pieces of food from the plates, outwardly not paying attention to his actions. Adults savored the food with pleasure, showing it to the child with all their appearance. A week later, the child, together with his mother, ate the offered food, which she allegedly ate. And gradually "tears" from the table and he chose the way of feeding and dishes. The problem with food intake has ceased to be dominant for the child and the family.

What is rumination?

Rumination (regurgitation disorder) is the conscious regurgitation of food, which is often re-swallowed or spit out.
The symptom appears in infancy more often in boys with a neuropathic constitution, but may occur or continue into older age. Regurgitation is also observed in healthy children when they are not properly fed or they are in a situation of emotional deprivation (restrictions).

There are 2 forms of rumination:
1) psychogenic form, which is based on:
- severe violations in the system of relationships "mother-child";
- the presence of stressful situations for the child (separation from the mother, conflict situations in the family);
- personality disorders in a mother who does not adequately treat her child;
2) the second option arises in mentally retarded children according to its own special mechanisms.

To get rid of rumination, timely conversations with the mother help to establish the right contact with the child, the selection of an adequate method of feeding for him.

In some cases, attention to the child in the family is clearly insufficient and is replaced by various benefits, gifts, and he needs emotionally rich contacts with parents, their warmth and care.
In such cases, rumination can occur even at school age.

For example, Luda, 10 years old, from a prosperous and wealthy family, whose mom and dad are more busy with their own affairs and business partners than with their own child. From childhood, the girl was brought up by periodically changing nannies. Luda was very worried that “an alien visiting aunt, not her mother” was constantly with her. From childhood, the girl grew up neuropathic, easily excitable, ate poorly, periodically regurgitated food. At school age, after a quarrel between her parents during lunch at the table, Luda began to chew her food thoroughly, then spat it out into a plate and swallowed it again.

Such eating behavior aroused indignation among the parents, and the girl was kicked out from the common table, which sharply worsened her condition. This went on for 2 years, she was scolded, but no one was sorry. In the end, the parents turned to a doctor and a child psychologist. Parents were interviewed about the unfavorable psychological climate in the family and advice was given on how to normalize relationships with the girl. Luda underwent a course of psychotherapy and became a completely healthy child.

What is a peak?

Pika is the eating of inedible or unpleasant-tasting objects (waste, garbage, sand, chalk, paint, etc.). The disorder is partially manifested in mentally retarded children or in families with an asocial structure, in “homeless children”. The prognosis depends on the treatment of the underlying disease - mental retardation, changes in the social status of the family and the child.

In some cases, the peak occurs in healthy children - they eat chalk, lime, which requires the attention of family doctors to study the state of the child's metabolic processes.
In adolescence, eating behavior takes on an even more personal perspective. Adolescents establish motives and values, orientation to the appearance of their body.

In adolescence, the following main forms of eating disorders are considered: anorexia nervosa and bulimia nervosa.
These disorders are observed in girls and boys in a ratio of 10:1.
The pathogenesis of these eating disorders in adolescents has several points: genetic factors; family influences; socio-cultural impacts; dietary measures aimed at weight loss; features of personal response to their appearance and the shape of their body; Vulnerability to restrict or impose food on adolescents.

Criteria for the diagnosis of anorexia nervosa according to ICD-10

- body weight is 15% below normal;
- weight loss is caused by the patient himself;
- violation of the body scheme and its proportions;
- an overvalued idea of ​​its exorbitant thickness;
- secondary endocrine disorders from the pituitary-hypothalamic and gonadal system;
- secondary disturbances in the system of functions of the digestive system up to the appearance of organic changes.

Clinic: the disease of anorexia nervosa begins with the fact that the patient refuses high-calorie foods, excludes fruits, butter, milk, meat, fish from the diet and brings himself to a minimum food intake. So, for example, one girl ate 1 apple a day and drank 1 glass of water. Usually in a conversation, such patients talk about a full-fledged "food day", three meals a day and the use of the entire set of food products. Comparison of information from the words of relatives and the patient about the dishes that the patient consumed during the day should alert the doctor. They explain their fasting with various theories and do not consider their eating behavior to be wrong. It is based on an overvalued idea about its exorbitant fullness and distortion of the image of its body and proportions.

In a number of cases, the starting point for such behavior is a phrase accidentally thrown by someone about their appearance. For example, a 14-year-old girl came to school after the summer holidays and heard from her friends the phrase: “You overeat over the summer, so you can get fat.” Since then, she began to restrict herself in food, threw it away, came up with a “modest diet” for herself, and ... for 8 months, with a height of 168 cm, she weighed 38 kg. But at the same time, she considered herself fat and aggressively resisted the requests and insistent demands of her parents to change her diet. Along with a strict diet, teenagers opt for enhanced physical education and try to move a lot. For example, a girl did homework while standing, a boy, after eating any food, did five-kilometer runs. And all this is aimed at getting rid of excess calories and excess weight.

In a patient with anorexia nervosa, selective eating behavior is noted, which is distinguished by a special food ritual. Sometimes they cook food and feed family members with pleasure, strive to make them eat as much as possible and literally feed them.
The perception of one's own body is characterized by a violation of the body scheme, namely, an incorrect assessment of the proportions of one's body. They constantly seem to have exorbitantly enlarged hips and a fat belly.

The personal characteristics of patients are typical: excessively developed ambition and high self-esteem, perseverance and perseverance in achieving their goals, introversion and a fairly high intelligence, which does not decrease even at the cachectic stage of the disease.

So, a girl of 17 years old took exams in the final class for one five, despite the fact that she weighed only 32 kg with a height of 165 cm and her parents brought her to the exam, because due to physical weakness she could not move independently.

According to DSM-4, 2 types of anorexia nervosa are distinguished based on what means and methods are used to achieve the desired thinness, which, due to an overvalued idea, the patient naturally does not recognize:
- restrictive type, in which the patient begins to actively restrict himself in food, reaching a complete refusal to eat food;
- a cleansing type, in which there is an alternation of a special diet and "gluttony" with the aim of artificially inducing profuse vomiting, cleansing with laxatives.

Bulimia nervosa is initially characterized by food attacks in which the patient consumes a large amount of food, usually easily digestible and does not require cooking - "you need to eat everything quickly!"
There is a loss of control over excessive food intake. Such food attacks most often occur in situations of psychological stress (exams, violations of interpersonal relationships with peers), or in the presence of emptiness, or imperceptibly for a person (watching TV shows, movies).

An attack of gluttony usually stops when the stomach is full, when vomiting or other sensations of discomfort from the digestive tract appear. This is followed by cleansing from food: artificially induced vomiting, taking laxatives, cleansing enemas.
But in some cases, such food attacks become more frequent and become habitual, turning into a stable state of overeating and obesity. This reveals a constant desire for food, even with a feeling of satiety, attempts to resist obesity in various ways, an obsessive fear of obesity. In a person, due to a change in the hierarchy of motives and values, overeating continues and an overvalued idea of ​​\u200b\u200bhis body image is formed.

With anorexia nervosa and bulimia nervosa, somatic changes appear in various internal organs and systems at different stages of the disease:
- the appearance changes - a violation of the weight and proportions of the body;
- there are violations of the skin and its appendages;
- pronounced caries;
- swelling of the salivary glands;
- endocrine disorders - disorders of the pituitary-adrenal system and thyroid function, amenorrhea;
- disorders in the digestive system - habitual constipation, periodically nausea and vomiting, lack of hunger and satiety, pain in the epigastric region and along the intestines, and over time, organic disorders of the digestive tract occur;
- laboratory data - a change in the blood picture (leukopenia, anemia), electrolyte imbalance, changes in lipid metabolism and then all types of metabolism, a decrease in total protein and albumin.

In advanced cases of the disease, cachexia or obesity require treatment in specialized hospitals.
Anorexia nervosa may intersperse with attacks of bulimia, especially in adults in the presence of a prolonged frustrating situation or chronically repetitive stressful situations.
Therapy for anorexia nervosa and bulimia nervosa should be carried out by family doctors in conjunction with medical psychologists, and in protracted cases with psychiatrists.

Svetlana ZINCHENKO
Candidate of Medical Sciences, Professor of the Department of Psychology
Kyiv Institute of Social and Cultural Relations
Ludmila CHURSINA
child psychiatrist of the highest category
Kyiv City Psychoneurological Hospital No. 2

1. Zinchenko S.M. Medical psychology. Head helper. Kyiv. KISKZ. 2009. p. 341.
2. Children's psychoneurology. Under the editorship of prof. L.A. Bulakhova. Kyiv. "Health". 2001. p. 496.
3. Khaitovich M.V., Maidannik V.G., Kovalova O.A. – Psychotherapy in pediatrics. Nizhin. "Aspect-Polygraph". 2003. p. 216.
4. Venar Ch., Kerig P. - Psychopathology of the development of childhood and adolescence. St. Petersburg, Prime-Eurosign, 2007, p.670.
5. Nora Newcomb - the development of the personality of the child. 8th ed. SPb, Peter. 2003, p. 640.
6. Psychology of development. Ed. Martsinkovskaya T.D. Moscow. "Academy", 2001. p. 352.

He eats this, but he doesn’t, he prefers only sweets, eats only sausage, you can’t put anything in your mouth at all ... How to avoid such problems and teach a child to eat right?

Many underestimate the role of eating behavior. Just think, today I ate, tomorrow I didn’t eat, today it’s like this, tomorrow it’s like that. Selective taste, limited menu - what's wrong with that? In fact, malformed eating behavior and, as a result, malnutrition, lead to problems such as:

• metabolic disorders due to a lack of certain elements in the diet;
• underweight or overweight;
• digestive problems, gastritis, colitis, abdominal pain;
• food allergy;
• decreased immunity, the development of chronic diseases, etc.

That is why it is so important to teach your baby to eat right almost from birth. What does it mean right and how to bring it up?

First steps

It is difficult to realize this, but it is possible to cultivate a certain eating behavior already in a newborn. If you have discussed with other mothers how your children eat, then you probably realized that they do it in completely different ways. Someone weakly and for a long time, with interruptions, someone quickly, in big sips. Some ask to eat more often, others less often.

The main rule for forming the foundation of eating behavior is to eat when you want, and as much as you want. That is, do not feed by the hour, rocking the baby with a dummy to blue until the cuckoo announces that 4 hours have passed since the last meal. Don't breastfeed when you want your baby to shut up. And not to allow grandmother to pour another bottle of formula into her grandson's mouth just because it seemed to her that he weighed little. A newborn’s body is fine-tuning all systems, and he knows better than anyone when it’s time or not to have a bite to eat. Feeding by the hour, regardless of the desire of the child, tearing off the breast before the child is satiated, overfeeding can once and for all disrupt the natural connection "hunger-food-satiety".

The second rule is: food is food. And not a means of calm, distraction, entertainment, games, etc. This is true for all children, except for breastfed newborns (for them, mother's milk is both a sedative and a cure for pain). If the baby has already learned to actively express his desires or eats the mixture, you should clearly let him know: when it's insulting, painful, bored or just in a bad mood, you can easily correct the situation by communicating with your mother and other relatives. Play, sing, dance, hug, lie down next to. And you only need food when you're hungry.

Usually, by the time the mother is already able to distinguish what exactly worries the baby: hunger or something else, it becomes clear that the child has naturally come to a certain diet. So feeding on demand by itself turns into feeding by the hour, only without any violence against the baby.

We introduce complementary foods

Complementary foods play an important role in the development of eating behavior. If you want your baby to not be afraid to try new foods, willingly eat what you offered him, eat fully, use the following tips.

1. It is necessary to introduce complementary foods only when the child is ready for this, that is, he himself shows interest in any food other than milk or formula. On average, this happens at the age of 6-8 months, but it happens earlier or later. Usually, a baby who is ready to try complementary foods already knows how to sit on his own and boasts his first teeth.
2. Start complementary foods with unsweetened and unsalted foods. Hypoallergenic vegetable purees are ideal for this: zucchini, cauliflower, broccoli. Some doctors advise starting with dairy-free unsweetened cereals or fermented milk products.
3. Give complementary foods when the baby is hungry, but before milk or formula.
4. If the baby frowns from the first spoon, do not insist and do not try by any means to shove complementary foods into it. Give him time to adjust: offer the same food for several days. If the child still does not show a desire to continue the meal, try with another dish. If your baby refuses any solid foods, stop trying for a week or two and then try again.
5. In no case do not try to divert the attention of the crumbs and shove him a spoon. Reading books, songs and dances of parents, games and watching cartoons while eating - the worst thing you can think of. In this case, the child concentrates not on food, its texture and taste, not on his feelings (he is hungry or full), but on something extraneous, that is, there is no question of any correct eating behavior.

Nutrition after a year

Perhaps the most difficult moment in the process of educating eating behavior is when the child begins to realize that he is not being fed what his parents eat. He demands your food, climbs into your plate, looks into your mouth with sad eyes ... At the same time, he may refuse to chew pieces, agree only to mashed potatoes. And after tasting something really tasty (especially sweets), he will start asking only for this. How to be?

1. Sit down at the table with the whole family. Who likes to pick at a plate alone? Much better when the whole family gathers at the table. Or at least part of the family. If you do not want the baby to beg for food from adults and refuse his own, build a schedule in such a way that you have breakfast, lunch and dinner with the baby. So he will be more willing to eat and quickly learn how to use cutlery. For the same reason, it is better to plant a grown-up peanut in a high chair at a large table, and not at a children's table.
2. Lead by example. It is easy to guess that if parents eat only burgers and french fries, the baby will not want to break away from the team and eat vegetable puree alone. The only way to teach a child to eat right is to do it yourself. Eat with him what he can try: vegetables, fruits, meat, side dishes, cereals. In the end, since you are concerned about the issue of proper nutrition for the baby, it means that you do not mind normalizing your diet. Moreover, it is extremely beneficial for health.
3. Say no to the TV in the kitchen. Do not let your child watch cartoons or read books while eating and do not set a bad example yourself (phone and tablet are equal to TV).
4. Be careful with snacks. Having eaten between meals, the child may not have time to get hungry by the appointed hour. Especially if he had a snack with a couple of sweet rolls or a piece of cake. Try to give up snacks, and in the case when the baby is hungry ahead of time, offer him a drink, a small fruit or vegetable.
5. Buy your child their own dishes and cutlery for children - so it will be more interesting and pleasant for him to try food.
6. Don't let yourself be independent. Many mothers try to feed their babies from a spoon for a longer time so that they do not get dirty and do not smear everything around. Not only is this way of eating very boring, it also quickly becomes a habit. So, with a high degree of probability, such a child will ask to feed him both at 3 and at 5 years old. Buy your baby a large apron with a pocket and offer to eat on their own. You will be surprised how willingly he will take up food that he previously refused to eat.

   
   

7. Pay attention to serving. A beautifully decorated dish is much more pleasant than a shapeless plop of something that seems to have already been chewed. The older the child, the more demands he makes on the type of food. And rightly so: normally, when a person is hungry, at the sight of an attractive dish, he begins to produce saliva and gastric juice, which facilitates digestion. If the baby does not want to eat, try putting food on a plate beautifully. Cut meat into cubes and vegetables into strips so that they are easy to take and put in your mouth.
8. Develop a smart menu. After a year, the child begins to show food addictions. Someone loves cereals more, someone loves vegetables, and someone cannot be torn off from cottage cheese. At the same time, feeding the baby with one thing, the most beloved, of course, is wrong and impossible, because the diet should be varied and complete. Exclude from the menu what the child categorically refuses to eat, and replace it with another, similar food (for example, it is absolutely normal to eat carrots and zucchini, but do not eat pumpkin and cucumber).
9. Combine different products in one dish (favorite with not the most favorite), offer compromise solutions (your favorite zucchini after a piece of meat). Prepare the main dish from what the baby will definitely eat. Offer the child several equivalent options to choose from (for example, rice or buckwheat, fish or cutlet) - this way he will feel that he has the right to decide what he will eat, which means he will eat with great pleasure.
10. And the last important advice - do not feed your child fried, spicy, fatty, limit pickles and sweets. Firstly, it is more beneficial for the digestive system and the whole organism as a whole. Secondly, dishes with too bright taste will make the baby refuse other, more neutral ones. It is impossible not to use salt and sugar at all, because in small quantities they are necessary for the body, but it is important to know the measure. And, of course, sweets should be given only after meals, and not instead of it.

Do not worry if the child has already formed an incorrect eating behavior - it can and should be corrected at any stage. It all depends on your patience and desire!

1. Anorexia nervosa

A.Etiology. Anorexia nervosa is observed in various mental illnesses. Most often it occurs in girls from the middle and upper socio-economic strata at the age of 10-30 years. The flow varies greatly. Mortality reaches 5-20%.

b.Survey

1) Early symptoms

A) Following a strict diet that gradually leads to significant weight loss.

b) Constant thoughts about food, normal appetite.

V) Fear of obesity, misconceptions about their own physique.

2) late symptoms

A) Loss of self control.

b) Bouts of gluttony, after which patients cause themselves to vomit; abuse of laxatives and diuretics; excessive exercise.

3) Be sure to exclude schizophrenia, depression, somatic diseases that cause weight loss (inflammatory bowel disease, endocrine disorders).

4) Physical research. Detect hypothermia, arterial hypotension, vellus hair growth, edema. Possible primary or secondary amenorrhea. In the later stages, osteoporosis and delayed physical development are noted.

5) Laboratory research. At a late stage of the disease, leukopenia, lymphocytosis, and a decrease in ESR are observed; decreased activity of LDH, decreased levels of fibrinogen, estrogens and T 3 in the blood; incomplete suppression of ACTH and cortisol secretion in the dexamethasone test.

V.Diagnosis based on the following symptoms:

1) fear of obesity despite weight loss;

2) misconceptions about their own physique;

3) the desire to lose weight, despite normal weight;

4) weight less than 85% of the age norm (according to the diagrams of physical development).

G.Treatment

1) With a slight weight loss, advice on proper nutrition is enough.

2) If weight loss continues, a psychiatric consultation is indicated.

3) In outpatient treatment, patients are weighed at least once a week.

4) Indications for hospitalization: severe malnutrition, instability of heart rate, blood pressure, respiratory rate and body temperature, acute dehydration, electrolyte imbalance (eg, hypokalemic alkalosis), failure of outpatient treatment.

5) Treatment in a hospital

A) Upon admission to the hospital, Frisch tables calculate the minimum weight required to restore menstruation (the weight at which menstruation is restored in 10% of patients). 4.5 kg is added to the result obtained and the weight to be gained in the hospital is obtained (R. E. Frisch et al. Hum. Biol. 45:469-483, 1973).

b) Patients should gain weight by 0.2 kg/day or 1.4 kg/week (daily weight gain may vary). The initial weight is determined the next morning after admission to the hospital, and in case of dehydration - not earlier than one day after admission.

V) Every morning after emptying the bladder, weight, heart rate, blood pressure, and body temperature are determined. Normal body temperature is above 36.1°C, diastolic pressure is above 60 mm Hg. Art., systolic pressure above 80 mm Hg. Art.

G) On the first day of hospital stay, the diet should not differ significantly from home.

e) Immediately after admission, the nutritionist determines the number of calories that the patient consumed before admission to the hospital, and the number of calories needed to gain weight by 1.4 kg / week. After that, an individual diet is developed.

e) If blood pressure and body temperature are lowered, bed rest is indicated. If they remain within the normal range 4 hours after hospitalization, the ward regime is allowed. After another 4 hours, they are allowed to move freely around the floor. If blood pressure and temperature are stable for 48 hours, physical activity is not limited.

and) If weight gain is less than expected, additional liquid nutritional mixtures are prescribed. Between the main meals - in the morning, afternoon and evening - under the supervision of a doctor, a mixture of Ensure or Sustacal (500 kcal) is given. If the mixture is not eaten within 15 minutes, it is administered through a nasogastric tube. The patient is explained that additional nutrition is an obligatory part of the treatment, and not a replacement for the main meals. If weight gain is too slow, supplementary food is increased by one pack per day up to a maximum dose of 8 packs per day. Within an hour after an additional meal, bed rest is indicated.

h) In some cases, parenteral nutrition is necessary.

And) Monitoring blood electrolyte levels can detect laxative abuse and induction of vomiting. To prevent patients from inducing vomiting, they are not allowed to go to the toilet for 2 hours after eating.

To) Constipation, as a rule, disappears after the normalization of nutrition. Sometimes emollient laxatives are indicated.

l) Antipsychotics and tricyclic antidepressants are ineffective.

m) Before discharge, find out if the patient needs a diet.

m) Conduct individual, family and group psychotherapy.

O) A psychiatrist is involved in the treatment of emotional disorders.

2. bulimia nervosa

A.Etiology unknown. Several theories have been proposed to explain the occurrence of the disease by psychological or organic causes.

b.Survey

1) Bulimia nervosa most often occurs in teenagers. The course is chronic with periodic remissions; disability rarely occurs.

2) Anorexia nervosa, CNS tumors, Kleine-Levin syndrome, Kluver-Bucy syndrome are excluded.

V.Diagnosis put on the basis of the following symptoms:

1) recurring episodes of rapid absorption of large amounts of food, lasting about 2 hours (attacks of gluttony);

2) awareness of the incorrectness of one's behavior, loss of control over oneself;

3) regularly trying to lose weight through exercise, inducing vomiting, using laxatives or diuretics, or a strict diet;

4) over-concern with physique and weight;

5) Bouts of overeating recur on average at least 2 times a week for at least 3 months.

G.Treatment

1) Conduct psychotherapy and behavioral therapy. A psychiatric consultation is recommended.

2) Eliminate dehydration and electrolyte imbalance resulting from vomiting, the use of laxatives and diuretics.

3) The use of tricyclic antidepressants is being investigated.

3. Obesity

A.Etiology. Social, emotional and genetic factors, physical activity, as well as the size and number of fat cells play a role in the development of obesity.

b.Survey

1) In children, obesity most often occurs before the age of 4 or between 7 and 11 years of age.

2) Obesity is not a mental illness and does not depend on the type of personality. However, it is often accompanied by emotional disorders.

3) Primary obesity should be distinguished from secondary obesity (with craniopharyngioma, pituitary tumors, ovarian dysfunction, Prader-Willi, Laurence-Moon-Biedl and Cushing syndromes).

V.Diagnosis set if the weight exceeds 20% of the age norm.

G.Treatment

1) Obesity is desirable to identify at an early stage and adjust the diet in time. Parents should not comfort the child with feeding.

2) Successful treatment is impossible without the active participation of the patient and family. Its important components are a balanced low-calorie diet and increased physical activity. The most effective behavioral therapy was positive reinforcement aimed at gradual weight loss. Individual psychotherapy is also used.

3) There are self-help groups that unite obese patients.

4. Pica

A.Etiology. Suggested causes are deficiencies in certain nutrients and unsatisfied emotional needs.

b.Survey

1) Perverse appetite, as a rule, occurs between the ages of 18 months and 5 years: children eat paint, hair, dirt, etc. The normal tendency of infants to put everything in their mouth should not be confused with perverted appetite.

2) Perverted appetite occurs in developmental disorders, mineral deficiencies (for example, iron), childhood autism, schizophrenia, poor child care.

3) Complications: intestinal obstruction (for example, due to the formation of a hairball), lead poisoning, alopecia, helminthiasis.

V.Diagnosis is based on the regular consumption of inedible substances.

G.Treatment

2) Exclude access to toxic substances (for example, paints containing lead).

3) Sometimes behavioral therapy with positive reinforcement is effective.

J. Gref (ed.) "Pediatrics", Moscow, "Practice", 1997

Parents often blame themselves for overlooking the symptoms of their child's eating disorder. I usually try to help them alleviate their guilt, as it is neither productive nor justified.

While eating disorders are fairly common in our culture, the likelihood of an individual child developing one is quite low, and most parents ignore the signs of an incipient disorder. However, in retrospect, many parents are able to identify some of the red flags and not regret their poor knowledge of the matter.

Eating disorders in children and adolescents often present differently than adults, and there is a lack of information even among medical professionals. As a result, it is not uncommon to miss the chance of early diagnosis during the onset of the disorder. This is unfortunate, since early treatment is the key to a successful recovery.

In the process of illness in children and adolescents, the symptoms characteristic of adult patients may not appear. For example, the youngest sufferers are less likely to binge and exhibit compensatory behaviors such as self-induced vomiting, diet pills, and laxatives.

So what are the symptoms parents should be aware of?

1) Insufficient weight gain and slow growth in a child at an age appropriate for active growth

Adult patients may think that they are fat, go on a diet and lose weight in a way that will be noticeable from the outside. For children, however, weight loss may not be observed. Instead, the pathology may manifest itself only as a lack of growth or a lack of weight expected at this age. Monitoring the growth of a child is the business of pediatricians, but not all specialists are competent in identifying eating disorders. It is a good idea for parents to pay attention to changes in weight and growth dynamics. Some doctors mistakenly refer only to standard tables, which can lead to omissions in the diagnostic process. It is very important to compare the height and weight of the child with his past performance.

2) Reduction in food intake or refusal to eat for unclear reasons or without explanation

Younger children are less likely to express concerns about body image, instead they may "sabotage" attempts to give them enough food to support growth and development.

A number of clever explanations for rejection include a sudden dislike of previously loved foods, a lack of hunger, or unclear goals to become healthier. Children may also complain of abdominal pain.

3) Hyperactivity or restlessness

In the case of adults, we would see excessive exercise, however, in children, activity is much less targeted. You won't see them working out for hours at the gym or jogging in the neighborhood, instead they will become hyperactive and restless, moving erratically and without a specific goal. Dr. Julia O'toole describes compulsive exercise or motor restlessness as "relentless." Parents often say that their children cannot sit still in one place. This condition can be similar to ADD, and parents do not have thoughts about the possible development of an eating disorder.

4) Increased interest in cooking and/or watching cooking shows on TV

Another misunderstood symptom is an increased interest in cooking. Contrary to popular belief, and often contrary to what they say out loud, people with restrictive eating disorders do not have poor appetites, they are actually hungry and think about food all the time. Adults can cook for others and read or collect recipes. In children, we can also observe a similar hobby in the form of watching cooking shows on TV. Parents are often initially pleased with the child's interest in food, but this may well be a sublimation of hunger. People who do not eat enough food are obsessed with food, and children and adults can replace the process of eating food with other food-related activities.

Eating disorders usually develop in adults, but cases of eating disorders have been documented in children as young as 7 years of age. Losing weight in a growing child should be taken seriously, even if the child was overweight. If you are concerned that your child has an eating disorder or if they have any of the above symptoms, talk to your pediatrician. If your doctor doesn't take your concerns seriously, trust your parenting instincts and seek more professional help, and you should also learn more about eating disorders. A useful resource for parents is the F.E.A.S.T. website.

Translation - Elena Labetskaya, IntuEat Center for Intuitive Eating ©

Department of Health of the City of Moscow
Scientific and Practical Center for Mental Health of Children and Adolescents. G.E. Sukhareva
Department of Psychiatry and Medical Psychology, Russian National Research Medical University. N.I. Pirogov
Department of Child Psychiatry and Psychotherapy, RMANPO

II ALL-RUSSIAN SCIENTIFIC AND PRACTICAL CONFERENCE
with international participation

“SUKHAREV READINGS. EATING DISORDERS IN CHILDREN AND ADOLESCENTS»

Moscow, December 11-12, 2018

INFORMATION MAIL

Dear colleagues!

We invite you to take part in the work of the II All-Russian scientific and practical conference with international participation “Sukharev Readings. Eating Disorders in Children and Adolescents”, which will take place on December 11-12, 2018 in Moscow.

The end of the 20th - the beginning of the 21st century was marked by a significant increase in mental illness, especially in childhood and adolescence. Children with mental disorders are faced by doctors of various specialties. Children and adolescents with eating disorders are among the most severe group of patients.

Today, eating disorders are a heterogeneous group of various mental disorders, including both classic anorexia nervosa and bulimia, and numerous syndromic eating disorders in various mental illnesses, including autism spectrum disorders, mental retardation, endogenous diseases and others

The high social significance and relevance of this topic are due to the severe consequences of such conditions. Diagnosis, treatment, rehabilitation and prevention of eating disorders require a comprehensive multi-professional approach involving different specialists: psychiatrists, pediatricians, gastroenterologists, endocrinologists, cardiologists, nutritionists, crisis and family psychologists.

We invite all interested specialists, representatives of the parent community and public organizations to take part in our conference.

List of main issues planned for discussion:

• Eating disorders as a polynosological category;
• Anorexia and bulimia: modern views on etiology, epidemiology, diagnosis, classification, pharmaco- and psychotherapy;
• Features of eating behavior in children with various mental disorders: autism spectrum disorders and other developmental disorders, schizophrenic spectrum disorders, affective disorders, etc. Modern approaches to etiology, phenomenology, diagnostics, pharmaco- and psychotherapy;
• Somatic disorders in children and adolescents with eating disorders: modern approaches to diagnosis and treatment;
• Eating disorders in the practice of a pediatrician, gastroenterologist, endocrinologist, gynecologist, nutritionist, cardiologist, pathologist and other specialists. Issues of professional interaction;
• Organization of care and routing of children and adolescents with eating disorders;
• Crisis and urgent conditions in children and adolescents with eating disorders;
• Working with the family of a child with eating disorders;
• Evaluation of the quality of medical care for children and adolescents with eating disorders;
• Issues of student and postgraduate teaching of child psychiatry and related disciplines.

Objectives and expected results Activities

The purpose of the event is to form a consolidated position on the creation of an effective system for the prevention, diagnosis, treatment and rehabilitation of children and adolescents with eating disorders.

Expected results Activities

• Development of new approaches to the classification of eating disorders;
• highlighting the main biological, psychological and social factors underlying various eating disorders in children and adolescents;
• development of a set of measures that contribute to the timely identification and further routing of children and adolescents with eating disorders;
• formation of a unified system for early detection, diagnosis, treatment and rehabilitation of children and adolescents with eating disorders;
• development of a system of multiprofessional interaction with the participation of psychiatrists, pediatricians, gastroenterologists, endocrinologists, gynecologists, nutritionists, cardiologists, psychologists and other specialists, as well as representatives of the parent community for the complex therapy and rehabilitation of children and adolescents with eating disorders.

The target audience: psychiatrists, psychotherapists, pediatricians, gastroenterologists, endocrinologists, gynecologists, nutritionists, cardiologists, pathologists, clinical psychologists and other specialists, as well as teachers, parents, journalists, representatives of public organizations.

Conference Chairman:

Bebchuk Marina Alexandrovna, Candidate of Medical Sciences, Director of the State Budgetary Institution of Health "Scientific and Practical Center for Mental Health of Children and Adolescents. G.E. Sukhareva DZM.

Organising Committee:

• Osmanov Ismail Magomedtagirovich, Doctor of Medical Sciences, Professor, Chief Freelance Specialist Pediatrician, Chief Physician of the Children's Clinical Hospital named after. Z.L. Bashlyaeva DZM, Director of the University Clinic of Pediatrics, SBEI HPE Russian National Research Medical University. I.I. Pirogov of the Ministry of Health of the Russian Federation, Professor of the Department of Hospital Pediatrics No. 1, SBEI HPE Russian National Research Medical University. N.I. Pirogov Ministry of Health of the Russian Federation;
• Petryaykina Elena Efimovna, Doctor of Medical Sciences, Professor, Chief Freelance Pediatric Endocrinologist of the Moscow Department of Health, Head of the Center for Pediatric Endocrinology, Chief Physician of the Morozov Children's City Clinical Hospital DZM;
• Shevchenko Yury Stepanovich, Doctor of Medical Sciences, Professor, Head. Department of Child Psychiatry and Psychotherapy, FGBOU RMAPE, Ministry of Health of the Russian Federation;
• Shmilovich Andrey Arkadievich, Candidate of Medical Sciences, Head. Department of Psychiatry and Medical Psychology, Russian National Research Medical University. N.I. Pirogov of the Ministry of Health of Russia;
• Zinchenko Yury Petrovich, Doctor of Psychology, Professor, Dean of the Faculty of Psychology, Lomonosov Moscow State University. M.V. Lomonosov, Head of the Department of Methodology of Psychology, Vice President of the Russian Academy of Education, Academician of the Russian Academy of Education;
• Kholmogorova Alla Borisovna, Doctor of Psychology, Professor, Head. Department of the Faculty of Psychological Counseling, MSUPU;
• Portnova Anna Anatolyevna, Doctor of Medical Sciences, Head of the Department of Child and Adolescent Psychiatry, Federal State Budgetary Institution “FMRCPS named after A.I. V.P. Serbian” of the Ministry of Health of Russia, Chief freelance child psychiatrist of the DZM;
• Basova Anna Yanovna, Candidate of Medical Sciences, Deputy Director of the GBUZ "NPTs PZDP them. G.E. Sukhareva DZM" on scientific work.

Register to participate in the conference, you can apply for a speech and get acquainted with the latest version of the program on the website http://www.npc-pzdp.ru

Requests to speak accepted until November 1, 2018

General requirements for the acceptance and execution of abstracts:

Call for Abstracts carried out before November 20, 2018 The Organizing Committee reserves the right to refuse to publish a paper that does not meet the criteria for a high-quality scientific research or is not suitable for the topic.