Eating disorders in young children. Psychology of food

Psychological parameters of eating behavior and its disorders largely determine the personal attitude towards eating food and its methods. These include various factors:
– violations of relationships in the “mother-child” system in early childhood;
– ways of eating that are unacceptable for a child in early childhood;
– stress, situations of frustration;
– personal problems of children and adolescents;
– conflict families;
– problems in interpersonal relationships in the family, child care institutions, with peers and other people around them.

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

Depending on age, eating behavior and its disorders are distinguished according to the reasons for its occurrence, the characteristics of the personal reaction of the child and adolescent, the structure of symptoms and the mechanism of their occurrence.
In infants and small children, eating disorders are often combined with appetite disturbances. Most often, they, especially those suffering from a neuropathic constitution, experience hyporexia and anorexia.

Symptoms of anorexia and hyporexia

Symptoms of anorexia and hyporexia can manifest themselves as follows:
– complete or partial refusal to eat;
– preference for a certain consistency of food (liquid, solid);
– slowing down the feeding process;
– eating only certain foods (porridge, 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 such eating disorders can be different:
– incorrectly chosen method of feeding the baby;
– insufficient patience on the part of the nursing mother;
– 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 (“as long as the child absorbs the food”);
– increased excitability or inhibition of the child during feeding;
– endless urging him to eat food, the taste of which the child often does not fully feel or the dish is unpleasant to him;
– initial disruption of relationships in the mother-child system:
– force-feeding, which usually ends in vomiting and can lead to habitual vomiting to any psychogenic stimulus (psychosomatic disorder);
– family conflict situations, especially during feeding of the child;
– when breastfeeding, the mother with all her thoughts and feelings should be occupied only with the baby, and not with her problems;
– a change in the child’s usual pattern of life, which is a stressful situation for him (moving to another apartment, separation from his mother, attending kindergarten, etc.). There are also many other reasons that disrupt the “psychological homeostasis” of the child.

Often, a child with anorexia finds the process of eating food unpleasant, its unusual smell and taste, or even preparing for food. The child shows anxiety at the sight of the high chair and table at which he is fed, bowls and spoons.
Parents and those 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, sitting her on his shoulder so that she could finger the pendants of the chandelier while feeding.
Until she was 2 years old, Ira took food from her mother’s hands, throwing away the cutlery from 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 foods, 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 to ensure that there are no organic disorders of the digestive system.
Then you should understand the psychological reasons for such eating behavior and the presence of neuropathic features of the child’s constitution.
Recommendations that can be given to parents to overcome this type of eating disorder may include the following:
– understand the correctness of your 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 focus on the process of feeding the child, but rather on the consumption of food by other family members;
– give the child the opportunity to eat on his own (pour some of the food into a bowl and help him eat);
- allow him to eat food he likes from the common table, even with his hands.
There may be many tips and options for changing feeding methods, but the main thing is that the child likes it. It is advisable to conduct play therapy sessions based on a plot related to eating behavior.

Case from practice: Zhenya, 10 months old, with hyporexia, was seated directly on the dinner table, surrounded by people close to him, and allowed to select pieces of food from the plates, outwardly not paying attention to his actions. The adults savored the food with pleasure, showing it to the child with all their appearance. A week later, the child and his mother ate the food offered, which she allegedly also ate. And gradually he “got off” the table and chose the method of feeding and dishes himself. The problem with eating has ceased to be dominant for the child and family.

What is rumination?

Rumination (regurgitation disorder) is the conscious regurgitation of food, which is often swallowed or spat out again.
The symptom appears in infancy more often in boys with a neuropathic constitution, but can occur or continue at an older age. Regurgitation is also observed in healthy children when they are not fed correctly or are in a situation of emotional deprivation (restrictions).

There are 2 forms of rumination:
1) psychogenic form, which is based on:
– severe disturbances in the system of mother-child relationships;
– the presence of stressful situations for the child (separation from the mother, conflict situations in the family);
– personality disorders in a mother who treats her child inappropriately;
2) the second option occurs in mentally retarded children due to its own special mechanisms.

Timely conversations with the mother on the issues of establishing correct contact with the child and selecting an adequate method of feeding for him help to get rid of rumination.

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

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

This eating behavior caused 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, they scolded her, but no one felt sorry. Eventually, the parents consulted a doctor and a child psychologist. Conversations were held with the parents about the unfavorable psychological climate in the family and advice was given on how to normalize the relationship with the girl. Luda completed a course of psychotherapy and became a completely healthy child.

What is a pike?

Pica is the eating of inedible or unpleasant-tasting objects (waste, garbage, sand, chalk, paint, etc.). The disorder partially manifests itself 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 also occurs in healthy children - they eat chalk and lime, which requires the attention of family doctors to study the state of metabolic processes in the child.
In adolescence, eating behavior takes on an even more personal perspective. Teenagers establish motives and values, and an orientation towards 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 aspects: genetic factors; family influences; socio-cultural influences; dietary measures aimed at reducing weight; features of personal response to your appearance and the shape of your body; vulnerability to restrictions or imposition of food on adolescents.

Criteria for diagnosing anorexia nervosa according to ICD-10

– body weight is 15% below normal;
– weight loss is caused by the patient himself;
– violation of the body diagram and its proportions;
– a super-valuable idea of its exorbitant thickness;
– secondary endocrine disorders of 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 reduces himself to minimal food consumption. So, for example, one girl ate 1 apple a day and drank 1 glass of water. Typically, in a conversation, such patients talk about a full “food day”, three meals a day and consumption of the entire range of foods. 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 incorrect. It is based on an overvalued idea of one’s exorbitant fullness and a distortion of the image of one’s body and proportions.

In a number of cases, the trigger for such behavior is a phrase casually 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 overate over the summer, so you can get fat.” Since then, she began to limit herself in food, threw it away, came up with a “modest diet” for herself and... in 8 months, with a height of 168 cm, she weighed 38 kg. But at the same time, she considered herself fat and aggressively resisted her parents’ requests and insistence on changing her diet. Along with a strict diet, teenagers choose intensive physical education and try to move a lot. For example, a girl did her homework while standing, a boy did five-kilometer runs after eating any food. And all this is aimed at getting rid of excess calories and excess weight.

A patient with anorexia nervosa exhibits selectivity of eating behavior, characterized by a special food ritual. Sometimes they prepare food and happily feed family members, trying to get them to eat as much as possible and literally feeding them.
The perception of one’s own body is characterized by a violation of the body diagram, namely, an incorrect assessment of the proportions of one’s body. They always seem to have exorbitantly enlarged hips and a thick belly.

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

Thus, a 17-year-old girl passed her final year exams with straight A's, despite the fact that she weighed only 32 kg with a height of 165 cm and was brought to the exam by her parents, since due to physical weakness she could not move independently.

According to DSM-4, two 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 limit himself in food, reaching the point of 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 eating attacks, in which the patient takes 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, disturbances in interpersonal relationships with peers), or in the presence of emptiness, or unnoticed by a person (watching TV shows, movies).

An attack of gluttony usually stops when the stomach is full, when vomiting or other sensations of discomfort in 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 when feeling full, attempts to resist obesity in various ways, and an obsessive fear of obesity. Due to a change in the hierarchy of motives and values, a person continues to overeat and develops an overvalued idea of his body image.

With anorexia nervosa and bulimia nervosa, at different stages of the disease, somatic changes appear in various internal organs and systems:
– changes in appearance – violation of body weight and proportions;
– disorders of the skin and its appendages appear;
– severe 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, periodic nausea and vomiting, lack of feeling 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 – changes in the blood picture (leukopenia, anemia), electrolyte imbalance, changes in lipid metabolism and then all types of metabolism, decrease in total protein and albumin.

In advanced cases of the disease, cachexia or obesity require treatment in specialized hospitals.
Anorexia nervosa can alternate with attacks of bulimia, especially in adults in the presence of prolonged frustrating situations or chronically repeated stressful situations.
Therapy for anorexia nervosa and bulimia nervosa should be carried out by family doctors together with medical psychologists, and in prolonged cases, with psychiatrists.

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

1. Zinchenko S.M. – Medical psychology. Chief assistant. Kyiv. KISCZ. 2009. p. 341.
2. Child psychoneurology. Edited by prof. L.A. Bulakhova. Kyiv. “Healthy.” 2001. p. 496.
3. Khaitovich M.V., Maydannik 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 – development of a child’s personality. 8th ed. St. Petersburg, Peter. 2003, p. 640.
6. Developmental psychology. Ed. Martsinkovskaya T.D. Moscow. "Academy", 2001. p. 352.

He eats this, and then he doesn’t eat, he prefers only candy, he eats only sausage, you can’t fit anything in his mouth at all... How to avoid such problems and teach a child to eat properly?

Many people underestimate the role of eating behavior. Just think, today I ate, tomorrow I don’t eat, today it’s like this, tomorrow it’s that way. Selective taste, limited menu - what's wrong with that? In fact, improperly formed eating behavior and, as a consequence, poor nutrition lead to problems such as:

metabolic disorders due to a lack of certain elements in the diet;
being underweight or overweight;
digestive problems, gastritis, colitis, abdominal pain;
food allergies;
decreased immunity, 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 to be correct and how to educate it?

First steps

It is difficult to realize this, but it is possible to instill certain eating behavior in a newborn. If you have discussed with other mothers how your children eat, you probably realized that they do it completely differently. Some weakly and for a long time, with breaks, some quickly, in large sips. Some people 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 pacifier until he turns blue, until the cuckoo announces that 4 hours have passed since the last meal. Do not breastfeed when you want the baby to shut up. And don’t allow the grandmother to pour another bottle of formula into her grandson’s mouth just because she thought he didn’t weigh enough. A newborn’s body undergoes fine tuning of all systems, and he knows better than anyone when it is or is not time to have a snack. Feeding by the hour, regardless of the child’s wishes, weaning from the breast before the child is full, and 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 formula, it is worth making it clear to him: when it is offensive, painful, boring, 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 next to each other. And you only need food when you are hungry.

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

We introduce complementary foods

Complementary feeding plays a major role in the development of eating behavior. If you want your baby to not be afraid to try new foods, to willingly eat what you offer him, and to eat well, use the following tips.

Complementary feeding should be introduced only when the child is ready for it, that is, he himself shows interest in any food other than milk or formula. On average, this occurs at the age of 6-8 months, but it can happen earlier or later. Typically, a baby who is ready to try complementary feeding already knows how to sit independently and can boast of his first teeth.
Start complementary feeding with unsweetened and unsalted foods. Purees made from hypoallergenic vegetables are ideal for this: zucchini, cauliflower, broccoli. Some doctors advise starting with dairy-free, unsweetened cereals or fermented milk products.
Complementary feeding should be given when the baby is hungry, but before milk or formula.
If the baby winces at the first spoon, do not insist and do not try to force complementary foods into him by any means. Give him time to get used to it: offer the same food for several days. If the child still does not show a desire to continue the meal, try with a different dish. If your baby refuses any complementary foods, stop trying for one to two weeks and then try again.
Under no circumstances try to distract the baby’s attention and shove a spoon at him. Reading books, parents singing and dancing, playing games and watching cartoons while eating is the worst thing you can think of. In this case, the child concentrates not on the food, its consistency and taste, not on his feelings (whether he is hungry or full), but on something extraneous, that is, there is no talk of any correct eating behavior.

Nutrition after a year

Perhaps the most difficult moment in the process of educating eating behavior is the one 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 and agree only to puree. And after trying something really tasty (especially sweets), he will start asking for only this. What should I do?

Sit down at the table with the whole family. Who enjoys picking at a plate alone? It is much better when the whole family gathers around the table. Or at least part of the family. If you don’t want your baby to beg food from adults and refuse his own, create a schedule so that you have breakfast, lunch and dinner with your baby. This way he will be more willing to eat and will quickly learn to use cutlery. For the same reason, it is better to seat a grown-up toddler in a high chair at a large table, rather than at a children's table.
Lead by example. It’s easy to guess that if parents eat only burgers and fries, the baby will not want to break away from the group and eat mashed vegetables alone. The only way to teach a child to eat healthy 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 your baby, it means that you are not against normalizing your diet. Moreover, it is extremely beneficial for health.
Say no to TV in the kitchen. Don’t let your child watch cartoons or read books while eating and don’t set a bad example yourself (phones and tablets are the same as TV).
Be careful with snacking. Having eaten between meals, the child may not have time to get hungry by the appointed hour. Especially if he snacked on a couple of sweet rolls or a piece of cake. Try to avoid snacking, and if your baby gets hungry ahead of time, offer him a drink, a small fruit or vegetable.
Buy your child his own dishes and cutlery for children - this will make it more interesting and enjoyable for him to try food.
Do not forbid to show independence. Many mothers try to spoon feed their babies longer so that they don’t get dirty and smear everything around them. Not only is this way of eating very boring, it also quickly becomes a habit. This means that with a high degree of probability such a child will ask to feed him at both 3 and 5 years old. Buy your baby a large apron with a pocket and encourage him to eat on his own. You will be surprised how willingly he will take up food that he previously refused to eat.
Pay attention to serving. A beautifully decorated dish is much more pleasant than a shapeless plop of something that looks like it’s already been chewed. The older the child, the more demands he places on the type of food. And this is correct: 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 your baby doesn't want to eat, try placing the food nicely on a plate. Cut the meat into cubes and the vegetables into strips so that they are easy to take and put in your mouth.
Develop a competent menu. After a year, the child begins to develop food addictions. Some people prefer porridge, some prefer vegetables, while others love cottage cheese. At the same time, it is, of course, wrong and impossible to feed the baby with one thing, the most favorite one, because the diet should be varied and complete. Eliminate from the menu what your child categorically refuses to eat and replace it with other, similar food (for example, it is absolutely normal to eat carrots and zucchini, but not pumpkin and cucumber).
Combine different products in one dish (your favorite with your least favorite), offer compromise solutions (your favorite zucchini after a piece of meat). Prepare the main course from what your baby will definitely eat. Offer your 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.
And the last important advice - do not feed your child fried, spicy, fatty foods, limit pickles and sweets. Firstly, it is healthier for the digestive system and the entire body as a whole. Secondly, dishes with too strong a taste will force the baby to refuse other, more neutral ones. It is impossible not to consume salt and sugar at all, because the body needs them in small quantities, but it is important to know when to stop. And, of course, sweets should be given only after meals, and not instead of it.

Don’t worry if your child has already developed unhealthy eating behavior - it can and should be corrected at any stage. It all depends only on your patience and desire!

1. Anorexia nervosa

A.Etiology. Anorexia nervosa is observed in various mental illnesses. It most often occurs in girls from middle and upper socioeconomic classes aged 10-30 years. The current varies significantly. 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 one's own physique.

2) Late symptoms

A) Loss of self-control.

b) Bouts of gluttony, after which patients induce vomiting; abuse of laxatives and diuretics; excessive exercise.

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

4) Physical examination. Hypothermia, arterial hypotension, vellus hair growth, and edema are detected. Primary or secondary amenorrhea is possible. In 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 LDH activity, decreased levels of fibrinogen, estrogens and T 3 in the blood; incomplete suppression of the secretion of ACTH and cortisol in a test with dexamethasone.

V.Diagnosis diagnosed based on the following symptoms:

1) fear of obesity despite weight loss;

2) misconceptions about your own physique;

3) desire to lose weight despite normal weight;

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

G.Treatment

1) For minor weight loss, nutritional counseling may be sufficient.

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

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

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

5) Treatment in hospital

A) Upon admission to the hospital, using Frisch tables, the minimum weight required to restore menstruation is calculated (the weight at which menstruation is restored in 10% of patients). 4.5 kg is added to the result obtained and the weight that needs 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 - no earlier than one day after admission.

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

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

d) Immediately after hospitalization, 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 this, an individual diet is developed.

e) If blood pressure and body temperature are reduced, bed rest is indicated. If they remain within normal limits 4 hours after hospitalization, ward mode is permitted. 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 formulas are prescribed. In the intervals between main meals - morning, afternoon and evening - under the supervision of a doctor, give a mixture of Ensure or Sustacal (500 kcal). 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 treatment, and not a replacement for main meals. If weight increases too slowly, the amount of additional nutrition is increased by one pack per day to a maximum dose of 8 packs per day. Bed rest is indicated for an hour after an additional meal.

h) In some cases, parenteral nutrition is necessary.

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

To) Constipation usually disappears after normalization of nutrition. Sometimes emollient laxatives are indicated.

l) Neuroleptics and tricyclic antidepressants are ineffective.

m) Before discharge, they find out whether 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 is rare.

2) Anorexia nervosa, central nervous system tumors, Kleine-Levin syndrome, Kluver-Bucy syndrome are excluded.

V.Diagnosis diagnosed based on the following symptoms:

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

2) awareness of the wrongness of one’s behavior, loss of control over oneself;

3) regular attempts to lose weight through exercise, inducing vomiting, using laxatives or diuretics, or strict dieting;

4) excessive preoccupation with body shape and weight;

5) bouts of binge eating occur on average at least 2 times a week for at least 3 months.

G.Treatment

1) Conduct psychotherapy and behavioral therapy. Consultation with a psychiatrist is recommended.

2) Eliminate dehydration and electrolyte imbalances 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, and 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 years or between 7 and 11 years of age.

2) Obesity is not a mental illness and does not depend on personality type. 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, Lawrence-Moon-Biedl and Cushing syndromes).

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

G.Treatment

1) It is advisable to identify obesity at an early stage and adjust the diet in time. Parents should not soothe their baby by 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. Behavioral therapy with positive reinforcement, aimed at gradual weight loss, turned out to be the most effective. Individual psychotherapy is also used.

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

4. Pica

A.Etiology. Supposed causes include deficiency of certain nutrients and unmet emotional needs.

b.Survey

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

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

3) Complications: intestinal obstruction (for example, due to hairball formation), lead poisoning, alopecia, helminthiases.

V.Diagnosis diagnosed on the basis of regular consumption of inedible substances.

G.Treatment

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

3) Behavioral therapy with positive reinforcement is sometimes effective.

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

Parents often blame themselves for missing the symptoms of their child's eating disorder. I usually try to help them relieve the guilt, since it is neither productive nor valid.

Although eating disorders are quite common in our culture, the likelihood of an individual child developing one is quite low, and most parents do not pay attention to the signs of an emerging disorder. However, in retrospect, many parents are able to identify some of the warning signs and not regret their lack of awareness in this matter.

Eating disorders in children and adolescents often present differently than in adults, and a lack of information exists even among medical professionals. As a consequence, there are often missed opportunities for early diagnosis during the onset of the disorder. This is sad, since early treatment is the key to successful recovery.

During the course of the disease in children and adolescents, symptoms characteristic of adult patients may not appear. For example, the youngest patients are less likely to suffer from binge eating and exhibit compensatory behavior such as self-induced vomiting, taking diet pills and laxatives.

So what symptoms should parents be wary of?

1) Insufficient weight gain and slow growth in a child at an age corresponding to active growth

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

2) Reducing food intake or refusing food for unclear reasons or without explanation

Younger children are less likely to express concerns about body image and may instead sabotage attempts to provide them with enough food to support growth and development.

A number of subtle explanations for refusal include a sudden dislike of previously loved foods, 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, but in children the activity is much less targeted. You won't see them working out for hours at the gym or going for jogs around the neighborhood; instead, they will become hyperactive and restless, moving erratically and without a specific purpose. Dr. Julia O'toole describes compulsive exercise or motor restlessness as "incessant." Parents often report that their children cannot sit still in one place. This condition may be similar to ADD, and parents do not think about the possible development of an eating disorder.

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

Another misinterpreted symptom is an increased interest in cooking. Contrary to popular belief, and often contrary to what they say out loud, people with inhibitory eating disorders do not have a poor appetite; 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 don't eat enough food become obsessed with food, and both children and adults may substitute other food-related activities for eating.

Eating disorders usually develop in adults, but there are documented cases of disorders in children as young as 7 years of age. Weight loss in a growing child should be taken with great care, even if the child was overweight. If you are concerned about whether your child has an eating disorder or has any of the symptoms listed above, talk to your pediatrician. If your doctor doesn't take your concerns seriously, trust your instincts as a parent and seek additional help from a professional, and you should also learn more about eating disorders. A useful resource for parents is the Family Eating Disorder Support and Assistance Organization (F.E.A.S.T) website.

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

II ALL-RUSSIAN SCIENTIFIC AND PRACTICAL CONFERENCE
with international participation

"SUKHAREV'S READINGS. EATING DISORDERS IN CHILDREN AND ADOLESCENTS"

Moscow, December 11-12, 2018

INFORMATION LETTER

Dear colleagues!

We invite you to take part in 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 and beginning of the 21st centuries were marked by a significant increase in mental illness, especially in childhood and adolescence. Doctors from a variety of specialties deal with children suffering from mental disorders. Children and adolescents with eating disorders are among the most severe group of patients.

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

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 an integrated multiprofessional approach with the participation of various 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;
Peculiarities of eating behavior in children with various mental disorders: autism spectrum disorders and other developmental disorders, schizophrenia spectrum disorders, affective disorders, etc. Modern approaches to etiology, phenomenology, diagnostics, pharmacotherapy 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 assistance and routing of children and adolescents with eating disorders;
Crisis and urgent states in children and adolescents with eating disorders;
Working with the family of a child suffering from eating disorders;
Assessing the quality of medical care for children and adolescents with eating disorders;
Issues of undergraduate and postgraduate teaching of child psychiatry and related disciplines.

Goals and expected results Activities

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

Expected results of the event

Development of new approaches to the classification of eating disorders;
identifying the main biological, psychological and social factors underlying various eating disorders in children and adolescents;
development of a set of measures to facilitate timely identification and further referral of children and adolescents with eating disorders;
the 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 complex therapy and rehabilitation of children and adolescents with eating disorders.

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 Aleksandrovna, Candidate of Medical Sciences, Director of the State Budgetary Institution “Scientific and Practical Center for Mental Health of Children and Adolescents named after. G.E. Sukhareva DZM".

Organizing Committee:

Osmanov Ismail Magomedtagirovich, Doctor of Medical Sciences, Professor, Chief Freelance Pediatrician Specialist, Chief Physician of the Children's Clinical Hospital named after. Z.L. Bashlyaeva DZM, Director of the University Clinic of Pediatrics, State Budgetary Educational Institution of Higher Professional Education, Russian National Research Medical University named after. I.I. Pirogov Ministry of Health of the Russian Federation, Professor of the Department of Hospital Pediatrics No. 1, State Budgetary Educational Institution of Higher Professional Education, Russian National Research Medical University named after. N.I. Pirogov Ministry of Health of the Russian Federation;
Petryaykina Elena Efimovna, Doctor of Medical Sciences, Professor, chief freelance specialist 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 of the Moscow Health Department;
Shevchenko Yuri Stepanovich, Doctor of Medical Sciences, Professor, Head. Department of Child Psychiatry and Psychotherapy of the Federal State Budgetary Educational Institution RMAPE of the Ministry of Health of the Russian Federation;
Shmilovich Andrey Arkadevich, Candidate of Medical Sciences, Head. Department of Psychiatry and Medical Psychology, Federal State Budgetary Educational Institution of Russian National Research Medical University named after. N.I. Pirogov of the Russian Ministry of Health;
Zinchenko Yuri Petrovich, Doctor of Psychology, Professor, Dean of the Faculty of Psychology, 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 Psychological Sciences, Professor, Head. Department of the Faculty of Psychological Counseling, Moscow State University of Pedagogical University;
Portnova Anna Anatolyevna, Doctor of Medical Sciences, Head of the Department of Child and Adolescent Psychiatry of the Federal State Budgetary Institution "Federal Medical Research Center named after. V.P. Serbsky" of the Ministry of Health of Russia, Chief freelance child psychiatrist of the Department of Health;
Anna Yanovna Basova, Candidate of Medical Sciences, Deputy Director of the State Budgetary Healthcare Institution “Scientific and Practical Center for Public Health and Prevention named after. G.E. Sukhareva DZM" on scientific work.

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

Applications for performances accepted until November 1, 2018

General requirements for the acceptance and preparation of abstracts:

Acceptance of abstracts carried out before November 20, 2018 The organizing committee reserves the right to refuse publication of work that does not meet the criteria for high-quality scientific research or is not suitable for the topic.