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Children’s Hospital Colorado
Anschutz Medical Campus
13123 East 16th Avenue
Aurora, CO 80045
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The Eating Disorder Treatment Program
Bulimia in Children and Teens
Parents and caregivers know their kids best. That’s why we put families at the center of every care team.
What is Bulimia?
Bulimia nervosa is a disorder that involves binge eating and then purging through self-induced vomiting or the use of laxatives, diuretics or diet pills. Some people with bulimia purge after a binge through excessive exercise or by fasting for days.
This binge and purge cycle can quickly become a routine that is difficult to break. People with bulimia tend to know their behavior is problematic and become secretive to avoid being discovered. They may spend more time alone than usual and sometimes go through the binge/purge cycle several times a day.
Physical health complications from bulimia can range from a sore throat and swollen glands in the neck and jaw area to dental issues, such as worn tooth enamel, decaying teeth, acid reflux, gastrointestinal problems, electrolyte imbalances and changes in heart rate.
Mental health complications of bulimia can be just as devastating as the physical ones. Relationships with family and friends often suffer as the affected person avoids eating with others or resists help from others. Kids with bulimia often feel isolated and depressed, and in some cases my consider suicide, which is the leading cause of death in people with eating disorders.
What causes bulimia?
Eating disorders do not have a single cause. They can develop from a combination of biological, psychological and social factors. Genetics and a family history of eating disorders or mood disorders can increase risk. Psychological factors, including perfectionism, low self-esteem, depression, anxiety and difficulty coping with intense emotions may be contributors.
Who gets bulimia?
Bulimia tends to affect children and teens, though it can begin at any age and often continues into adulthood. Children and teens with bulimia are especially concerned with how others see them and may feel emotionally insecure or lack confidence. The individual may feel like they live behind a facade—competent and attractive on the outside but inadequate underneath. Dieting often begins as a way to feel better about oneself and to gain approval from others.
People with bulimia often use food to cope with stress and emotional difficulties. This can lead to unusual eating patterns and an inability to appropriately respond to hunger. People with bulimia usually maintain close-to-normal weights and often go through their binges and purges in private, making the condition difficult to detect.
What are the signs and symptoms of bulimia?
People with bulimia have episodes of binge eating at least once a week, followed by purging through self-induced vomiting, excessive exercise, fasting or the use of laxatives. Here are some signs that may help you recognize bulimia in someone you know:
- Weight fluctuations. Although people with bulimia usually maintain near-normal body weight, their binge and purge behaviors may cause erratic weight gains and losses.
- Avoiding family meals. The child might make excuses about being too busy or claim to be eating elsewhere.
- Secretive behavior around eating and bathroom use. A child who habitually runs water, plays music or flushes the toilet repeatedly while using the bathroom may be masking the sounds of vomiting.
- Use of laxatives or diet pills. Taking any medication outside of recommended use can be dangerous.
- Regular disappearance of food. This can be a sign of binge eating.
- Excessive and obsessive exercise. The child may attempt to burn calories consumed.
- Physical signs of malnutrition. These can include dull hair, hair loss, the splitting or softening of nails, dental cavities and gum disease.
- Low self-esteem or mood changes. These may include irritability, depression or talk of suicide.
- Drug or alcohol abuse. Sometimes teens with eating disorders turn to substance abuse to relieve feelings of fear, shame, and depression.
How is bulimia treated?
Our approach to treatment gives families the support and education they need to manage bulimia and help their child work toward recovery, while minimizing time out of school and away from home. Learn more about treatment for bulimia.
For patients with significant medical concerns, an inpatient medical stabilization stay may be necessary before the family-based treatments below can safely begin.
The Eating Disorders Program provides support to hundreds of children and teens, ages 6 to 18, each year.
We offer two program options, each customized to meet every patient’s unique needs:
- Day Treatment Program: Also known as Partial Hospitalization Program, this is designed for children and teens who need intensive support through eating disorder recovery but do not require 24-hour care. This typically is between 5 and 7 days, with some or all meals eaten in program. A specialized care team guides families and children in developing healthy coping skills and supporting nutrition needs in their recovery process. Learn more about the Day Treatment Program.
- Outpatient Clinic: Includes individual, family and group therapy, as well as psychiatric medication management, as needed. If you’re not sure if outpatient services are right for your child, call us at 720-777-6200 to speak with our team. Learn more about the Outpatient Clinic.
Remember that there is no single cause for a child to develop an eating disorder. Early identification and treatment are among the best indicators of recovery, so discuss your concerns openly with your child and seek professional help as soon as you identify concerning behaviors. Most families start by contacting their pediatrician or primary care provider.
For more information about the Children's Hospital Colorado Eating Disorders Treatment Program, call 720-777-6200.
The Family Health Library
Children's Hospital Colorado's Anschutz Medical Campus location offers a Family Health Library with information on parenting, child development, medical diagnosis in children and more. Families are welcome to visit and use this resource at any time.
Recommended books
- "What Causes Eating Disorders – And What Do They Cause?" by Guido Frank, MD (2016)
- "Off the C.U.F.F. (Calm, Unwavering, Firm and Funny)" by Nancy Zucker, Ph.D., a parent skills manual that provides the curriculum taught to parents in group programs. Duke University Eating Disorders Program. (2008)
- "Unlocking the Mysteries of Eating Disorders" by David B. Herzog, M.D., Debra L. Franko, PH.D., and Pat Cable, RN (2007)
- "Skills-Based Learning for Caring for a Loved One with an Eating Disorder. The New Maudsley Method" by Janet Treasure, Grainne Smith and Anna Crane. Routledge Taylor and Francis Group, London and New York (2007)
- "Help your Teenager Beat an Eating Disorder" by Jim Lock, MD, PhD, and Daniel LeGrange, PhD. The Guilford Press, New York and London (2005)
- “Survive FBT: Skills Manual for Parents Undertaking Family Based Treatment (FBT) for Child and Adolescent Anorexia Nervosa” by Maria Ganci. LMD Publishing (2016)
Organizations and recommended websites
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