anorexia nervosa in children
Introduction
Introduction to anorexia anoxia in children Anorexia eros (anorexianervosa) is an eating disorder characterized by intentional weight loss that is caused and/or maintained by the patient himself. As early as 1694, Richard Morion described two typical cases and separated them from tuberculosis. In 1874, William Gull proposed the name anorexianervosa. In 1950, Hilde Bruch analyzed the psychological characteristics of this disorder. At present, this disorder has become an independent disease unit, and people have a certain understanding and understanding of its etiology, clinical manifestations, treatment and prognosis. basic knowledge Sickness ratio: 0.0002%-0.0005% Susceptible people: children Mode of infection: non-infectious Complications: malnutrition, electrolyte imbalance
Cause
Pediatric anorexia anoxia
(1) Causes of the disease
The cause of the disorder is not clear and may be the result of a combination of genetic and environmental factors.
(two) pathogenesis
1. Biological factors: Some studies have reported that the same twins have the same incidence rate (54% to 55%) than the fraternal twins (7% to 9%); this disorder has a tendency to family aggregation. The prevalence of female first-degree relatives of the proband is 8 times that of the general population; the proportion of female first-degree relatives with affective disorder is also significantly higher than that of the normal control, suggesting that the disorder is related to genetic factors, Studies have reported that the disorder has hypothalamic-pituitary-gonadal axis function or cerebrospinal fluid serotonin (5-HT), norepinephrine (NE) content abnormalities, although in most cases these abnormalities are secondary to hunger However, once these abnormalities occur, the disease may persist or worsen. Recently, some scholars have observed that the serotonin activity is also enhanced after the patient's body weight returns to normal, which may explain why the patient has obsessive-compulsive symptoms during the active period. And other anomalous behavior.
2. Social psychological factors
(1) Social culture with thinness and beauty: Advocating slimness, skinnyness, and promoting thinness are the expressions of charm and self-control ability. In the 1950s, this fashion style was flourishing, and it has not yet decayed. This wind is also It will inevitably affect the modern teenagers who pursue fashion, so that they blindly pursue slimness; some special professionals, such as ballerinas and fashion models, cater to this kind of social fashion; the increasingly fierce competition in the profession makes young women have serious psychological problems. The burden makes them pursue perfection to meet the needs of society, and weight loss is also one of the perfect signs, which play a role in the occurrence of anorexia nervosa.
(2) Poor family environment: It may also play a certain role in the onset of the disease. Some studies have reported that the patients with this disorder have more likes to control, the mother who is over-interfering and the passive, the father who is useless, the family structure tends to be restrained. Stereotype, overprotection, avoiding conflicts.
(3) Personality characteristics: patients often dissatisfied with self, adopt self-abandon attitude, exist avoidance personality characteristics, excessive obedience to others' desires, stereotypes, or pursuit of perfection, or sexual abuse during childhood. Related to the occurrence.
Prevention
Pediatric anorexia prevention
Chronic mental stimulation and over-stressed learning burden are the main factors for adolescents to develop this disease. They are slim and beautiful, while those who are interested in dieting are only a minority (13%). Therefore, it is prevention to relieve chronic irritation and overburden. Or the main measures to reduce the incidence.
Emotion prevention
The incidence of adolescent women in this disease is more, indicating that the personality is unstable during this period, vulnerable to external stimuli, or at home, contradictions between parents, serious illness or death of relatives and friends in the family, or frustration in school accidents. Wait, it is easy to have this disease, so it is crucial to keep the spirit optimistic and open-minded.
2. Work and rest
Reasonable arrangement of study and life, so that mental work and appropriate physical exercise, physical labor combined, appropriate arrangements for recreational activities and rest, can prevent the disorder of hypothalamic function caused by excessive fatigue.
3. Carry out the education of correct human beauty
A small number of cases have stubborn prejudice and morbid psychology for eating and obese body weight, resulting in a strong fear of getting fat and tempering diet, maintaining the so-called "beauty" of body shape, so the education of correct health "beauty" is also indispensable. .
Complication
Pediatric anorexia complication Complications, malnutrition, electrolyte imbalance
Due to less eating and consumption, patients may have multiple physical complications such as moderate to severe malnutrition, water, electrolyte imbalance, edema, anemia, leukopenia, delayed gastric emptying, constipation, bradycardia, hypotension, Arrhythmia, peripheral neuritis, pseudo-brain atrophy, seizures, dry skin, fetal hairy hair, dental caries, periodontitis, decreased resistance, easy infection, and may have mental symptoms such as anxiety, depression, irritability Get rid of, compulsive thinking and movement, insomnia, inattention, etc.
Symptom
Children with anorexia nervosa symptoms common symptoms anorexia nervosa development slow body image disorder refusal to eat abnormal mood anorexia babies anorexia hoarding hoarding anorexia in summer
The main cause of this disorder is adolescence and insidious onset. The main clinical manifestations are as follows:
1. Make every effort to reduce calorie intake and absorption. Patients may take various possible methods, such as eating very little every day; not eating staple food, meat, eggs or milk; taking vomiting after eating; taking laxatives or diuretics In order to achieve the purpose of reducing calorie intake and absorption, patients may lie, avoid others or explain their behavior with other reasonable reasons for the above purposes.
2. Make every effort to use the various methods to consume the absorbed heat. Patients often use excessive exercise to achieve this goal, including running, jumping, brisk walking, etc., and may lie to avoid others.
3. The weight is obviously reduced. However, the patient is still afraid of fat, and has body image distortion. Although he is skinny, he still feels fat.
4. Delayed development of secondary sexual characteristics: patients with pre-puberty onset have delayed development of secondary sexual characteristics, primary amenorrhea, amenorrhea in women with post-puberty onset, men with loss of libido and impotence.
5. Others: Some patients have periodic gluttony episodes, and they are induced to vomit after eating.
Examine
Pediatric anorexia check
There are multiple abnormalities in the blood test of patients with comorbidities.
1. Peripheral blood: There may be a decrease in hemoglobin and red blood cell counts, and a decrease in white blood cell count. There may be an increase in white blood cells and neutrophils in the event of an infection.
2. Blood biochemical examination: serum protein reduction, electrolyte imbalance, metabolic acidosis, etc.
Generally, B-ultrasound, chest X-ray and ECG should be performed.
3. It is possible to carry out trace element examination to find out that children are anorexia or ecstasy caused by lack of trace elements.
4. It can also be tested by fiber endoscopy or according to the extraction of coffee-like substance and fecal occult blood in the gastric tube during gastrointestinal bleeding.
Diagnosis
Diagnosis and diagnosis of anorexia anoxia in children
diagnosis
The following diagnostic points are required:
1. Significant weight loss: Weight remains at least 15% below the expected value (either weight loss or never reached expectations), or Quetelets body mass index {ie: weight (kg) / [height (m)]} At or below 17.5, pre-pubertal patients may exhibit weight gain that does not meet expectations during growth and development.
2. Weight loss is caused by yourself: including refusal to eat fat food and one or more of the following: self-induced vomiting, self-induced laxation, excessive exercise, taking food inhibitors and/or diuretics.
3. Distortion of body image in a specific form of psychopathology: manifested as the persistence of an irresistible concept of over-price that is afraid of getting fat, and patients strongly demand a lower weight limit.
4. Extensive endocrine disorders including the hypothalamic-pituitary-gonadal axis: in women with amenorrhea; in men with loss of libido and impotence, the following can also occur: elevated levels of growth hormone and cortisone, thyroid Peripheral metabolic changes and abnormal insulin secretion.
5. Delay in puberty development If puberty occurs before puberty, puberty development will slow down or even stagnate, as the condition recovers, puberty can be normal, but menarche is delayed.
Differential diagnosis
1. Pay attention to the identification of "pseudo-anorexia"
You must first rule out whether your baby has a cold or chronic medical disease, such as long-term diarrhea, chronic hepatitis, tuberculosis, etc. If the anorexia caused by these diseases is natural, the anorexia will improve after the disease is cured. True anorexia means that children have long lost their appetite, don't want to eat food, and even refuse to eat. This situation usually lasts for more than two months to meet the so-called "anorexia".
2. Certain chronic diseases such as peptic ulcer, chronic enteritis, tuberculosis, indigestion and long-term constipation may cause anorexia.
3. Pay attention to the identification of iron deficiency anemia
Iron deficiency anemia is a frequently-occurring disease in children. In addition to causing effects on hematopoietic function and cellular immune function, iron deficiency can also cause gastric acid reduction, stomach, duodenitis, intestinal mucosal atrophy and absorption dysfunction and other gastrointestinal digestive functions. Abnormal, affecting children's appetite, and even growth and development. It has certain similarities with the symptoms of anorexia in children, so it is necessary to check it out in order to avoid misdiagnosis.
4. Pay attention to the identification of hookworm disease
Children with hookworm disease have symptoms such as anemia, ecstasy, and loss of mental appetite. They should be checked for stool routinely to find hookworm eggs, and deworming treatment should be timely after diagnosis.
5. Most anorexia in children is not caused by disease, but by poor eating habits, unreasonable diet, poor eating environment and psychological factors of parents and children. In addition to poor dietary habits in the family environment and medical history, it is necessary to rule out the relevant disease factors in order to diagnose, and pay attention to correct bad habits, step by step, correct induction and encouragement.
