Giulia was only 17 when, on March 15, 2022, she fell asleep never to wake up again. She was blamed for a cardiac arrest caused by the very fragile physical conditions in which she found herself due to the disease - anorexia, which later turned into bulimia - which had struck her 4 years before her. Her father, Stefano Tavilla, did not give up, and continued to fight by founding the association Mi feedro di vita, which since 2022 has been organizing the March 15, the National Day of the lilac bow in contrast to eating disorders (DCA). With events and awareness-raising initiatives on the issue scattered throughout the country.
This year the attention is focused in particular on a very worrying phenomenon, namely the lowering of the age of onset of anorexia. If up to a few years this disorder affected almost exclusively adolescents and young women, today diagnoses are increasingly frequent even under the age of 14, and even among girls - but also boys - of eight or ten years.
"With us it is more and more frequent to meet children of this age group" says the neuropsychiatrist Valeria Zanna, specialized in eating disorders at the infantile neuropsychiatry of the Bambin Gesù Pediatric Hospital in the city. A figure confirmed by the results of a survey by the Ministry of Health conducted between 2022 and 2022 at six other Del Paeseni centers that deal with these conditions.
According to some international investigations, about one in 100 children would suffer from anorexia, bulimia or other eating disorders: mostly females, but not only. While from adolescence onwards, males are about 10% of the sick, under the age of 14 they are close to 25%.
Sometimes, anorexia manifests itself already around the age of eight or nine with the typical characteristics found in adolescence. "We meet little girls who already are obsessed with their own physical image, they look continuously in the mirror, they see themselves fat and are afraid of gaining even more weight "says Zanna. Other times, however, the onset is more nuanced, and therefore more difficult to recognize." The fear of gaining weight is not always declared and the concern for one's own appearance "explains psychiatrist Laura Dallaragione, head of the Eating Disorders Center of the Palazzo Francisci Residence in Todi, and scientific referent of the Ministry of Health for the investigation of DCA." In these cases, weight loss and food restrictions risk being interpreted as a simple infantile loss of appetite, perhaps associated with a period of stress ".Not recognizing the problem, however, means delaying the diagnosis and therefore the possibility of treatment. And as often happens, the later action is taken, the harder it is to recover. With consequences on the physical plane that can be important.
"A major malnutrition at 10-11 years can result in a blockage of bone growth"explains Dallaragione." And even when you start eating and growing again, you may not be able to reach the height you would have reached without malnutrition ".
However, anorexia is not the only eating disorder that can occur in childhood. There are also other forms and for example the selective eating disorder. "It occurs when the child categorically refuses to eat various categories of food" explains Dallaragione. "It is seen in a mild and transient form in many children, and in these cases it is obviously not a big problem, even if it must be kept under control to prevent it from degenerating".
The problem arises when the child eat fewer than 10 different foods, often all of the same color. "In these cases it may seem that the child is fine, maybe he doesn't even lose weight. In reality, however, he is facing a nutritional imbalance and severe limitations in relationship life. And he is manifesting some form of psychological distress".
Another type of childhood disorder, which can in turn evolve towards anorexia, is the so-called functional dysphagia. "It occurs when the child does not eat because she is afraid of doing so" continues Dallaragione. "Maybe he saw someone who risked choking on a bite that went wrong, or he himself experienced some difficulty in swallowing. The reaction is the refusal of food, especially solid food."
Anorexia, bulimia, binge or selective eating (here a concise explanation of the various eating disorders) they are all multifactorial disorders. "It means - states Dallaragione - that they do not have a single and precise cause, but depend on the combination of various factors: genetic predisposition, personal vulnerability, as can be the tendency to anxiety, obsessive behavior or depression, family dynamics".
Without excluding the social context, which by now proposes a unique ideal of beauty coinciding with thinness, and which pushes more and more towards an early adultization of girls. "Let's think of the clothing industry, which offers very 'grown-up' clothes for the little ones as well" remembers Zanna. "Or that of the toy, which produces dolls with absolutely unreal bodies, but which become a reference for girls".
In addition, a traumatic cause is often involved in children. There can be a traumatic event - a major family bereavement, separation of the parents, sexual abuse, but also a move to another city, with the loss of a best friend - which leads to a mood disorder that time it can result in an eating disorder. "It may happen that at the beginning there is only a lack of appetite, the refusal of food because the stomach feels closed but over time a stiffening of eating behavior, which leads to real anorexia "says Zanna.
But how do parents realize that their daughter or son, perhaps still children, are entering or have entered the tunnel of an eating disorder? "In reality, parents, especially mothers, they tend to feel early on that something is wrong, because they pay a lot of attention to how much and what their children eat "says Zanna." However, this does not immediately correspond to a request for help, also because the refusal of food, which is interpreted as a refusal to life, sends them into crisis. ".
However, there are signs that - especially if they last for more than a couple of months - allow us to realize that the situation is getting complicated.
- Strange attitudes during meals: the little girl or boy begins to break up food, to remove the fat from the ham or the breading from the cutlet, they drink much more water, they ask to go to the bathroom often;
- Whole categories of foods are avoided;
- For the older ones: tendency to eat outside the home to ease parental vigilance. Maybe they claim to have eaten from a friend, or they bring a sandwich that they don't eat.
- Always for the little ones: increased physical activity, both organized sports and informal activities (no longer take the lift, go to school on foot or by bike instead of by bus.
- A progressive change of character. Children and teenagers affected by an eating disorder become sadder and more isolated, dull, and are always very nervous and irritable.
Until a few years ago, some theories on the origin of eating disorders pointed the finger at particular attitudes of parents. "They are outdated theories", states Dallaragione. "As we have seen, the origin is always multifactorial. It is true, however, that parents can make a difference after diagnosis and indeed in this sense they are an important resource. For this reason, today we tend to involve them a lot in therapy. Both to help the children and not to leave them alone, because undoubtedly a diagnosis of this type brings a considerable burden of anguish to the parents ".
So here is a small handbook to try to better manage the situation.
1. If in doubt, it is best to intervene immediately. "If you think that something is wrong, you can begin to get an idea of the problem by consulting some website on the Internet or by talking to your pediatrician" advises Zanna.
2. Don't be scared. It's not easy, but a parent today needs to know that eating disorders can be cured.
3. Don't blame yourself, don't feel responsible, but accept the idea that the disturbance could also be a request for attention. Not because you are bad parents, but for example because the family is experiencing a particular moment, in which there is a little less "mental space" for the children.
4. Promote communication immediately, both within the couple and with the children. "If parents are worried, they should immediately declare it to their daughter or son, underlining that the concern is more about the well-being of the body than the physical image," explains Zanna. In other words, we should not be worried because "you are losing too much weight", but because "we see that you have changed your diet and we doubt that it is not adequate for everything you do".
5. Do not put the question of "food" at the center of the life of the whole family. It doesn't have to revolve around meals, but you have to look for other moments to be together and share emotions and feelings.
6. Never emphasize the aspect of weight and body shape. For example, don't compliment your daughter because she finds her "a little fitter, a little fatter".
7. Never blame your children for their illness. "Parents often take a judgmental attitude, and children feel very guilty, because they know that their parents are suffering," says Dallaragione.
8. Don't get the message across that willpower is enough to get out of it. With the implication that, if you do not heal, it is because you are not trying hard enough. Instead, we must make it clear that we are all working together to achieve healing.
9. Set a good example, set yourself an example of healthy and balanced nutrition. Children cannot be expected to eat a full meal if they do not even sit down at the table and just eat two salad leaves standing up.
10. Don't turn mealtime into a clash of wills, with obligations and punishments. Also because it is useless: if a child does not want to eat, they will not. On the contrary, the moment of the meal should be a moment of dialogue and sharing, in which everyone "talks about himself". No, therefore, with the television on and comments on the news and the politics of the day.
If there is a suspicion that your little girl or boy is suffering from an eating disorder, the first figure to turn to is that of the pediatrician. "Not everyone is adequately trained to recognize these disorders, but in recent years a lot is being done in this regard," said Dallaragione, who coordinated a training course for pediatricians in which 5000 doctors participated.
The pediatrician, in turn, will refer to a specialist service for DCAs, or a child neuropsychiatry service. A list of the facilities present in Del Paese is available on the website dedicated to Eating Disorders of the Ministry of Health. "Unfortunately, the assistance network is quite varied throughout the country" explains Dallaragione. "If there are various structures to refer to in the Center and the North, the South and the islands are decidedly more devoid of them".
There is also a toll-free number SOS Eating Disorders active H24 from Monday to Friday: 800180969.
Once the diagnosis is made, the approach to the disease is of an integrated type: both nutritional, to restore balance to the nutritional state of the affected person, and psychological, to work on issues related to the suffering of the child or young person. The family is usually involved as well.
- eating disorders
- March 15 lilac bow
- 6-14 children years