Pediatric Bulimia Treatment & Management

Updated: Feb 28, 2020
  • Author: Maggie A Wilkes, MD; Chief Editor: Caroly Pataki, MD  more...
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Medical Care

Inpatient care is warranted if the patient is suicidal, has abnormal ECG findings or electrolyte levels, is dehydrated, or has had no response to outpatient therapy. Intensive outpatient treatment is currently being evaluated as an alternative to inpatient care. [23, 24, 25]

Inpatient care should include the following:

  • Supervised meals

  • Supervised bathroom privileges

  • No access to bathroom for 2 hours after eating

  • Monitoring of weight and physical activity. If underweight, patients will often attempt to artificially increase their weight by drinking water, not emptying their bladder or hiding weighted objects in their clothing prior to known weighing periods.

  • Assessment of nutritional state

  • Identifications of precipitants to binge and purge

  • Frequent assessment of electrolytes

  • Individual psychotherapy [26]

  • Frequent doctor visits

See Further Outpatient Care for outpatient management. [4, 5, 6, 7, 9]

Future directions

In addition to medications and therapy, there has been some preliminary work investigating effects of brain stimulation and neuromodulation in adults with bulimia. Further research is needed to see if transcranial magnetic stimulation will become an effective modality in treating bulimia and other eating disorders. [27, 28]


Surgical Care

Surgical care is indicated only in cases in which gastric or esophageal ruptures are suspected. [4, 5, 7, 8]



Cognitive behavior therapy (CBT) has been shown to improve outcomes in patients with bulimia. Referral to a mental health provider with experience in CBT is recommended.

Dental consultation is appropriate to help avoid progression of enamel erosion due to frequent vomiting.

Nutrition consultation can be very helpful in guiding patients toward normal eating patterns and healthy food choices.



Emphasis in diet instruction is on eating balanced meals, achieving a normal eating pattern, and consuming adequate calories.

Another goal is to reintroduce feared foods that patients previously binged on in small amounts, allowing patients to enjoy these foods without overeating.



Patient and family should be counseled to monitor excess activity. Practitioners should stress the importance of playful, pleasurable activities to reduce stress.