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is wrong, even when emaciated. Bulimia is a disorder characterized by repeated
bouts of overeating followed by secretive self induced vomiting or purging with
laxatives. Both of these are very serious and potentially life threatening eating
disorders. They are much more common in teenage girls, but do occur in boys,
and result mainly from the pressures of our society. Certain activities such as
ballet and wrestling seem to promote eating disorders possibly due to pressures
to achieve a certain weight. These adolescents develop a distorted view of
themselves, thinking they are fat when they are normal or thin. Typically, these
children are overachievers and are described as being the "perfect" child.

You may suspect that anorexia is developing in a child who has become
obsessed with her body image or has started to diet and or exercise excessively.
She may fear obesity and still feel fat despite a normal weight. Weight loss may
continue to an extreme. In females, absence of at least 3 menstrual cycles when
they are expected to occur may indicate excessive weight loss.

Look for other signs such as abnormal use of laxatives or purgatives (medicines
that make you vomit like Syrup of Ipecac). You may catch your child vomiting
after a meal. But most signs are very subtle and difficult to catch. If you have
any suspicions, contact your pediatrician to discuss it.

0. Lead Exposure
As indicated in our Well Child Care screening schedule all children six years of
age and under have their blood screened periodically for the presence of lead.
Childhood lead poisoning is a preventable pediatric health problem today.

Evaluating Risk: The following questions are used to evaluate the risk of
exposure to lead in a child's environment:

Does your child:
IA. Live in or regularly visit a house built before 1978? This could include a
day care center, babysitter or relative.

IB. Live in or regularly visit a house with peeling paint or recent, ongoing, or
planned renovation or remodeling, inside or outside?

2. Have a brother, sister, housemate or playmate with lead poisoning?

3. Live with an adult whose job or hobby involves exposure to lead?
4. Live near an active lead smelter, battery recycling plant, or other industry
likely to release lead?

A yes answer to question 1, part A and B, or any of the other questions would
indicate that lead screening should begin at 6 to 9 months of age for your child.

Sources of Lead Exposure:
1. Lead-based paint is the most common high-dose source of lead exposure.

Children are exposed when they ingest paint-contaminated dust and soil or
chips of lead-based paint. Many cases of lead poisoning result when
homes containing lead-based paint are remodeled or renovated without

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