Eating Disorders in Children: Recognize Red Flags

In Part 1 of my series, Eating Disorders in Children, you read about the different types of eating disorders, from anorexia nervosa (AN) to Avoidant Restrictive Food Intake Disorder (ARFID).  Now, I’m covering the signs of an eating disorder so you can get treatment early on.

6 Signs of an Eating Disorder

In this segment, I want to emphasize prevention, which includes recognizing the signs of an eating disorder so early identification of them in children can be made and treatment can get underway.  

Weight Changes

Rapid weight loss or weight gain is one of the hallmark signs of an eating disorder.  Don’t just focus on weight changes, though.  In children there may be a lack of weight gain over time, which appears like a flat line on the weight for age growth chart (rather than incremental increases over time). If lack of weight gain persists, you may see a flattening of the height curve as well. These flattened curves represent slowed or decreased growth.  

Dieting  

Dieting or restrictive eating can take shape in different forms. In children, we may not see “classic” dieting where kids are counting calories. Some children may complain of tummy aches, not liking certain foods they used to enjoy, or being “too busy” or “too tired” to eat. Another sign of dieting may include a change in a child’s view of food, especially as it pertains to unhealthy or bad foods. They may start avoiding high fat or high calorie foods. Other red flags for dieting are denying one’s feelings of hunger, counting (or knowing) the calories in food, and avoiding eating out at restaurants or fast food establishments. More dangerous behaviors associated with dieting are taking diet pills, laxatives, and diuretics to incur fast weight loss.

Eating Behavior Changes 

Another category of eating disorder symptoms involves eating behavior, and these can be more subtle, but are often noticed by a parent. For example, skipping meals is a common practice of teens, but not of children.

Radical diet changes without any specific motivation, like becoming a strict vegan without a clear “why” behind it can be a sign of an eating disorder. On the other hand, eating abnormally large amounts of food and going to the bathroom immediately following a meal could mean something is going on.

Food rituals can also warn of an eating disorder, such as cutting food into small pieces, eating food in a certain order, not allowing foods to touch each other, or weighing food.

Last, persistent picky eating, including dropping foods from the diet so that there is a limited number of foods (20 or less) that are acceptable to eat, an unwillingness to try new food, or an emotional response or aversion to certain foods may indicate ARFID. 

Exercise Habits

Compulsive working out may be another sign of an eating disorder. Look for extra trips to the gym or clues of extreme exercising like distress over missing a work out, continuing to exercise when injured, or skipping fun social events to get a workout in. 

Physical changes

Bodily changes like unusual swelling of the cheeks or jaw, calluses on the back of hands or knuckles, and staining of teeth are marks of self-induced vomiting. Downy hair covering the body, protruding bony joints, and hair thinning may be a sign of anorexia nervosa.

Weight or body topics

Frequent weighing, body checking and frequent comments or conversation about weight, physique, food, and eating may also alert parents to a potential eating disorder. Regret and guilt after eating may also be a clue.  

Of course, some of these signs won’t indicate an eating disorder. They will represent a normal phase of child or teen development, such as becoming a vegetarian to experiment with different eating patterns.

However, if you start to see persistent changes that accumulate over time, your child may need treatment. Be proactive, ignoring the signs of an eating disorder will not make them go away!

What to Do if You See the Signs of an Eating Disorder

Get professional help 

Your first stop should be your child’s pediatrician.  If an eating disorder is suspected or diagnosed, consider getting a treatment team involved.  A treatment team usually consists of a physician, psychiatrist, therapist, and registered dietitian that specialize in eating disorders.  To find treatment professionals in your area, go to a reputable source like the Academy for Eating Disorders’ website and their Find a Professional resource.

Educate yourself

Learn as much as you can about eating disorders.  Read books, articles, and brochures.  Don’t forget reputable sources on the Internet like The National Eating Disorders Association.  Gurze bookstore is a great resource for finding books about preventing and understanding eating disorders.

Ask questions 

You can never ask too many questions when it comes to your child.  See the National Eating Disorders Association’s handout, Treatment of Eating Disorders for questions to ask professionals.

Treatment is available and recovery is possible! 

Remember, the earlier treatment is sought, the higher the likelihood for a full recovery.

Next up:  Eating Disorders in Children: How Parents Can Prevent Them