Identifying Eating Disorders in Children: 4 Signs You Might Not Recognize

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Parents often feel guilty for missing the signs of an eating disorder in their child.  I usually try to help them assuage this guilt.  It’s not productive and not warranted.  Although eating disorders seem to be common in our culture, the odds of any particular child developing an eating disorder are quite low, and most parents are not actively watching for the initial indicators.  Yet in retrospect, many parents are able to identify some of the early warning signs and regret not having been better informed about them.

Eating disorders in children and younger adolescents often present differently than they do in older individuals, and misinformation about eating disorders abounds, even among medical professionals.  As a consequence, missed opportunities for diagnosis are common during the early course of a child’s eating disorder.  This is unfortunate since early treatment significantly improves treatment outcome. 

Children and younger adolescents may not display the more obvious (and stereotypical) signs of an eating disorder that we see in older sufferers.  For example, younger patients are less likely to binge and to use compensatory behaviors such as purging, diet pills, and laxatives. 

So what are some of the early warning signs that parents may want to investigate further when/if they occur?

1) Lack of weight gain or growth in a growing child

Older patients may state they are fat or express diet intentions, and they often exhibit weight loss.

  However, in children there may not even be actual weight loss.  Instead, this may show up only as a lack of growth or a failure to make expected weight gains. Monitoring your growing child’s growth is something the pediatrician should do, but not all pediatricians are trained in spotting eating disorders.

  It’s a good idea for parents to keep an eye on weight and growth trajectories. Some physicians mistakenly compare a child’s growth only to standardized charts and this can lead to a missed diagnosis. It is important to compare height and weight against the child’s past growth charts.

2) Eating less or refusal to eat with no or a vague explanation

Younger children are less likely to express body image concerns – instead, they may “sabotage” attempts to get them to eat enough to maintain weight and growth. Some of the more subtle excuses kids give for not eating include rejecting previously liked foods, not being hungry, or having vague goals of being healthier (which many parents, accustomed to their kids consuming a certain amount of junk food, initially support).  Children may also complain of stomachaches. 

3) Hyperactivity or restlessness

In adults we see excessive exercise, but in children, the activity is less goal-directed.  You won’t see them spending hours at the gym or running around the neighborhood; instead, they may appear restless or hyperactive and may move around a lot in a non-goal directed way.

Dr. Julie O’Toole describes the exercise compulsions/motor restlessness as “relentless.” Parents often report their children won’t sit still and/or fidget. This manifestation may look more like a child with ADHD and parents may not be thinking about an eating disorder as a possible explanation. 

4)  Increased interest in cooking and/or watching cooking shows

Another commonly misinterpreted symptom is an increased interest in cooking.   Contrary to common perception (and maybe even contrary to what they verbalize), people with restrictive eating disorders do not lack an appetite, but are in fact hungry and thinking about food all the time.  Adults may cook for others and read or collect recipes.  In children, we often observe a similar preoccupation with watching cooking shows on TV.  Parents usually initially think this is a good thing as the child is taking an interest in food; however, it may be a sublimation of the hunger drive.  People who are not eating enough obsess about food, and children and adults with anorexia may replace eating with other food-oriented activities.

Eating disorders most commonly develop during the adolescent years but have been documented in children as young as seven. Weight loss in a growing child is unusual and even if the child started out overweight, should be met with caution.  If you are concerned that your child is struggling with eating and/or showing any of the above signs, speak to your pediatrician.  If your pediatrician does not seem to take your concerns seriously, trust your parental instinct, seek additional consultation, and learn more about eating disorders.  A helpful resource for parents is Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T).  

A successful treatment for children and adolescents with eating disorders is Family Based Treatment.

Read more about identification of eating disorders in children:

Not Just Small Adults:  Eating Disorders in Young Children

Eating Disorders in Children

The Very Young Child With Anorexia

10 Steps to an Accurate Eating Disorder Diagnosis

 

Eating With Your Anorexic

Additional Sources:

Peebles, R., Wilson, J. L., & Lock, J. D. (2006). How do children with eating disorders differ from adolescents with eating disorders at initial evaluation? Journal of Adolescent Health39(6), 800-805. 

Walker, T., Watson, H. J., Leach, D. J., McCormack, J., Tobias, K., Hamilton, M. J., & Forbes, D. A. (2014). Comparative study of children and adolescents referred for eating disorder treatment at a specialist tertiary setting. International Journal of Eating Disorders47(1), 47-53.

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