Identifying eating disorders in young children and teens – early warning signs and first steps if you suspect your child might have an eating disorder
The early signs of an eating disorder can be difficult to notice. The onset is often very subtle and then begins to snowball until your kiddo or loved one has experienced a significant change in their weight or is experiencing medical complications. You may even feel like you don’t recognize your kiddo anymore - both physically in their appearance and often in changes to their personality as well. Unfortunately, the nature of diet culture, abundance of nutrition information online and on social media, makes many of the initial warning signs of an eating disorder more challenging to recognize. I’ve heard a story like this next one too many times to count; Your kiddo or loved one makes seemingly “healthy” changes to the foods that they eat or stops eating certain foods that are commonly labeled as “unhealthy.” These behavior changes gradually build until your kiddo is displaying extremely rigid food rules, expressing anxiety around food, restricting a majority of their energy needs, hiding or hoarding food, bingeing, and/or making themselves throw up after eating (purging). Many parents see these initial changes as positive – often noting that their kiddo ate everything before the eating disorder, were “big eaters,” or “loved junk food.” Parents may assume their kiddos are taking more responsibility for their health and making “good choices,” because that’s what diet culture tells us we should be eating. I totally understand this thought process! Not every shift in behavior with food is going to result in the development of an eating disorder, but these seemingly innocent changes might be warning signs to pay attention to.
This is why I encourage parents - and really anyone that eats with kiddos regularly - to pause before they make any comments about what, how much, or how a child is eating. You cannot look at a kiddo and know if they possess some of the common traits, genes, and environmental factors that predispose them to an eating disorder. Eating disorders are one of the most deadly mental illnesses, and the number of individuals suffering has increased significantly since the pandemic, especially in younger populations. Identification and early treatment of disordered eating behaviors and eating disorders can be lifesaving.
So, what are some early signs that your kiddo may be struggling with their relationship with food and/or body, disordered eating, or an eating disorder?
Cutting out or eating fewer foods that might be seen as “unhealthy” or “junk” foods or an increased focus on incorporating more “healthy” foods.
An increase in questions or comments about food, nutrition, weight, exercise that feel different - maybe more judgmental - from how your kiddo talked about those topics before.
Skipping meals or snacks they had always eaten before.
Making up reasons for missing family meals (i.e. taking on more shifts at work, joining an extracurricular at school, hanging out with friends).
Eating smaller portions at meals or bringing home leftovers in their lunch box.
A switch from typically eating school lunch to needing to pack their own lunch.
An increased interest or scrutiny over what’s being served for dinner or family meals, especially if they were previously pretty open to what was being served.
A sudden desire to adopt a vegetarian or vegan diet if they had previous consumed animal protein.
Experimenting with various diets or trends, such as keto, paleo, “detoxes,” intermittent fasting, or other programs.
Finding food, food wrappers or containers hidden in their room, car, or other discreet spots.
Avoiding going out to eat with family or friends or social/family events that tend to involve food.
Withdrawing from family and friends; engaging less in social activities.
Increase in exercise outside of organized athletics, gym class, or other typical physical activity.
Pacing around the house, having a hard time sitting still, and increased fidgeting.
A shift in the way they dress – more layers, baggier clothes, and/or changing multiple times per day or before they leave the house.
More noticeable mood fluctuations or increased irritability.
Decreased energy levels, increased frequency of naps or complaints of being tired.
Note: This list is certainly not comprehensive, and these behaviors and attitudes alone may not signify that your kiddo is struggling with an eating disorder. You know your kiddo(s) best! But if you are noticing these changes, this may be a good opportunity to check in with your kiddo and make sure they are feeling confident and supported in their relationships with food and their bodies.
What are some of the more overt signs of eating disorders to check for?
Weight changes, whether that looks like weight loss or weight gain. While a clinically significant weight change will likely flag sooner, we still need to be aware of any changes in weight because the number on the scale is just one factor in diagnosing the severity of an eating disorder.
Abnormal labs – electrolytes, glucose, renal function, and liver enzymes.
Abnormal vital signs - low blood pressure, slow/irregular heartbeat, low body temperature.
Complaints of dizziness or fainting.
New complaints of headaches and/or increased frequency.
Amenorrhea, or absence of a menstrual cycle in females. This can be difficult to assess if your kiddo is already taking hormonal birth control, which produces a “false period.” For females that haven’t started menstruating, an eating disorder can delay the onset.
Complaints of always feeling cold, wearing clothes that seem inappropriate for the weather or temperature of the room, or always covering up with blankets.
Gastrointestinal complaints, such as stomach aches (especially after eating), nausea, constipation, bloating, and reflux.
Swollen salivary glands can be a symptom of purging behaviors.
Increase in dental cavities or complaints of teeth sensitivity.
Changes to their skin, such as dry, pale skin. Parents will often describe their kiddo as looking “gray,” and with nourishment and healing, the “color coming back” into their face.
Changes to hair, such as fine hair growth on body (called lanugo), thinning of their hair, and increased hair loss.
Nails that chip or break easily or have a blueish tint to them.
If your kiddo plays sports or is very active, they may experience an increase in injuries, stress fractures, or delayed recovery after training.
Note: Again, this list is not comprehensive to every possible symptom of an eating disorder, nor does every person that has an eating disorder experience these complications. However, many of these can be life-threatening, which is why early identification and intervention is SO important!
{What are some first steps if you suspect your kiddo may be struggling with their relationship with food, body image, disordered eating, or an
eating disorder? …}
Don’t wait! Recovery from an eating disorder is possible at any stage, but treatment is more effective the earlier it starts.
Reach out to your kiddo’s pediatrician for further evaluation and diagnosis.
Start assembling a treatment team. At a minimum, this should include your kiddo’s pediatrician or regular physician, a therapist, and a dietitian. Other specialists may be required as well, and that’s okay! You want your kiddo to have the best chance at recovery.
Start your research on how to support loved ones with an eating disorder. You’re reading this, so you’ve already started. Check out these resources as well:
NEDA (National Eating Disorders Association)
F.E.A.S.T.-ED (Families Empowered And Supporting Treatment for Eating Disorders)
Express concern using “I” statements: i.e. “I’m worried about you. I’ve noticed that you’ve been skipping meals more often and not hanging out with friends. I’m here if you want to talk about anything. I’m going to make an appointment with your pediatrician to make sure everything is okay.” It is very common to be met with resistance or denial, but saying something is better than silence.
While a lot of comments come from a well-intentioned place of love and concern, here a few that I would recommend avoiding:
Try not to make the focus on weight or body size – eating disorders are about so much more than the body, even if there is a body image component to the eating disorder.
Telling them to “just eat.” It’s just not that simple.
Comparing your kiddo to their friends, siblings, or even yourself in terms of weight, activity level, or food intake.
Complimenting your kiddo’s physical appearance (particularly if there has been a change because of the eating disorder). Compliment them on qualities that are not based on physical appearance – their kindness, generosity, humor, intelligence, courage, etc.
Know that your kiddo and family are not alone! Recovery is possible.
