How To Spot Eating Disorders in Kids and Teens

Are you sending your kids the right messages about food and body image? Eating disorders are diagnosed not just in teens, but in children younger than 12. So it’s important to teach your kids from an early age to have a healthy relationship with food and positive feelings toward their body.

The dinner table is a great place to start. That’s where you can have a hand in what your kids eat and how they think about food in concrete ways that may last a lifetime. 

Eating Disorders Not Always About Food 

Many eating disorders aren’t about food at all — they’re indicative of other behavioral or physical problems such as anxiety, lack of control or emotional management. 

In addition to the more well-known eating disorders such as anorexia, bulimia and binge eating, children may also suffer from what’s called avoidant/restrictive food intake disorder or ARFID. This is driven by a child’s avoidance of certain textures or by fear of choking due to a past incident. It can affect children with autism or other sensory processing disorders. 

Eating disorders and unhealthy attitudes toward food can be particularly dangerous for children because they need calories to promote healthy brain development. In older children, a lack of calories can sometimes cause severe electrolyte problems that require hospitalization and extended treatment. 

A reaction to malnutrition called refeeding syndrome occurs when the phosphorus in the blood has been so depleted and cells’ energy stores are so low that a return to normal too quickly can actually lead to cardiac problems such as arrhythmia. In this case, it’s best to have the patient hospitalized so that doctors can monitor food intake and the body’s reaction to it. 

Signs To Look Out For 

A child’s body changes so quickly that it can be easy to jump to conclusions about what constitutes an eating disorder. Look for these clues:

• avoiding family meals

• claiming to have already eaten or promising to eat later

• becoming secretive about eating or hiding food

• scarring on the hands from induced purging

• breakdown of dental enamel from repeated vomiting

• talking obsessively about food’s nutritional values

• preoccupation with calorie counting

• exercising excessively or having a preoccupation with body image 

Reinforcing Healthy Food Habits and Body Positivity 

Parents ultimately have a say in what, when and how their children eat, but you can build independence and encourage creativity in eating from toddlerhood. Give your children multiple healthy snack options a week, for example, and let them choose which one to eat each day. 

Kids are naturally curious, and you can encourage that curiosity by helping kids understand how ingredients turn into meals: A tomato isn’t just a tomato; it’s a pizza topping, pasta sauce or ketchup. 

When your kids are older, they may have more independence when it comes to their food. They’re out of the house more often, so you can’t always check up on their eating habits. At this point in their development, have healthy snacks around the house. 

Children also can see and internalize how you act around food. Try to avoid talking about calorie counting and dieting at home and instead keep the focus on health and well-balanced nutrition. This applies at the doctor’s office, too. Remaining within a certain percentile range is more important than BMI. Overall health is determined by whether your child’s weight falls within a range your pediatrician deems healthy and does not wildly fluctuate from visit to visit. 

Pediatricians often will talk to kids and teens alone first before they talk to parents to establish a safe environment and build trust. If a child isn’t overtly in harm’s way, doctor-patient confidentiality applies. But if a child appears to be suffering from an eating disorder, doctors will involve parents and come to a decision about whether to involve a therapist or nutritionist, or whether hospitalization and rehabilitation may be necessary. 

Outside of your pediatrician’s office, some excellent resources available to parents with concerns about their child’s eating habits include: 

• Families Empowered and Supporting Treatment for Eating Disorders (FEAST)

• National Eating Disorder Association

• AAP Healthy Children