How to Identify Eating Disorders in Children

How to Identify Eating Disorders in Children Eating Disorders Symptoms Print 4 Signs of Eating Disorders in Children By Lauren Muhlheim, PsyD, CEDS facebook twitter linkedin Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy. Learn about our editorial policy Lauren Muhlheim, PsyD, CEDS Medically reviewed by Medically reviewed by Steven Gans, MD on July 25, 2015 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on June 24, 2019 Brand New Images, Taxi, Getty Images More in Eating Disorders Symptoms Treatment Diagnosis Awareness and Prevention Eating disorders in children are often very hard to recognize even for some health professionals. Children are not just little adults. 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. Parents commonly feel guilty for missing the signs of an eating disorder in their child. This guilt is 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. 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 patients with eating disorders. For example, younger patients are less likely to binge or to use compensatory behaviors (behaviors designed to minimize the consequences of binge eating) such as purging, diet pills, and laxatives. Children are more likely to be diagnosed with avoidant restrictive food intake disorder (ARFID) than older patients.   So what are some of the early warning signs that parents may want to investigate further when/if they occur? Four Signs That Might Surprise You 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 will only evaluate a childs weight in comparison to population norms 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 concernsâ€"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 with eating disorders, we often 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 attention deficit hyperactivity disorder (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. A Message from Verywell 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.  You need to act. Your childs fate is in your hands. Parents are not to blame and can play an important role in helping a child with an eating disorder to recover.