Signs of eating disorders in children and teens

Eating disorders are serious but treatable illnesses that can affect any age, ethnicity, gender, body shape or size. Although there is no single cause for an eating disorder, a combination of biological, sociocultural and psychological factors can lead the to development of disordered eating patterns.

Unfortunately, some teens and children may develop eating disorders that can harm their health, emotions and relationships with others.

Here, Dr. Wayne Nguyen, director of psychiatry, and Dr. Alexandra Roche, division chief of adolescent medicine at CHOC, discuss the signs of eating disorders, their medical complications and what parents can do to help.   

What signs can parents look for to indicate that their child may have an eating disorder?

There are many signs that parents can look for that may indicate that their child may have an eating disorder, says Dr. Nguyen.

Children or adolescents with a possible eating disorder may exhibit the following behaviors:

• Showing extra preoccupations or concerns about their body image.
• Spending extra time looking at food, counting calories and preparing for a meal.
• Isolating themselves, including eating alone.
• Changing or restricting their diet.
• Weighing themselves more frequently.
• Putting excessive focus on healthy eating and the foods that they eat.

Some children and teens struggling with eating disorders will start wearing baggy clothes to hide their bodies, says Dr. Roche. Additionally, they may even start to show changes in their attitude and behavior. They may become crankier, more irritable and more isolated than normal, and may start to withdraw from friends and activities they once enjoyed.

Parents should look for signs and symptoms of other mental health problems like depression or anxiety. Eating disorders may coexist with these types of disorders.

CHOC offers mental health resources for parents, with overviews and tips on a variety of mental health topics.  

Types of eating disorders

There are several types of eating disorders that children and teens may struggle with, including:

Anorexia Nervosa

Those struggling with anorexia nervosa:

• Consume significantly fewer nutrients then their body needs, which can lead to dangerously rapid weight loss, a very low body weight, changes in blood pressure and heart rate that can result in cardiac abnormalities.
• Have an intense fear of weight gain.
• Have a distorted body image. They have unrealistic views of their bodies (for example – seeing themselves as bloated or overweight despite being underweight).

Those struggling with anorexia often follow rigid food rules about portions sizes or the types of foods they will eat. They may think about food, calories or the possibility of gaining weight almost all the time. To lose weight, some may practice fasting or exercise too often. Others may use laxatives, diuretics (water pills) or enemas.

Bulimia Nervosa

Those struggling with bulimia nervosa:

• Binge eat. They often overeat and feel out of control during these binging episodes.
• Engage in behaviors to make up make up for overeating. They may make themselves throw up on purpose after they overeat. Other responses to the binging episodes include using laxatives, diuretics, weight loss pills, fasting or over exercising.
• Judge themselves based on their body shape and weight.

Many, but not all, of those struggling with bulimia may have yo-yo weight changes, either up or down.

Binge Eating

Those struggling with binge eating disorder:

• Overeat and feel out of control to stop.
• Eat large amounts even when they are not hungry.
• May feel upset or guilty after binge eating.
• Often gain weight and may become very overweight.

Many children and teens struggling with binge eating disorders eat faster than normal and may eat alone to avoid having others see how much they are eating. Unlike bulimia, those struggling with binge eating disorder do not make themselves throw up, use laxatives or over-exercise to make up for overeating, but the related emotions can result in significant guilt or mood changes.

Avoidant/restrictive food intake disorder (ARFID)

Those struggling with ARFID:

• Are not interested in food or avoid foods.
• Lose weight or don’t gain expected amount of weight.
• Are not afraid of gaining weight.
• Don’t have a poor body image (often they are aware they are underweight).

Often, people with ARFID don’t eat because they have a negative response to the smell, taste, texture or color of food. Some may have choked on food in the past and are afraid it may happen again. Many kids with ARFID are underweight, but others are normal weight or overweight with nutritional deficiencies — especially if they eat only junk food.

What are some of the medical side effects of having an eating disorder?

There are actually numerous medical side effects that aren’t always associated with eating disorders, says Dr. Nguyen. Physicians may see the following medical conditions caused by eating disorders:

• Electrolyte imbalance — changes in potassium phosphate sodium levels can affect the way the human body regulates itself. As a result, these changes can cause seizures.
• Changes in blood pressure and heartrate — these changes can lead to dizzy spells, fainting, fatigue, weakness. They may also be a sign of pending cardiac arrhythmias, or when the heart beats differently, which can lead to sudden death.
• Kidney damage — dehydration caused by eating disorders can damage the kidneys and cause kidney stones.
• Tears in the esophagus — frequent vomiting caused by bulimia can lead to tears or even the rupture of the esophagus.
• Bone loss — when the bones aren’t receiving necessary nutrients through food, they may weaken and break down. This may not be reversible even with nutritional recovery.
• Loss of tooth enamel — stomach acid from frequent vomiting can cause tooth enamel to breakdown, making it painful to eat or drink hot or cold substances.
• Loss of periods – low body weight can reduce the body’s fat stores, which play a necessary role in the production of reproductive hormones.
• Anxiety, depression and obsessive-compulsive disorder (OCD) — children with eating disorders are more likely to develop other mental health disorders and turn to alcohol and substance misuse.

If a parent suspects that their child has an eating disorder, what should they do?

It can be difficult to determine if your child truly does have an eating disorder, says Dr. Roche. It’s important to not ignore the signs you may see in your child’s eating behavior or weight loss. Allow your child’s pediatrician to do a thorough medical evaluation.

During your child’s evaluation, the provider will look for things like thyroid problems, celiac disease or inflammatory bowel disease. They will make sure that your child is healthy from that standpoint, and then start to talk about if could there be some other reason why they’re not eating healthy foods and gaining or losing weight.

If there isn’t another reason for your child’s weight fluctuations and eating habits, your pediatrician can make referrals to build a supportive care team for your child.    

How parents can help

Family members can play a key role in helping their child recover from an eating disorder and to return to a healthy weight. Eating disorders are linked to strong emotions and worries about body size and shape. Help your child have a healthy body image. Be supportive and encourage positive attitudes about exercise and nutrition at home. Try these tips:

• Be a role model. Don’t criticize your own weight, body, or looks. Talk about your body in positive ways.
• Avoid talk about weight or weight shaming your child.
• Focus on a healthy lifestyle. Encourage everyone in your family to be active every day and eat a varied diet.
• Set regular mealtimes. Skipping meals and limiting calories can trigger binge eating. 
• Identify other triggers. Stress, mood and poor sleep can lead to unhealthy eating behaviors. Ways to manage stress and improve mood include music, art, dance, writing or talking to a friend. Yoga, meditation or taking a couple of deep breaths also can help your child relax.

If you are concerned your child may have an eating disorder, call your child’s pediatrician for advice. Your pediatrician can recommend nutrition and mental health professionals who have experience treating eating disorders in kids and teens.

Learn more about CHOC’s eating disorders program.

The treatment and recovery for chronic or long-term eating disorders may be long. Because of this, treatment should take a team-based approach with your pediatrician, nutritionist and mental health professionals. Your care team can offer your family support both in the clinic and at home.

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