It is not uncommon that I get asked about how to recognize eating disorders, including but not limited to Anorexia Nervosa and Bulimia, in kids and teens. Eating disorders are life-threatening illnesses that require intensive treatment and early intervention. Eating disorders look differently in every patient, which can make early detection tricky; however, there are some themes that unite youth with eating disorders that I would like to share.
Changes in Eating Behaviors
Often these early eating changes, such as avoiding sweets or increasing veggies, are exciting to parents. However, when an eating disorder is involved, parents start to notice that the rules about good and bad foods begin to increase rapidly. The child eliminates all sugars, adds vegetables to all meals, eats only 1-2 times per day, cuts out snacks, avoids carbohydrates, and eliminates sweets. At first it looks like a gravitation towards “clean eating” or “healthy eating.” Kids with developing eating disorders may suddenly become vegetarian or vegan. While none of these changes is concerning in isolation, when many of them happen and are combined with weight loss or change in growth and development, the concern for an eating disorder increases.
With bingeing or purging behaviors, we see secretive eating and frequent trips to the bathroom after eating. After a binge episode, hidden stashes of wrappers and empty food containers can be found in the trash or tucked away in a child’s room. With purging, the stomach acid that is produced by vomiting may leave a stain on bathroom fixtures or parents are able to hear the gagging noises while a child is in the restroom after eating. Additionally, when purging occurs in the shower it is not uncommon for pipes to become clogged and back-up more frequently.
Changes in Personality and Social Activities
With weight loss or slowing of growth and development, a youth with an eating disorder will also have personality and behavior changes. I hear from families about previously outgoing, talkative children turning into withdrawn, irritable loners that live in their bedrooms. Parents report fights about food and eating or having to walk on eggshells to avoid near constant conflict. Children with eating disorders will often isolate from social situations that involve food and eating. Parents may notice that their child avoids grabbing a bite to eat with friends and attending birthday parties, or resists attending food-related holiday activities. Most patients with eating disorders often maintain excellent grades in school and athletic performance.
Changes in Physical Health
There is no one weight or body mass index (BMI) that equals malnutrition. The diagnosis of malnutrition is usually based on departure from previous growth trends. A patient can have the negative physical effects of malnutrition at any weight or BMI. Malnutrition negatively impacts every single body system, so it is important that you monitor your child’s growth closely with your primary care provider.
When teens are malnourished, we notice tiredness, poor concentration, irritability, constantly feeling cold, dizziness, menstrual irregularities, hair loss and fluctuations in weight.
Changes in Self-Evaluation
Eating disorders change the way a person sees their body. Youth with eating disorders engage in body checking throughout the day as a measure of self-worth. A young person who body checks measures or monitors certain body areas to look for changes that would indicate weight gain, like taking thousands of pictures to monitor stomach size, berating themselves in the mirror every morning about pants being too tight now that they have grown, and pinching arms, stomachs, and thighs to “measure” the fat in these areas. For youth with eating disorders, these body checking behaviors often determine how much or if they will eat that day.
It All Comes Down to Change
One of the most protective and supportive things you can do as a parent is to get to know your child and to continue to know them as they grow and develop. All of these warning signs involve change in your child. To recognize a change, you must have a good understanding of what your child is like prior to developing an eating disorder. Trust your gut. As a parent you know when your child seems different or something feels off. Listen to your parental intuition and seek help and guidance if you are noticing these signs in your child.
Casey Cottrill, MD, MPH, is a member of the Section of Adolescent Medicine at Nationwide Children's Hospital and an assistant professor of Clinical Pediatrics at The Ohio State University College of Medicine. Her clinical interests include the treatment of patients with eating disorders and substance abuse.
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