Could it be an eating disorder? Know the warning signs of anorexia and bulimia in children and teens

All of us, from time to time, have experienced moments in which a little voice inside our head manages to put us down and make us feel less than perfect. For individuals who have eating disorders, that voice is repetitive and all consuming.

Preoccupation with body image is common in our society. But when does concern about weight and food develop into a dangerous obsession that qualifies as an eating disorder?

Recognizing the signs

Dr. Holly Agostino [1], a specialist in Adolescent Medicine at the Montreal Children’s Hospital, says that while each case is different, there are signs any parent can look out for that might indicate their child is suffering from some form of eating disorder. Sometimes, the signs are obvious, sometimes they are quite subtle. The signs can include, but are not limited to:

preoccupation with food, weight, counting calories and what people think about their appearance;
change in eating habits (cutting out desserts and high-fat food, counting calories, expressing a desire to eat alone);
the use of excuses to avoid eating with family: “I ate already”, “I’m really not hungry”, “I’ll eat later”;
low self-esteem;
social withdrawal;
claims of feeling fat when weight is normal or low;
anger or denial that they have a problem.

While these signs might indicate that an eating disorder is developing, more serious signs can indicate that disordered eating may be a practice that the child or teenager has been doing for some time. Some of the conditions and symptoms of clinical eating disorders include:

Anorexia nervosa

Children and teens suffering from this condition tend to:

refuse to keep body weight at or above the normal weight for one’s age;
diet to extremes, usually coupled with excessive exercise;
feel overweight despite undergoing a dramatic weight loss;
have an extreme preoccupation with body weight and shape;
are deeply afraid of gaining weight.

Bulimia nervosa

Children and teens suffering from this condition tend to:

eat beyond the point of fullness with little control;
eat in secret, or in between meals;
feel a lot of shame and guilt about the eating and therefore have repeated episodes of “purging” behaviours which may include self-induced vomiting, abuse of laxatives, diet pills or diuretics, or excessive exercise.

Eating Disorder Not Otherwise Specified (ED-NOS)

Children and teens suffering from this condition tend to:

experience a mix of anorexia, and/or bulimia but don't fall neatly into one of the medical categories.

Diagnosing an eating disorder

“In the past, diagnosing an eating disorder focused more on a patient’s weight,” says Dr. Agostino. “Today, any child or teen who is heavily focused on his or her eating and weight, is extremely concerned and fearful of gaining weight, and has a poor body image is considered to be suffering from an eating disorder of some kind–even if they are at a normal weight or even overweight.”

Early detection of key signs of an eating disorder is therefore extremely important, and requires the support and attention of all family members.

Delayed diagnosis of an eating disorder can be extremely dangerous, as individuals can suffer from very serious health problems as a result of their eating habits. “Patients who don’t seek treatment for an eating disorder can suffer from heart arrhythmias, a tear in their esophagus, reflux, erosion of their teeth, weak bones, and hair loss, and can have severe heart and blood pressure problems as their bodies slow down due to malnutrition and starvation,” says Dr. Agostino.

What can you do if you suspect your child has an eating disorder?

“It’s very important that parents talk to their children if they notice changes in their child’s behaviour, particularly in how they talk about themselves and their bodies,” says Dr. Agostino, who also advises parents to speak with their child’s pediatrician or family doctor if the behaviour continues.

If a child makes special requests around eating, Dr. Agostino advises not to give into them since they can enable unhealthy behaviour. “Encourage your child to eat with the family, not alone in a separate room, and try to ensure that the family eats the same meals together” she explains.

Finally, Dr. Agostino says modeling healthy eating patterns and a positive body image is the biggest antidote to eating disorders. “Parents have a great deal of influence in their children’s lives and it’s important to remember that kids will model the behaviour they see around them.”

For more information about eating disorders and body dysmorphia, visit the following websites:

Anorexia and Bulimia [2]Quebec
[2]
National Eating Disorder Information Centre [3]
[3]
Canadian Mental Health Association [4]