As we bring in the new year, diet and fitness culture may inspire your child to take action to become healthier. Yet, sometimes, the initial intention of getting fit and healthy can snowball into something else entirely: an eating disorder. While this doesn’t mean all children who strive for wellness or a balanced diet will develop an ED, parents should be aware of the signs–especially among adolescents and teenagers. Read more to learn the signs and symptoms of two common eating disorders: anorexia and bulimia–and what you can do as a parent to help.

Identifying an eating disorder

When identifying an eating disorder, early intervention is critical. The reason? It prevents the brain from getting stuck in a cycle of maladaptive eating patterns. If you’re a parent and notice signs, discuss your concerns with your pediatrician. A common red flag among children (frequently done in secret) is calorie counting. It’s important for kids who are calorie counting or hyper-focused on weight to meet with a nutritionist to ensure they get all the calories and nutrients they need.

If you’re concerned your child has an eating disorder, there are mental and physical signs to look out for.

Mental health symptoms of eating disorders:

Isolation from friends and family.
Loss of focus/difficulty concentrating.
Anxiety around eating.
Depression.
Extreme mood swings.

Physical symptoms of eating disorders:

Rapid weight fluctuations (both up and down).
Irregular periods (menstrual cycles) or the absence of one (amenorrhea).
Increased fatigue.
Stomach pain, including bloating, gas, pain, and constipation.
Anemia or other abnormal laboratory findings.
Dizziness and fainting.
Hair loss, dry skin, and brittle nails.
Fine skin and hair on the body (lanugo).
Tooth decay.
Feeling cold all the time.

Anorexia

Anorexia nervosa is a restrictive eating pattern that eventually leads to severe malnutrition. Symptoms of anorexia include food intake restriction and a distorted body image, where the sufferer perceives their body as “fat” when they are severely underweight.

Signs of anorexia to look out for in your child include:

Dramatic weight loss. Maintaining a healthy body weight for height and age may be difficult.
Preoccupation with calorie counting and dieting, including restricting foods to the same kind of low-fat and low-calorie “safe foods.”
Makes negative comments about their body, such as “feeling fat.”
They limit the amount of food they eat or avoid eating food by moving it around on their plate/cutting it into tiny pieces.
Wears baggy or layers of clothing to hide weight loss or stay warm–even in hot weather.
Exercises excessively or obsessively.

Bulimia

Bulimia is an eating disorder that results in binging and purging behaviors around food. These behaviors are cyclical and start with a binge, which leads to a purge, followed by restrictive eating behaviors. Children with bulimia have difficulty controlling their eating behaviors, which is often emotionally distressing. Many experience feelings of guilt and fear.

Restrictive behaviors around food last until the next binge–and the cycle continues. These restrictive behaviors overlap with symptoms of anorexia. Children with bulimia can appear of average weight or be overweight, which can make diagnosing bulimia challenging.

Signs of bulimia include:

Frequent trips to the bathroom immediately following meals, sometimes with a faucet or shower running to mask the sound of vomiting.
Use of laxatives, enemas, and emetics (medications that induce vomiting) excessively.
Hoards food and stashes it in odd places, such as their closet or under their bed.
Secretive about binge eating, setting aside specific times to binge and purge.
Cuts and calluses along the finger joints (from induced vomiting).

Bulimia takes a toll on the body physically and mentally. Purging affects the liver, kidneys, intestines, and heart. You may notice changes in your child’s appearance, such as:

A puffy face, burst blood vessels in the face, and discolored teeth or tooth decay.
Upset stomach, constipation, and sore throat.
Dehydration from losing body fluids.
Dizziness and fainting spells.
Muscle weakness.
Swelling of the feet or hands.

Parental support and influence

As a parent, you can encourage healthy food choices, exercise, and a positive self-image. Adolescence is an especially vulnerable time for body image, as bodies change and hormones adjust. Boys, girls, and nonbinary children are all susceptible to eating disorders. As a parent, you can help to create a body-positive and food-friendly environment in the home.

The way parents talk about their own bodies or eating habits in front of their children can impact how children perceive their bodies. For example, calling yourself “fat” in front of your child or frequently critiquing others’ eating behaviors or bodies can teach your children that they have to look a certain way. Commenting on your child’s eating behaviors or body in a critical way can also have a negative impact.

Promote healthy feelings around body image and eating behaviors. Instead of critiquing bodies, you can encourage exercise and provide positive feedback when your child moves their body, participates in sports or activities they enjoy, or selects healthy and nutrient-dense food. You can engage with your kid by cooking nutritious meals together. This way, kids can find safety at home when it comes to their bodies and food.

Setting a healthy example as a parent can be a challenge. You may have your own bias towards weight and food. You can find resources for prevention at NEDA, the National Eating Disorder Association website, for more support.

Treatment

Treating an eating disorder is most effective when treated as soon as symptoms appear. Breaking the cycle is key, and it takes a team. Treatment for eating disorders involves psychological counseling, family therapy, and nutritional counseling. The goals of treatment include getting weight to a healthy range and stopping or reducing binging, purging, and restrictive eating behaviors.

Counseling is crucial for helping children understand and cope with disordered eating patterns. Sometimes, psychological medications are indicated. Many eating disorders coexist with depression, anxiety, and other mental health illnesses.

Early identification and treatment of an eating disorder is critical. Your child may not realize they have a disorder. It’s important to talk to your child if you notice disordered eating habits. If you suspect that your child may have an eating disorder, make an appointment with their pediatrician.

Resources:

This article was written by Katie Taibl, BSN, RN, CPN. Katie has over nine years of experience working in pediatrics, with a background in travel nursing and clinical writing. As the Patient and Family Outreach Educator at Roslindale Pediatric Associates, she writes articles on relevant pediatric health topics to help RPA patients and their families access user-friendly health content.