Despite the stereotype that eating disorders are largely limited to sorority sisters or models, they are becoming increasingly equal opportunity, affecting individuals of all races, genders and backgrounds. Similarly, eating disorders are becoming more common in younger children, as opposed to simply impacting older teens.
Eating disorders are diagnosed in approximately 3 to 6 percent of children and adolescents. Furthermore, 30 percent of boys and 55 percent of girls experiment with at least one risky eating disorder behavior during adolescence.
Eating disorder symptoms are dangerous and are associated with the highest mortality rate of any psychological disorder. As such, it is important for parents to be aware of eating issues in children and be prepared to intervene quickly.
This is difficult, because eating disorders are often characterized by secrecy, shame and denial of the illness’s severity. This means that even a usually reliable child might struggle to recognize or report symptoms that require intervention. Eating disorders in younger children can be even harder to detect, as children often present with unusual symptoms, such as anxiety around eating and fewer body image concerns.
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So, what’s a parent to do? Despite the fact that eating disorders are often difficult to spot, here are a few red flags:
▪ Changes in eating. Many eating disorders start with a minor shift in eating patterns (eliminating desserts, becoming a vegetarian, etc.). Often changes are prompted by good intentions — getting in shape for sports, wanting to be healthy, trying to follow medical recommendations — but spiral out of control. Be alert for any rigid eating rules (outside of legitimate allergies) or anything that prevents your child from eating with the family. Additionally, eating in secret or evidence of binge eating, including large amounts of disappearing food and piles of empty food wrappers, are also warning signs.
▪ Dieting. Dieting is a strong predictor of eating issues. Studies have found that teenagers who are considered serious dieters have a one in five chance of developing an eating disorder, as compared to the one in 500 chance of non-dieters. Even exposure to parents’ attempts to diet can increase a child’s risk of an eating disorder, so work to eliminate dieting from your home, and be alert for any dieting behaviors in your child.
▪ Social withdrawal. Eating disorders are unusual in that very sick individuals are often able to maintain high levels of achievement. Many patients present with a 4.0 GPA or a rigorous schedule of extracurriculars. At the same time, however, children and adolescents with eating disorders often become isolated from friends and family. Eating disorders can result in individuals avoiding social situations they used to enjoy and making excuses to get out of activities or family meals. If your child seems more withdrawn, more stressed about socializing or appears depressed or anxious, intervention is likely needed.
▪ Weight/shape concerns. Worries about physical appearance are sometimes dismissed as typical teenage behavior, but can be a precursor to unhealthy eating issues. Be aware if your child consistently compares himself or herself unfavorably to peers or makes negative comments about his or her body or weight.
▪ Physical changes. Physical changes associated with an eating disorder are often hard to spot in a growing child. By the time changes in weight or other physical signs become evident, the eating disorder is often already very serious. Weight loss and irregular or missed menstrual cycles are cause for concern, as is failure to achieve expected height and weight milestones. Contrary to popular belief, eating disorders are not always characterized by overall weight loss. Frequently, eating disordered children and teenagers who are still growing will maintain or even slowly gain weight over time. For these individuals, the effects of an eating disorder will only be seen in changes of developmental trends, evident through a doctor’s longitudinal growth chart.
If you suspect that your child is developing disordered eating, the best thing to do is act. Early intervention is associated with the best outcome, so it is better to overreact than underreact if you notice any red flags. Treat an eating disorder like you would any other life-threatening illness and seek an evaluation immediately. The University of Miami Eating Disorder Treatment Program offers comprehensive evaluations and treatment for patients of all ages, and is currently conducting research to develop new prevention programs designed to target child and adolescent eating issues before they develop into life-altering diseases.
You should also be prepared to play a role in treatment. Family involvement is often a crucial component of successful child/adolescent eating disorder treatment. The Eating Disorder Treatment Program offers Family Based Treatment (also known as FBT or the Maudsley approach) for those seeking help. For more information, call (305) 243-2301.
Jocelyn Lebow, Ph.D., clinical psychologist at UHealth – University of Miami Health System, treats patients in the University of Miami Eating Disorder Treatment Program. For more information, visit UHealthSystem.com/patients/pediatrics.