Eating disorders in children and teens: the early signs, and what happens after you call

Parents often expect an eating disorder to look like extreme thinness. Most of the children we see with one are a normal weight, and some are above it. What they share is a set of rules about food that has taken over, and a body that is starting to show the cost.

Signs worth a call

• Weight loss, or a child who stops gaining while growing taller
• New rules: cutting out food groups, skipping meals, eating only “clean” foods, counting calories
• Secrecy or distress around meals, eating alone, bathroom trips after eating
• Exercise that is rigid and cannot be missed
• Cold hands, dizziness, fainting, missed periods, hair thinning, fatigue
• Preoccupation with body shape, or comments about being fat from a child who is not

The types, briefly

Anorexia nervosa is restriction with a fear of weight gain. Bulimia nervosa is bingeing followed by vomiting, laxatives or exercise to compensate. Binge eating disorder is bingeing without compensation and is the most common. Avoidant restrictive food intake disorder (ARFID) is restriction without body-image worry, often in younger or autistic children, driven by texture, fear of choking or lack of interest in food. All four are treated, and earlier treatment works better.

What we do at the first visit

A medical assessment comes first, because malnutrition affects the heart, the bones and the brain. We check weight and growth against the child’s own history, heart rate and blood pressure lying and standing, temperature, and blood work for electrolytes, blood counts and thyroid. We screen for depression and anxiety, which travel with eating disorders. And we talk with the child alone as well as with the parents.

Who needs the hospital

A slow heart rate, low blood pressure, fainting, low potassium or rapid weight loss are reasons for admission to stabilize the body before any other treatment. We send those children to Children’s Healthcare of Atlanta the same day.

Treatment that works

For children and teens living at home, family-based treatment has the best evidence: parents take charge of feeding until weight and eating are restored, with a therapist coaching the family. A registered dietitian sets the plan; a therapist works on the thoughts; we monitor the body every week or two. Medication treats the depression or anxiety alongside, not the eating disorder itself. Recovery takes months, and most children who start early recover fully.

What we ask of parents

• Do not comment on weight, yours or theirs, and do not diet in front of children
• Eat together, with the same food for everyone
• Treat the illness as an illness; the food rules are the disorder talking, not your child
• Call sooner than feels necessary; we would rather see a child who turns out to be fine