Eating Disorders in Children and Tweens

School-based studies of 8- to 13-year-olds have found that between 20%–56% report dieting. While this is shocking, and while actual eating disorders in children this young are still relatively uncommon, anorexia nervosa has been identified in children as young as seven years old.

Importantly, eating disorders in children and tweens look different than eating disorders in teens and adults. For this reason, eating disorders in younger people are often misdiagnosed. Parents need to understand what eating disorders can look like in children and teens.

Differences in Children and Tweens

Children and tweens are less likely to have disturbances in body image, often seen as the hallmark of an eating disorder. Thus, a parent whose child loses weight and shows less interest in eating, but doesn’t express fear of being fat, may be thrown off course.

Young patients with eating disorders are more likely to be male than older patients with eating disorders. Younger patients with eating disorders are also less likely to report bingeing or purging and are less likely to have tried diuretics or laxatives to lose weight. A diagnosis of avoidant restrictive intake disorder (ARFID) is also more common in younger patients. 

Instead of rapid weight loss, younger patients may fail to make expected gains in weight or height. Children and adolescents who start out in higher weight categories may develop eating disorders and are at risk for delayed diagnosis.

Exercise, a common symptom of an eating disorder in older teens and adults, may also appear different in children and tweens. Younger people are less likely to engage in goal-directed exercise such as running or going to the gym. Yet, they may exhibit behaviors that look like hyperactivity such as running around, pacing, and refusing to sit when others do such as while watching television.

While older teens may give an explanation of dieting for the reasons they are not eating particular foods, children and tweens are less likely to give a coherent reason for their refusal to eat certain foods. They may just start rejecting certain foods or complain of stomach aches. This can also throw parents off the track.

Eating disorders can have dangerous medical consequences. A child with anorexia nervosa, bulimia nervosa, or other eating disorder can develop malnutrition, anxiety, and depression, as well as damage to the teeth, esophagus, gums, and internal organs. Eating disorders can also be fatal.

Eating Disorder Warning Signs

To be sure your child isn't developing an eating disorder, be on the lookout for the following signs and symptoms:

• Weight loss or lack of weight gain in a growing child (even if that child was previously in a larger body)
• Refusal to eat foods previously enjoyed (often with no explanation as to why)
• Dieting, talk about dieting or preoccupation with losing weight
• Negative comments about their body shape or associated behaviors such as wearing loose clothing
• Increased anxiety at mealtimes, claiming they have already eaten, and/or making excuses to avoid meals
• Hyperactivity or excessive exercise (there may be no obvious connection to attempts at weight loss)
• Preoccupation with cooking, watching cooking shows, reading recipes, and/or cooking for others and refusing to eat what they have made
• Large quantities of food missing (could indicate binge eating)
• Going to the bathroom and/or showering after meals (could indicate purging)
• Other less specific symptoms sometimes noticed by parents before their children were diagnosed include anxiety, changes in sleep patterns, social withdrawal, mood swings, depression, angry outbursts, irritability, and physical symptoms (such as dizziness or stomach pain).

Taking Action

If you suspect your child is displaying signs of an eating disorder, you'll have to take action. Discuss your concerns with your child, but be aware that many children and tweens with eating disorders will not admit there is a problem even when there is one.

Next, share your concerns with your child's pediatrician. Consider consulting a mental health professional who specializes in eating disorders for advice and support.

Be aware that not all pediatricians are adept at spotting an eating disorder in its early stages. Even if they reassure you that everything is okay and you remain concerned, trust your gut and continue to seek guidance and observe your child.

If your child is diagnosed with an eating disorder, be aware that there are many different treatment options. Research these options carefully. Early diagnosis and treatment lead to the best chances for long-term recovery.