Identifying Eating Disorders in Children and Teens

Regular doctor visits are essential to a child’s and teenager’s overall health. These routine checkups are an opportunity to not only chart growth and development, but also to screen for a range of physical and mental health conditions, including eating disorders.

In fact, pediatricians and other primary care providers are often our first line of defense against eating disorders. Well-positioned to monitor ongoing health at well-child visits and other physicals, providers have a unique role in detecting and addressing any issues with food and body. Early identification of eating disorder symptoms can help prevent and interrupt the development of these serious disorders.

The Importance of Early Screening and Intervention

Eating disorder screening and intervention is particularly important for children and teens, as onset of these disorders often occurs in adolescence and young adulthood. The physical, emotional, and social changes that accompany this pubescent period can interact with other risk factors to cause an eating disorder in those susceptible.

Eating disorders are the third most common chronic illness among adolescents, and roughly 3% of adolescents ages 13-18 are diagnosed with one. Though these illnesses affect people across the lifespan, research suggests that the vast majority originate in younger years. A ten-year study conducted by the National Association of Anorexia Nervosa and Associated Disorders (ANAD) showed that 86% of those with an eating disorder reported onset before the age of 20. Of that 86%:

• 10% reported onset at 10 years old or younger
• 33% reported onset between the ages of 11 and 15
• 43% reported onset between the ages of 16 and 20

Symptoms often worsen as eating disorders take root, leading to significant, potentially life-threatening consequences. According to research, people with anorexia between the ages of 15 and 24 are 10 times more likely to die than their peers.

Eating disorders are treatable, however—at any age. And the earlier the treatment, the better the outcome. Early detection in children and teenagers can reduce the severity of symptoms and promote normal growth and development.

Signs of Eating Disorders in Children and Teens

Children and teenagers may exhibit signs similar to those in adults with eating disorders, as well as some unique to their age.

Look for these signs and symptoms in your patients:

• Significant weight gain or loss, or failure to gain weight/height according to growth pattern
• Electrolyte abnormalities, including low potassium and high blood alkaline levels
• Low blood pressure
• Low body temperature
• A slow or irregular heartbeat
• Amenorrhea
• Cold intolerance
• Complaints of nausea, stomachaches, bloating, or constipation
• Complaints of dizziness, weakness, or fatigue
• Swollen salivary glands
• Dry, pale skin
• Fine hair growth on body and thinning hair on head
• Brittle nails and blue nail beds

In addition to screening for physical signs, learn about the patient’s eating habits by inviting discussion with the child and/or parent. Indications of the following behaviors may signal a larger problem:

• Preoccupation with food
• Distorted body image or excessive worry about weight and shape
• Sudden significant changes to diet
• Avoidance of social situations involving food
• Aversion to tastes, smells, or textures
• Fear of vomiting or choking
• Obsessive exercise
• Purging by self-induced vomiting or abusing laxatives, diuretics, or diet pills
• Hiding or hoarding food, or eating in secret

What to Do When You Suspect Your Patient Has an Eating Disorder

If you suspect your patient is struggling with an eating disorder or disordered eating, continue the conversation. Ask the patient (and/or their parent) the following questions:

• Do you worry about your weight and body shape more than other people? 
• Do you avoid certain foods for reasons other than allergies or religious reasons? 
• Are you often on a diet? 
• Do you feel your weight is an important aspect of your identity? 
• Are you fearful of gaining weight? 
• Do you often feel out of control when you eat? 
• Do you regularly eat what others may consider to be a large quantity of food at one time? 
• Do you regularly eat until feeling uncomfortably full? 
• Do you hide what you eat from others, or eat in secret? 
• Do you often feel fat? 
• Do you feel guilty or depressed after eating? 
• Do you ever make yourself vomit (throw up) after eating? 
• Do you use your insulin in ways not prescribed to manage your weight? 
• Do you take any medication or supplement to compensate for eating or to give yourself permission to eat? 
• Do you exercise for the sole purpose of weight control? 
• Have people expressed concern about your relationship with food or your body? 

Two or more “yes” answers strongly indicate the presence of disordered eating. Refer these patients to an eating disorder specialist for a more comprehensive assessment, diagnosis, and treatment.

To refer your patient to The Emily Program, please call 1-888-364-5977 or complete our online referral form. We will contact your patient within one business day and connect them with an Admissions Specialist who will guide them through screening and intake.

Pediatricians and other primary care providers play a critical role in eating disorder detection and intervention. By including this screening in regular checkups, you can reduce the serious impact of these disorders on a child’s or teenager’s overall health and quality of life.

References 

Golden, N., Katzman, D., Kreipe, R., Stevens, S., Sawyer, S., Rees, J., et al. (2003). Eating disorders in adolescents: Position paper of the Society for Adolescent Medicine. Journal of Adolescent Health, 33(6), 496-503.

Patino-Fernandez, A.M. (2013) Eating disorders: Anorexia and bulimia nervosa. In M. Gellman & Turner, J.R. (Eds.), Encyclopedia of Behavioral Medicine. New York, NY: Springer.

Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., & Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 68(7), 714–723.