From Vincent Iannelli, M.D.,
Your Guide to Pediatrics.
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Eating disorders are common and many people believe that they have reached epidemic levels. By some estimates, about 5% of women and 1% of men suffer from an eating disorder, such as anorexia nervosa or bulimia. And since most of these eating disorders began in the teen years (76% between age 11-20 and 10% in children less than 10 years of age), parents and pediatricians should learn how to recognize, prevent and treat children with eating disorders.

Eating disorders can cause serious and life-threatening medical (malnutrition, dehydration, kidney, heart and liver damage) and psychological problems (depression, poor self-esteem, anxiety), so early identification is important.

Could your child have an eating disorder?

You might suspect one if your child has any of the following classic symptoms, such as:

• being underweight, losing weight, or not gaining weight normally. Keep in mind that even children who appear to be at a healthy weight can have an eating disorder depending on what they are doing to maintain their weight.
• having an intense fear of gaining weight or becoming fat, especially if your child is underweight
• having a disturbed body image, meaning that your child thinks that he or she is overweight, even though they are really underweight or at a healthy weight.
• in girls that have begun having regular periods, having amenorrhea, or the absence of at least three consecutive menstrual cycles.
• episodes of binge eating
• trying to prevent weight gain by performing self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications, fasting, or excessive exercise.
• refusing to eat and continuous dieting

Children with more subtle signs can be more difficult to diagnose or discover. These less obvious signs of an eating disorder might include hair loss, dramatic weight fluctuations, sensitivity to cold, excessive facial hair, swollen salivary glands, broken blood vessels in the eyes, taking OTC or natural weight loss medications, exercising compulsively, development of food rituals, refusing to eat certain foods, skipping meals, disappearing after meals (perhaps to vomit), withdrawn behavior, mood swings, not wanting to eat around other people, tooth decay, and wearing loose clothing to hide weight loss. And be aware that a teen with anorexia usually has a perfectionist type personality and is a high achiever in school.

Surprisingly to most doctors and parents, there are a number of organizations and websites that actually advocate or encourage teens to have eating disorders. These include pro-anorexia (pro ana) and pro-bulimia (pro mia) websites. Does your teen know what a pro ana or mia is? Is she trying to be an ana or mia? If you spot some of the early warning signs of an eating disorder in your child, you might ask some screening questions to get more information. According to the National Eating Disorders Screening Program, these include:

• Are you terrified about being overweight?
• Have you gone on eating binges where you feel you may not be able to stop?
• Do you feel extremely guilty after eating?
• Do you vomit or have the impulse to vomit after meals?
• Do you feel that food controls your life?

The American Academy of Pediatrics also suggests asking your child:

• What do you think you ought to weigh?
• What is the most you ever weighed? How tall were you then? When was that?
• What is the least you ever weighed in the past year? How tall were you then? When was that?
• Exercise: how much, how often, level of intensity? How stressed are you if you miss a workout?

Your child's answers to these questions might help you to discover whether or not he or she has any of the more classic symptoms of anorexia or bulimia. You might also ask if any of your kids' friends have an eating disorder. And don't ignore the warning signs in younger children. Keep in mind that 10% of people with eating disorders begin before age 10. So even if your 8 or 9 year old is concerned about getting fat or talks about dieting, look for other red flags that he or she may have an eating disorder.

Once you suspect an eating disorder, further evaluation is important. This might include a medical evaluation from your Pediatician. and a psychological evaluation with a psychiatrist and/or psychologist.