Early Signs of Pediatric Eating Disorders and Why Early Intervention is Key
How an Eating Disorder Might Show Up
Let’s start with a story of how the development of an eating disorder in children may look through the eyes of an unsuspecting parent:
You’re at the dinner table with your family. Your 12-year-old, Devon, barely touches their plate. You made baked chicken, green beans, and their favorite—macaroni and cheese. Devon finishes the chicken and most of the green beans but skips the mac and cheese entirely. Maybe they’re just full or snacked after school? When you ask, Devon shrugs and says they’re not hungry. Everyone moves on with their evening, and you don’t give it much more thought.
A few weeks later, the school nurse calls—Devon fainted during gym. You pick them up, bring them home, and encourage rest. The next morning, Devon complains of dizziness. You decide to keep them home and plan to call the pediatrician if it doesn’t pass. Later that day, Devon comes downstairs and you suddenly notice how thin they look. Their shorts, which fit last summer, are now falling off. You realize you haven’t seen them in anything but hoodies for months.
Now the pieces start coming together: saying they’re full, fainting, always wearing baggy clothes. You start to wonder—could this be an eating disorder? Or another medical issue you’ve missed? You reach out to the pediatrician for help.
That night, you make baked fish, vegetables, and mac and cheese again. As dinner begins, you pay closer attention. Devon pushes food around and again doesn’t touch the mac and cheese. When you ask if something’s wrong, they shrug. You remind them they haven’t eaten all day. Devon gets irritated and leaves the table.
The next morning, you tell Devon they’re seeing the pediatrician. You offer them a banana or cereal bar on the way—they say they’re not hungry. At the visit, the doctor notes more weight loss since their last checkup. Devon says they just haven’t had much appetite and don’t like the food at school. Labs are ordered, a follow-up is scheduled, and you're encouraged to monitor meals more closely.
As you do, you notice Devon rarely finishes meals and often refuses past favorites like pizza, pasta, or mac and cheese. Nothing you say seems to help. Mealtimes become tense, filled with worry and frustration.
At the next appointment, Devon has lost more weight and their blood pressure is low. Labs are normal, but the pediatrician gently explains that Devon meets the criteria for an eating disorder in children. Even though you’ve suspected it, hearing the words out loud is still a shock. Devon is only 12. They’ve never seemed concerned about their body or weight before. You leave with a list of treatment providers—maybe a pediatric dietitian for eating disorder care—and a heart full of questions about what comes next.
Early Eating Disorder Signs in Kids
Maybe the above story sounds familiar, or perhaps the signs were more subtle. Even if symptoms are less severe, seeking help for pediatric eating disorders is still recommended to address the behaviors before they have a chance to progress. The signs that a child may be struggling can vary depending on both the type and severity of the eating disorder. Some of these signs may include:
Rapid weight loss or weight gain
A lack of weight gain or falling off their growth curve
Complaints of frequent abdominal pain or early fullness
Eating smaller portions or skipping meals all together
Developing a new focus on “clean eating” including calorie counting, excluding food groups, or following a new set of food rules
Lack of flexibility around food choices, amounts, eating times
Excessive exercise
Frequently weighing themselves, or body checking
Ongoing dizziness, fatigue, or fainting spells
Wearing loose fitting clothing to mask weight changes
Withdrawing at meal times
Making trips to the bathroom after meals
Picky eaters who start refusing previously accepted foods
While the above can be signs of an eating disorder (1,2), it’s important to note that they do not indicate a definitive diagnosis.
Early Intervention for Eating Disorders
Adolescence is a time of significant change—physically, emotionally, and socially. Many teens face challenges related to peer pressure, self-image, and identity because of these changes.
Due to the rapid growth and development that occurs during adolescence, early interventions that address restrictive eating patterns and focus on increasing food intake to sustain the adolescent’s growth and prevent any further weight loss are essential.
Since children already have higher energy needs due to their growing bodies, the onset of malnutrition from undernourishment can happen at a faster pace. When untreated, malnutrition in the pediatric population can lead to medical conditions such as cardiovascular complications, kidney damage, dysfunction of the endocrine system, stunted growth, and impaired development of bone mass. (1,3,4)
While many of the medical complications associated with eating disorders resolve when adolescents have become renourished and weight restored, there can be irreversible damage to their bone health, leading to increased risk of bone fractures and predisposing them to osteoporosis later in life.(1,3)
Research has shown that when children and teenagers with eating disorders reach weight restoration and return to their growth trajectory prior to restriction, that their duration of symptoms along with the length of the recovery process shortens. (1,2,4) This means that knowing the warning signs to be able to identify and address the eating disorder early on can lead to a quicker recovery and return to normal eating patterns; improving the quality of life of the child and bringing a sense of normalcy back to the household when it comes to mealtimes.
If you are concerned that your child may have or is developing an eating disorder, it’s important to reach out to their pediatrician and share your concerns, so they can direct you to the appropriate resources. Depending on the severity of your child’s disease, this could range anywhere from hospitalization, residential treatment, or outpatient treatment with a trained Eating Disorder dietitian and therapist.
References
1. Hornberger, L. L., Lane, M. A., Hornberger, L. L., Lane, M., Breuner, C. C., Alderman, E. M., Grubb, L. K., Powers, M., Upadhya, K. K., Wallace, S. B., Hornberger, L. L., Lane, M., FRCPC, M., Loveless, M., Menon, S., Zapata, L., Hua, L., Smith, K., & Baumberger, J. (2021). Identification and management of eating disorders in children and adolescents. Pediatrics, 147(1). https://doi.org/10.1542/peds.2020-040279
2. Eating disorders and problems: Parent guide. YoungMinds. (n.d.). https://www.youngminds.org.uk/parent/parents-a-z-mental-health-guide/eating-disorders/
Weblink: Eating Disorders and Problems | Parent Guide | YoungMinds
3. Golden, N. H., Katzman, D. K., Kreipe, R. E., Stevens, S. L., Sawyer, S. M., Rees, J., Nicholls, D., & Rome, E. S. (2003). Eating disorders in adolescents. Journal of Adolescent Health, 33(6), 496–503. https://doi.org/10.1016/j.jadohealth.2003.08.004
Weblink: Eating disorders in adolescents - Journal of Adolescent Health
4. Anorexia nervosa in children. Johns Hopkins Medicine. (2024, October 22). https://www.hopkinsmedicine.org/health/conditions-and-diseases/eating-disorders/anorexia-nervosa-in-children
Weblink: Anorexia Nervosa in Children | Johns Hopkins Medicine