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Eating disorders can be tricky to identify. How do you know if your son or daughter’s new preoccupation with food and calories has gone too far? Pediatrician Michelle Bowden, MD, answers some helpful questions for parents below. She and Brittany Andry, MD, are leading Le Bonheur’s new Eating Disorders Clinic – a comprehensive program for children and adolescents with a suspected or confirmed eating disorder.

Is there a particular age during which eating disorders usually start?

Symptoms of eating disorders typically arise in the teen years. Some kids will display symptoms earlier, with many who struggle with body image issues as early as puberty.

What signs might parents notice if their child has an eating disorder?

Some behavioral symptoms parents might notice*:

• Increased preoccupation with weight, size, body image (may check mirror often)
• Preoccupation with weight, food, calories, carbohydrates, fat grams, and dieting
• Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
• Food rituals (e.g. eats only a particular food or food group, eats the same foods with little variation)
• Appears uncomfortable eating around others (misses family meals or refuses to eat out)
• Spends extended periods of time in bathroom (including shower) after meals
• Skipping meals or taking small portions of food at regular meals

Physical signs: 

• Noticeable fluctuations in weight, both up and down
• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
• Menstrual irregularities — missing periods
• Difficulties concentrating
• Dizziness, especially upon standing
• Fainting/syncope
• Feeling cold all the time
• Cuts and calluses across the top of finger joints (a result of inducing vomiting)
• Dental problems, such as enamel erosion, cavities, and tooth sensitivity
• Dry skin and hair, and brittle nails
• Swelling around cheeks (salivary glands)
• Fine hair on body (lanugo)

If you suspect your child might have an eating disorder, what steps should you take? When should you seek a doctor’s help?

Eating disorders are the most deadly psychiatric illness, so concerns raised by parents, friends, teachers, or others should be taken seriously and evaluated by a physician as soon as possible.  

Treatment for eating disorders has the greatest success when the symptoms are recognized early, and the patient receives appropriate, multi-disciplinary team treatment.

If you think you child may have an eating disorder, make note of symptoms/concerns and relay those to your doctor. Most patients with eating disorders are experts at covering it up, and will not share eating behaviors or body image concerns with their doctor

Communicate your concerns to your child's doctor and inquire about referral to an eating disorder specialist who can determine the diagnosis and best treatment plan for your child.

How are eating disorders treated?

Treatment for an eating disorder will depend on the severity of the patient's symptoms: the degree of weight loss, frequency of purging and medical complications such as abnormal labs or heart conditions. As with any psychiatric illness, patients will require ongoing treatment, which may involve hospitalization, residential care, or intensive outpatient (day-treatment) programs. It is important that your child receive treatment with a multi-disciplinary team involving a therapist, dietitian and physician.

*Adapted from