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Signs of Eating Disorders in Children

National Eating Disorders Awareness Week

One in seven men and one in five women in the U.S. will have an eating disorder by age 40 – with the onset occurring mostly during adolescence and young adulthood. Rates of eating disorders among adolescents are on the rise, and they are affecting more than the stereotypical female patient.

A recent study of more than 11,000 pediatric eating disorder hospitalizations in Ontario found rates of hospitalizations increased 139% from 2002 to 2019. But among young male patients, hospitalizations increased at an even starker rate – rising 416% during the 18-year period analyzed in the study.

Also notable to the experts conducting the study was the 196% increase in hospitalization rates among some of the younger patients ages 12 to 14.

Historically, health care providers did not consider boys at risk for eating disorders. As awareness and screening for eating disorders has advanced to be inclusive of boys and men, some experts believe it could be contributing to the increased rates of identified eating disorders in boys. Feeding and eating disorders are considered mental health disorders and medical illnesses. Understanding the types of eating disorders, as well as the signs, is important regardless of an individual’s age and gender.

Types of feeding and eating disorders

Some of the most common eating disorders include:

  • Anorexia nervosa: Individuals with this disorder have an intense fear of gaining weight and exhibit persistent behavior that interferes with weight gain. This can be manifested by irrational, impulsive behavior and a distorted body image. They may follow a dangerously low-calorie diet, avoid eating altogether or exercise for hours per day to avoid weight gain. This can lead to physical signs of malnourishment like becoming extremely frail or appearing weak and emaciated. They may also exhibit thinning hair, brittle nails, and lanugo (fine hair that covers the entire body).
  • Bulimia nervosa: Bulimia is characterized by uncontrolled binge-eating episodes where a person consumes large amounts of food followed by a compensatory behavior. Examples of compensatory behaviors include self-induced vomiting; misuse of laxatives, diuretics or other medications; fasting; or excessive exercise. This can lead to dehydration, dental issues, cardiac issues and tears in the esophagus.
  • Binge eating disorder: Recurrent episodes of binge eating includes behaviors where a person eats much more rapidly than normal, may eat until feeling uncomfortably full or eats large amounts of food when not feeling hungry. They may eat alone because of feeling embarrassed by how much one is eating, and afterwards have feelings of disgust, guilt or depression. The key difference from bulimia is the lack of compensatory behavior in binge eating disorder.

Signs of feeding and eating disorders

Signs of feeding and eating disorders can be emotional and behavioral:

  • Eliminating food groups
  • Extreme preoccupation with body size, shape and image
  • Obsession with weight, food, calories and dieting
  • Food rituals, including only eating one type of food or food group, excessive chewing, not allowing foods to touch
  • Mood changes
  • New practices with food or fad diets
  • Skipping meals or taking small portions
  • Uncomfortable eating around others
  • Withdrawing from friends and activities

Signs of feeding and eating disorders can also be physical:

  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts)
  • Big changes in weight, both up and down
  • Cold, mottled hands and feet or swelling of feet
  • Cuts and calluses across the top of finger joints (a result of inducing vomiting)
  • Dental problems
  • Difficulty concentrating
  • Dizziness and/or fainting
  • Dry skin and hair, and brittle nails
  • Feeling cold all the time
  • For women: missing periods or only having a period while on the pill
  • Weakened immune system
  • Muscle weakness
  • Sleep problems
  • Stomach cramps or general gastrointestinal complaints like constipation
  • Swelling around salivary glands
  • Wounds that heal poorly

When to talk with a doctor

When a child or a teen has disordered eating behaviors, there may be symptoms a parent or caregiver may not understand. Parents and caregivers should start a conversation with the child’s primary care provider and ask if a feeding and eating disorder may be causing any noticed changes in behavior or physical symptoms.

Feeding and eating disorders require professional treatment and consistent support from families. A dietitian is an important part of the care team, in addition to medical and mental health professionals. Remember children and teens don’t choose to have eating disorders – and they need consistent support from their families to fight them.

Shanthi Appelö is a registered dietitian and health and wellness spokesperson for Blue Cross Blue Shield of Michigan based in Detroit. Passionate about the science of nutrition and behavior, Shanthi has experience working in clinical nutrition, public health and teaching in the university setting. In her free time, she enjoys experimenting in the kitchen, exploring the outdoors, working on art and spending time with family. For more recipes and health information, visit

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