When Your Child Is On The Verge Of An Eating Disorder
Your Child is Not “Fine”
Our kids are getting sick. It’s not with what you might expect. It’s with disordered eating. It seems like overnight, your previously ambitious eater, starts to refuse certain foods or meals. They begin going to school on empty stomachs. They say it’s because breakfast makes them feel sick, gross or bloated. They don’t eat lunch because it’s not “cool “to eat. Their friends are not eating either, so why should they? They ask you to leave them alone and stop bugging them about food. They feel fine, so they must be fine.
Yet, you overhear them say that they feel fat, ugly and “out of shape”. They want to do sports, but as a parent you might be wondering how they can possibly have enough energy to engage in two or more hours of vigorous exercise daily when they are barely eating. They say they feel better when they don’t eat. They adamantly state that they are eating enough, and that eating more makes their stomachs hurt. You notice your child has gotten a bit thinner, but well-meaning adults tell you not to worry so much, that all kids do this. That it’s just a phase. After all, you have a teenager. They don’t look that thin, so they must be fine.
Yet you suspect something is wrong. You might notice some of the following:
They get sick easily
Your child is very interested in healthy eating and exercise
Your child complains of dizziness, vision changes or fainting, especially if they get up too quickly
They are following a variety of food, fitness, and diet media
Your child isn’t sleeping well, waking up early or frequently, or having difficulty falling asleep
They express disgust or guilt after eating
They are doing a lot of body checking; weighing themselves, looking in the mirror, pinching parts of their body
Suddenly your child is very picky with food
Meal times are filled with tension
Your child makes negative comments about themselves
You may notice wrappers or other evidence that your child occasionally eats an unusually large amount of food (bingeing being a completely normal response to deprivation)
Your child feels cold a lot
They have lost interest in things they used to be interested in
They have become more isolated
They fixate on certain parts of the body and have plans to change them
Their moods are irritable and often abruptly change
Your child complains of fatigue
Their performance at school declines
They get angry when asked to eat
Your child complains of stomach pain and constipation
They do not want to eat with the family or their friends
They suddenly stop eating foods they used to like
They have adopted new eating lifestyles such as vegetarianism or veganism
Your child is praised for their dedication to fitness and nutrition
It’s often in middle school or early high school when parents first observe these symptoms. It used to be said that the most common age of Anorexia Nervosa onset was fourteen. Yet it seems that kids are being diagnosed at younger and younger ages. I have had five and six-year old’s in my own office. For some kids it will start and end with disordered eating, or dieting, and for others a full eating disorder will develop.
We can partially blame our externalized, health and fitness culture. A culture that equates abs with health and success. Even as adults we are conditioned to fall for many of these messages. We have become afraid of obesity as the war on obesity has become a widespread public effort. Yet in this effort, mistakes are made. More health dogma is spread, including in schools. If these messages are not delivered with great sensitivity, children may feel anxious, singled-out, even discriminated against.
What do we do?
Talk to your child
Share your concerns and validate that they may not want to talk about this. It could go something like this.
“Your dad and I are sitting down with you because we have noticed some things that concern us. We see that you are bringing your lunch bag home with food uneaten. We notice that you no longer eat breakfast before school. You seem sad, irritable, and less like yourself. It pains us to hear you speak negatively about yourself. We are concerned that you are slipping into disordered eating behavior and want you to know that we take that seriously.”
You can then outline what the plan will be. It doesn’t matter if your child is agreeable to this or not. You are the parents. It is not your child’s choice to agree to go to medical appointments. Concern, even when met with anger is always better than neglect. Your child does not know fully what is happening to them. Eating disorders come with great denial. They are disorders, that tell them that they are not really sick. Do not invalidate or minimize what can become a fatal condition.
Monitor your Child
Part of the plan, if they have not been eating regular meals is enforcing structured meals and snacks. This means sitting down with them and perhaps even making all meals. Shifting the choices to the parents can be relieving, even when met with anger. If they cannot eat with you, explain that they will need to learn how to eat with the guidance of a professional. If your child’s desire is to lose weight, know that dieting in childhood creates a strong risk factor for developing an eating disorder especially in a genetically predisposed child. Instead of letting your child diet, adopt a balanced, structured, body-honoring way of eating and moving as a family. Never single out any child for having a different body and try not to allow them to drive their own health behaviors.
Seek Professional Help
Start with the pediatrician. Talk to your doctor about your concerns ahead of time if you can and be proactive. Here are some things to ask for
· Orthostatic Vitals: This is best measured with a pulse and blood pressure reading at rest. This means your child will need to lie down at the doctor’s office. A slow pulse should not automatically be interpreted as an “athlete’s heart rate”. Pulse also slows down in response to starvation as the heart tries to conserve energy.
· A “Blind” weight which means the child steps on the scale backwards and does not see or hear their weight. And while we are on this topic, remove all accessible scales from the house. If your child is showing these symptoms, self-weighing becomes unsafe.
· Blood work including a Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), Serum Iron, Magnesium and Phosphorous, Thyroid panel (*See common results below)
· A discussion about weight without the child present. Assess the growth chart with the pediatrician. Every child has their own unique growth pattern that is measured through a percentile where they tend to rest both for weight and height. Small deviations are normal, however sharp declines can represent a problem. For example. If your child’s weight was normally closer to the 80th%ile and now it is at 50th %ile, just because it’s about “average” does not mean that this is healthy for your particular child.
The American Academy of Pediatrics’ (AAP) recommendations include “discouraging dieting, skipping of meals or the use of diet pills; promoting a positive body image; encouraging more frequent family meals; and suggesting that families avoid talking about weight.”
It is also recommended that you seek at least an initial nutrition assessment with an eating disorder dietitian so that you can obtain an individualized meal plan for your child. The education provided to you and your child should be reassuring and will begin to return some of their permission to eat.
Find a good therapist. Ideally someone your child will feel comfortable with and who has knowledge on this topic.
Statistics tell us that about 1 in 10 children will develop an eating disorder. Your child may simply be falling for the societal pressures to look a certain way when they temporarily change their eating habits. It may be short-lived and never turn into anything more. However, do not assume that your child is fine simply because they tell you so.
Observe and trust your parental instincts.
*Often serum lab results come back normal. However some changes that can occur when your child isn’t eating enough include hypoglycemia (low BG), low white blood cell count (WBC), anemias, elevated thyroid stimulating hormone (TSH) with other thyroid hormones declining (T3, T4), and electrolyte abnormalities.