Understanding Eating Disorders in Children and Teens

An estimated 5% of children and teens have an active eating disorder, and it isn't uncommon for early signs of trouble to float under the radar until serious health repercussions begin to occur. If you've noticed changes in your child’s or teen's behavior in regards to eating and weight loss or weight gain, and they seem to have experienced a significant personality change, an eating disorder may be occurring.Here's what you should know if you're worried your child doesn't have a healthy relationship with food.

1. There are four primary types of eating disorders in children, including under- and over-eating.

It's important to note that though these are generalized categories and that it's common for children to exhibit atypical and complex presentations of an eating disorder. For instance, restriction and binge eating are frequently seen together. Or a child may have bulimia but use exercise as their form of purging. Always talk with your child's doctor if you have any concerns.

Anorexia Nervosa

Self-starvation and extreme weight loss are the two most commonly reported characteristics of anorexia nervosa. Anorexia sufferers typically have a deep fear of gaining weight or becoming "fat," and often have intense body dysmorphia that tricks them into believing they're overweight, even when they’re not.There are two types of anorexia nervosa: restrictive and binge/purge. Restrictive is a state of unsafe weight loss caused by starvation, extreme dieting, and excessive exercise. Binge/purge anorexia is a state in which a person will occasionally eat a lot of food at once, followed by self-induced vomiting. Though this is usually a characteristic of bulimia, clinicians don't typically add a diagnosis of bulimia to a child who has already been diagnosed with anorexia.

Bulimia Nervosa

Bulimia nervosa can also have life-threatening consequences in spite of the fact that they may be overweight, a "healthy" weight, or underweight. Those suffering with bulimia typically engage in unhealthy cycles of binging and purging— consuming large amounts of food followed by efforts to get rid of the calories consumed. Remember that just because your child is overweight or maintains a "healthy" weight doesn't mean their body is getting the nutrients it needs!

Binge Eating Disorder

A growing number of professionals believe that binge eating disorder may be the most common form, and one that's also under-diagnosed. Children or teens who experience a loss of control with eating, and consume very large quantities of food in a short time, may have a binge eating disorder. Unlike bulimia, binge eating sufferers don't purge, although they may eat to the point that they become physically ill due to too much food in their stomach.

Avoidant Restrictive Food Intake Disorder (ARFID)

When a picky eater begins to suffer from a nutritional perspective, they may have this form of eating disorder. ARFID can be recognized in children and teens who don't have an interest in food, have extreme avoidance of foods due to sensory issues with tastes or textures, or have some sort of anxiety about eating (i.e., choking). If a child is exhibiting these behaviors and has become underweight or develops a medical condition due to malnutrition, ARFID is likely the culprit.

2. Signs of eating disorders can range from quite obvious to deceptively subtle.

If you notice your child or teen exhibiting these behaviors, it's a good idea to have an open conversation with them about their eating habits:

• Dieting with the aim of losing weight, especially with a focus on caloric restriction.
• Lack of interest in eating or barely touching food during family meals.
• Signs of anxiety, stress, or even fear when certain foods are presented to them during meals.
• Picky eating developing into a very selective diet with minimal nutritional value or variation.
• Visiting the bathroom immediately after meals, or even hearing your child or teen purging after meals.
• Major mood changes, such as withdrawing in social situations, personality changes, mood swings, or signs of general depression and anxiety.
• Practicing OCD-like behavior during meals, such as sorting foods or refusing to eat foods that have touched.
• Witnessing binge eating sessions, or finding evidence of secretive binge eating (i.e., wrappers hidden in the trash or their bedroom, missing food from fridge or pantry).

3. Professional help is vital in treating eating disorders and preventing relapse.

Successfully helping your child recover from an eating disorder is truly a team effort requiring professional assistance. Your child's doctor or pediatrician should be involved to monitor your child's health, and you may need to reach out to a nutritionist experienced in eating disorder recovery for guidance. Treatment for eating disorders also includes some level of regular psychotherapy to help your child understand what's happening, why they might struggle with food, and to learn the tools they need to recover mentally and physically.It's strongly recommended that parents inform their child's dentist as well to ensure their child’s oral health is protected during their recovery. A great dentist will be gentle, kind, and supportive of your child. If a dentist makes you or your child feel ashamed or embarrassed, that is a big red flag that it's time to see a new dentist.

4. Untreated eating disorders can have a severe impact on oral health.

Children and teens with eating disorders are at a higher risk of developing tooth decay, pediatric gum disease, and premature loss of baby and adult teeth. These oral health issues are primarily caused by the state of malnutrition that occurs when not enough food is being consumed. A lack of nutrition can also cause serious deficiencies in enamel-essential vitamins and minerals, like calcium.Keep in mind that the act of frequent purging can lead to tooth enamel erosion caused by stomach acid on the teeth, similar to what may happen to someone with chronic acid reflux. The dentist may even notice this erosion before your child's doctor makes a formal eating disorder diagnosis.

5. The language you use when discussing the importance of food is crucial.

Words have a lot of power, especially when it comes to food. Using the terms "good" and "bad" to describe different types of foods is reflexive, but it can also contribute to an unhealthy mindset by triggering guilt or shame.When speaking with your child about different foods, foster the mindset of all foods being sources of energy, nourishment, or enjoyment, rather than bringing a sense of morality into the picture. Incorporate education and the "why" of why some foods are good to eat. For example, cheese is a wonderful source of calcium, and calcium is important for strong teeth and bones.Encourage other members of your family or close family friends to also be mindful of the language they use when describing foods. This awareness of language can really open up your eyes and foster your own healthy relationship with food.

6. Support your child with nutritious meal options and gentle encouragement.

Some helpful things you can do to support your child during this time include:

• Eating more meals together as a family.
• Sticking to regular meal times during the day when your child or teen is home.
• Cooking or baking together as a way to try new foods and pique their interest in eating.
• Providing a wide variety of different foods, and trying different methods of preparation (i.e., roasted veggies vs. steamed).
• Refraining from talking about food and eating while enjoying family meals together.
• Avoiding comments about a person's weight or size—even your own. This includes what you might consider "positive" or complimentary comments based on size.

Remember that there is a lot of support available for parents in your position. You can find local or social media groups with parents just like you looking for advice or simply a safe space for discussions.

Tomasik Family Dental is a safe, supportive space for your child to receive dental care.

Tomasik Family Dental is a welcoming, comfort-focused practice that can care for your child's smile throughout their eating disorder recovery. Our dentists can teach your child how healthy eating positively impacts their teeth and how they can best care for their smile at home. Your child's preventive dental care routine will also be tailored to combat the increased risks of developing enamel damage or tooth decay.Schedule your child's check-up at our family dental practice in Bee Cave via phone or online request.