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Warning Signs of Pediatric Eating Disorders

November 17, 2023

A young girl stares at her bathroom scale.

Is your child a picky eater or does he have ARFID (avoidant/restrictive food intake disorder)? Is your tween choosing fruit over ice cream to be healthier or does she have anorexia? Is your irritable teenager just moody or is it bulimia?

Eating disorders affect children as young as eight years old. And while more girls than boys seek treatment, male and nonbinary children are often underrepresented in the statistics.

Unfortunately, treatment for pediatric eating disorders is often delayed because parents either miss the signs or are overwhelmed by feelings of guilt and shame, wrongfully blaming themselves. Research shows parents cannot cause eating disorders in their children, but the stigma still exists.

Know this: It is not your fault.

Pediatric eating disorders such as anorexia, bulimia, ARFID, and other specified feeding or eating disorders (known as OSFED) are illnesses that need to be treated — and the sooner your child gets help, the better chance there is for a full recovery.

Meghan Feehan, PsyD, a psychologist with Atlantic Health System who specializes in pediatric eating disorders, explains the warning signs, when to seek help and what treatment options are available.

Warning Signs

Pediatric eating disorders are defined as affecting young people between the ages of 8-21. The experts at Atlantic Health System manage a range of pediatric eating disorders that include anorexia, bulimia, ARFID, and OSFED.

There are both physical and psychological warning signs that indicate your child may have an eating disorder. Each condition has its own set of symptoms, but there is some overlap.

In terms of physical signs, children and young adults with both anorexia and bulimia will present with the following:

  • Notable fluctuation in weight or significant weight loss
  • Lack of energy/easily fatigued
  • Dizziness or fainting spells
  • Irregular lab work indicating low heart rate and low blood cell count
  • In younger children, failure to thrive and not make appropriate weight gain goals

With anorexia, other physical warning signs include:

  • More dramatic weight loss
  • Loss of period or irregular menstrual cycles
  • Feeling cold all the time

With bulimia, additional physical warning signs may include:

  • More weight fluctuation
  • Dental problems such as erosion of tooth enamel
  • Swelling of cheeks
  • Cut or calloused hands (if used to force vomiting)

There is also some overlap with common psychological warning signs for both anorexia and bulimia, including:

  • Preoccupation with food or calories, either by reading labels and tracking calories or obsessing over recipes and food photos to “feed” themselves
  • Not eating in public settings or even with friends and family
  • Having food-related rituals, like eating food in a specific order or at a slow pace, taking small bites, and drinking excessive amounts of water to “feel full”
  • Having body image rituals such as touching their collar bone or hip bones as a way to check their size
  • Intense feelings of being too big and not liking certain body parts
  • Excessive exercising with no rest days
  • Mood changes, including increased irritability, anxiety and depression
  • Loss of interest in past activities and friends

Parents of children with bulimia may also notice frequent trips to the bathroom after meals and evidence of food hoarding (such as having a stash of snacks in their bedroom) and vomiting in the bathroom.

Children with ARFID present differently because their food issues are not tied to weight.

“Kids with ARFID often look like picky eaters times a million,” Dr. Feehan says. “It’s more than just not liking green vegetables. These children have a very limited number of foods they will eat. They fear food because they experienced or witnessed an aversive reaction such as vomiting or a bad smell and they can’t disassociate from it.”

When ARFID isn’t addressed, it often leads to anorexia.

Interventions: When and Where to Seek Help

It can be easy to miss the warning signs at first. But Dr. Feehan says there are some red flags to look out for that signal it’s time to intervene, including:

  • Healthy eating that becomes too inflexible and strict, without exceptions
  • Cutting out entire food groups
  • Overly rigid food rituals
  • Avoiding eating with friends or family
  • Making own food (when developmentally inappropriate for age)
  • Increased irritability or sadness
  • For younger kids with ARFID, growth chart plateaus or no weight gain from year to year

If this sounds like your child and you’re concerned, Dr. Feehan suggests starting with your child’s pediatrician. They can tell if your child has dropped in weight percentage for their age group or if they are failing to gain weight year over year.

“Your child’s pediatrician will also be able to check vitals such as heart rate that may indicate a health problem,” says Dr. Feehan.


Treatment Options

The Pediatric and Adolescent Eating Disorder Center at Atlantic Health System Children’s Health is the gold standard of care for managing pediatric ED. Our team of doctors, nurses, dieticians, psychologists and psychiatrists work together to address your child’s physical and psychological needs.

Our three main treatment options include:

Family-based therapy (FBT) — This type of therapy involves both the parents and child, teaching them how to break food habits. It includes having parents supervise meals with support from therapists. The goal is to restore your child to a healthy weight. If medically stable, this treatment is offered as a once-a-week outpatient program.

Partial hospitalization — For children with medical complications, we offer a partial hospitalization program that meets for seven hours a day, five days a week. It combines FBT and medical monitoring, and the goal is to interrupt eating behaviors, increase weight, and become medically stable before transitioning to an outpatient program.

CBT-AR — This outpatient program uses cognitive behavioral therapy designed for kids with ARFID to address their food fears. As with other ED programs, parent involvement is crucial for success.

“There are lots of options for treatment,” Dr. Feehan says. “What sets Atlantic Health System apart from other hospitals in the area is our comprehensive approach. We have an expert team of doctors, nurses, dieticians, and psychologists who work together to address the physical and psychological needs of young people with eating disorders, and we are the only center in New Jersey that offers in-person FBT.”

Pediatric eating disorders can lead to serious health complications. With evidence-based treatments like family-based therapy and other medical interventions offered through the Eating Disorder Program at Goryeb Children’s Hospital, recovery is possible.

“We are the experts in pediatric eating disorders, but you are the expert in your child,” Dr. Feehan says. “Parental involvement is vital to a successful recovery. Together, there is hope.”

  • Mental Wellness
  • Children's Health