Common Risk Factors for Childhood Eating Disorders

During my pediatric clinical residency as dietetic student, I worked with plenty of children who suffered from fully developed eating disorders as well as those showing early indicators of the illness. Every case was (quite literally) dealt with using “kid gloves”. ED’s are always a sensitive topic, no matter the age, but this is especially true when it comes to young and impressionable minds. 

Although more common in adolescents and young adults, eating disorders are equal opportunity offenders. The pressure to be thin, the idea that foods are either “good” or “bad”, and the false theory that “smaller is better” is usually instilled in the mind beginning in childhood. So, what can we do to avoid triggering disordered eating in children? How do we spot the signs? In this post, I cover some of the more common contributors to poor body image and disordered approaches to eating as well as how to spot the red flags of a budding issue.  

Risk #1: The child has a parent or other relative with an eating disorder or poor body image. 

Unfortunately, ED’s are heritable and are more likely to occur when someone else in the family is struggling as well. If you’re a mother or around children frequently, then you know that they’re sponges. They watch what we do, how we handle certain situations, our reactions, etc., and begin to form their own ideas and opinions based off of ours. Our influence on young minds can be positive if we’re careful and intentional, but it seems that in today’s society, this is less often the case.

When we apply this ideology to specific circumstances, we can better imagine it’s potential affect on a child. For example, a 6 year old watches as her mother expresses disgust with her reflection in the mirror. That 6 year old (who thinks her mom walks on water) then mimics disgust with her own image. If her mother, whom she admires and sees as perfect, doesn’t even love herself, then from whom does the child learn self love and acceptance?

What should we do, then? The answer may seem obvious… simply don’t speak negatively about ourselves, right? Well, yes… but there are a number of things we need to watch out for to ensure that the nonsense of diet culture isn’t entering the minds of our young ones. This includes unchaperoned television and internet, which instills false ideals of beauty (think, stick thin models, photoshopped faces and bodies on Instagram, articles obsessing over what foods “yOu ShOuLd NeVeR cOnSuMe”, etc.). Remember, a child’s mind is like a sponge. Their bullshit meter isn’t exactly attuned just yet. Consider how tough it is for you and I to sift through real vs. fake. A child is way more susceptible to these lies and deceptions. The key takeaway from this first point is, don’t let your child grow up thinking it’s normal to hate their body. Don’t give them false ideas of what beauty is. Teach them how to love themselves by simply loving yourself.

Risk #2: Negative Associations 

In most households, there are limits to what is and isn’t allowed to be eaten at certain times. For the most part, this is good. It’s important to have boundaries surrounding how often sweets and treats are consumed, and ensuring we’re getting enough fresh fruits, vegetables, whole grains, and lean proteins at meal time. However, these boundaries can sometimes become damaging to how children view certain foods, if done incorrectly.

Something I reiterated with my pediatric patients (and their parents!) is that there are no inherently “good” or “bad” foods. Food doesn’t have a conscience, and therefore doesn’t hold moral value. Growing up fearful of certain foods can develop into a lifelong internal struggle, and can even lead to an obsession with this particular food type. When things like cookies and candy are restricted or have to be “earned” (by eating all of your veggies or doing your homework, for example), they become a prize and are obsessively sought after. We begin to view these foods as forbidden, and as humans, we seem to always want more of what we can’t have.

Children aren’t born with the perspective that vegetables are healthy and cookies should be avoided. They simply see all food as fuel, each with differing tastes and textures. They’re born in food freedom, with just their intuition as their guide. Take a baby for example: they continue to eat or drink until they’re full, and then have no problem pushing the bottle away when satisfied. Somewhere along the line, diet culture weasles itself in and we stop listening to our bodies. We also project this mindset onto our children, setting them up for a lifetime of preoccupation with what’s on their plate.

For example, Rebecca (a made up child) was rarely allowed to eat ice cream as a child. Sugar and processed foods were heavily restricted in her house growing up. As an adult, she enjoys the taste of ice cream but feels a sense of guilt when allowing herself to eat it. Because she’s stuck in the “all or nothing” mentality, she has trouble portioning out an appropriate amount. Rebecca now feels as if she has lost control and can’t trust herself around sweets. Had Rebecca been taught that there is room for all foods in moderation, she may have a better relationship with food in adulthood.

Another example is Michelle, who’s parents used food as a reward while raising her. Whenever Michelle received a good grade on a test or scored a goal at her soccer game, her parents allowed her to have a sugary treat of her choice. This behavior was reinforced throughout her childhood and adolescence, and now Michelle continues to use food as a reward or as a source of comfort when she’s feeling down. If she’s had a bad day at work, she eases her emotional distress by hitting the drive through on the way home. When she has an argument with her boyfriend, she relies on excessive amounts of sugar to get her through. Emotional eating is a completely normal human behavior, to a certain extent. However, it’s typically due to the fact that we’re taught, at some point, that food must be earned. Instead, we should show our children that sweets and less nutritious foods can be enjoyed on any random day, in moderation, regardless of performance.

The takeaway here is that we need to teach our children the importance of balance. A balanced diet has room for all of our favorite foods, such as: watermelon, carrots, chocolate chip cookies, whole grains, and popsicles. Try not to make a big deal over “treats”. Mix them in with healthy foods so that they don’t become the forbidden item to obsess over. In many cases, children quickly become disinterested in certain things once they learn they are “allowed” to have them. As I mentioned, there still needs to be boundaries surrounding these foods (I’m not recommending you let your child eat a sleeve of Oreos for dinner). Rather, place a couple of Oreos on the same plate alongside the main entree. When dessert is placed next to a food such as broccoli, it becomes just another part of the meal. It takes away it’s power, and ultimately, the preoccupation with it. Ultimately, it’s up to you as to what works best for your family at meal time. But if you’re struggling to find an equilibrium, give this a shot and see how it works. 

As far as signs of an eating disorder, some of them are more obvious than others: weight loss, lack of growth, etc.. What I want to focus on though, are the more subtle signs that disordered thoughts and actions may be brewing. As a disclaimer, I do want to point out that just because one or more of the signs below describes your child, doesn’t mean they have an eating disorder. The circumstances vary and should be further investigated by your pediatrician. 

Sign #1: Reducing portion sizes and an unusual interest in food

As children grow, their appetites change. This is completely normal when under regular circumstances. However, what we often see in children developing disordered eating patterns, is something quite different. A child who suddenly becomes obsessed with portioning out/measuring food or claims they no longer like a certain food that they formerly had no issue with, could be a red flag. 

Sign #2: Hiding or stashing food 

Eating disorders present themselves in many different forms. It’s important to remember that just because your child doesn’t look any different, doesn’t mean they aren’t struggling. Binge eating disorder (BED) involves eating large quantities of food, past the point of fullness, in a short period of time. This often leaves the consumer feeling ill, and sometimes leads to purging (bulimia, more on this next). A couple of red flags here are: finding large amounts of food hidden in your child’s room/backpack/etc., your child frequently resorts to eating when emotionally distressed, or your child feels ashamed or embarrassed by the amount they’ve eaten. 

Sign #3: Digestion Problems, Damage to tooth enamel, Scarring on knuckles, and Swelling of salivary glands  

As mentioned above, eating disorders come in all shapes and sizes. Another one of these is called bulimia. It’s not uncommon for BED and bulimia to coexist, as once a binge is completed, the individual often feels shame and resorts to purging (which makes binge eating one of the signs). Others include disappearing to the restroom not long after a meal has been consumed and unprescribed use of laxatives or diuretics. Other physical signs comprise of scarring of the knuckles (due to self induced vomiting using fingers), tooth decay or damage to the enamel (the acidic nature of the stomach contents are damaging to teeth), frequent upset stomach and other gastric discomfort, and swelling of salivary glands (from repetitive self induced vomiting). 

Sign#4: Excessive and/or compulsive exercising 

Although excessive exercise alone is not indicative of an eating disorder, it can be a sign of poor body image. Your child may see this as a way to control their weight or compensate for something they’ve eaten. This is a tricky one because, while we want to encourage children to be physically active, we want to also avoid the tipping point into obsession. If you notice your child doing one of the following, it may be time for a talk: exercising when injured or sick, missing social functions in order to exercise, extreme rigidity when it comes to the type and duration of exercise, and expressing anger or frustration when unable to exercise. 

Speaking with your child about a balanced lifestyle is key here. Identifying and eliminating underlying issues is the first step. From there, education from a trained health professional on what is an appropriate amount of exercise is also beneficial. This will serve to make clear any preconceived notions of exercise, how it should be used, and it’s effect on our bodies. 

Sign #5: Delayed/infrequent/or loss of menstruation 

Amenorrhea is the absence of the menstrual cycle in woman who are of childbearing age (or when a females cycle has not begun by the age of 16). Although loss of mensuration can be caused for a number of reasons, excessive exercise and restrictive eating are often the culprit. If you learn that this is the case, it’s recommended that your daughter be assessed by her physician in order to regain her cycle in a timely manner. 

Final Thoughts

Please remember that any of the information in this article can be attributed to other medical conditions and are not solely indicative of an eating disorder. If you are worried about your young one and think they may benefit from speaking with a professional, I encourage you to do so. Instilling healthy habits and positive self image in children at an early age can help set them up for a life of self love and acceptance for who they are.