How to Identify an Eating Disorder in Your Child
If you’re beginning to wonder whether your child might be struggling with an eating or feeding disorder, please know you are not alone. This is a difficult and emotional realization for any parent to face, and it often comes with a swirl of concern, worry, and even confusion. But taking that first brave step to explore your child’s eating behaviors is a powerful act of love and protection.
Recent research suggests that roughly 1 in 5 children and adolescents show signs of disordered eating, with girls statistically more likely to be affected. Boys and gender-diverse youth are deeply impacted as well. The truth is, eating disorders do not discriminate, and they can affect children of all body types, backgrounds, and personalities. Eating disorders are more than just a phase or a change in appetite. They involve a persistent disturbance in eating behavior, whether through restriction, overconsumption, or aversion, that impairs both physical health and emotional wellbeing.
At Whole Lifecycle Nutrition, we support families in understanding these disorders not just through a clinical lens, but by honoring the deeper emotional, developmental, and environmental roots.
Recognizing the Signs: Understanding Eating and Feeding Disorders in Children
Eating disorders are characterized by a prolonged disruption of eating behaviors that change the consumption or absorption of food, impairing physical health and psychosocial functioning. There are six feeding and eating disorders that we will address: Avoidant Restrictive Food Intake Disorder, Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder, Rumination Disorder, and Pica. Each of these feeding disorders have specific symptoms to look out for, and some symptoms may overlap between the diagnoses.
There are six primary feeding and eating disorders recognized in children and teens:
- Avoidant/Restrictive Food Intake Disorder (ARFID):
Characterized by extremely selective eating or a lack of interest in eating—not due to body image concerns. It can lead to nutritional deficiencies, growth concerns, or dependence on supplements. - Anorexia Nervosa:
Involves food restriction, intense fear of weight gain, and distorted body image. Often accompanied by rigid routines, excessive exercise, and visible changes in weight or behavior. - Bulimia Nervosa:
Includes episodes of binge eating followed by compensatory behaviors such as vomiting, fasting, or excessive exercise. Weight may appear average, making it harder to detect. - Binge-Eating Disorder:
Recurrent episodes of eating large quantities of food, often quickly and to the point of discomfort, accompanied by feelings of shame or loss of control—without compensatory behaviors. - Rumination Disorder:
Characterized by repeated regurgitation of food that may be re-chewed, re-swallowed, or spit out. This is not due to a medical condition and can interfere with nutrition and growth. - Pica:
Involves eating non-food items (like dirt, paper, or hair) over a sustained period. It can lead to serious health risks and is often associated with developmental concerns.
While the symptoms of these disorders may vary and sometimes overlap, what they all have in common is the need for compassionate, informed support. If you notice changes in your child’s relationship with food, their body, or their mood, trust your instincts. Early intervention makes a profound difference. In upcoming posts, we’ll explore how to identify red flags, how to seek care, and how to create a supportive healing environment at home. And remember: no matter where you are in this journey, you’re not alone. Healing begins with awareness, and continues with hope.
Avoidant/Restrictive Food Intake Disorder (ARFID)
ARFID is characterized by a long-term eating disturbance and consistent failure to meet appropriate nutritional or energy needs. This often leads to significant weight loss or failure to thrive, nutrition deficiencies, dependence on tube feeding or oral nutrition supplements, and declining psychosocial functioning. ARFID can occur in someone of any age or gender, but is most common in young children and is more common in males than females.
ARFID may also be related to various mental and medical conditions. Within a group of adolescents being treated for eating disorders, 14% were diagnosed with ARFID. Within this group, one third had a mental disorder, three-quarters were diagnosed with anxiety, and 20% had a variation of Autism Spectrum Disorder. Having one of these conditions or other medical conditions might put your child at higher risk of developing ARFID.
Reasons for food avoidance might fall into one of the three subcategories:
- Sensory characteristics: some children are selective eaters who may have a serious negative reaction to a food’s taste, smell, texture, or color.
- Limited appetite or general disinterest in eating: some kids may not find eating to be rewarding and have little to no interest in the activity. These children often deny being hungry.
- Fear of consequences, based on previous experiences or assumptions. Children who fall into this avoidance category are often fearful of eating due to negative experiences such as vomiting, choking, or gastrointestinal distress from eating.
Signs of ARFID
Notably, ARFID is not characterized by intentional weight loss or fear of gaining weight as seen in anorexia nervosa. ARFID is not avoidance of foods based on a cultural practice, such as fasting. Signs and symptoms include weight loss, stunted height, failure to thrive, limiting the amount or type of food, fear of choking or illness during meal times, avoiding social situations where food is present, vomiting, falling (due to fainting or weakened bones), anemia, low hormones, low potassium levels, slow heart rate, and menstrual irregularities. More physical symptoms to look out for include, dry skin and nails, thinning hair and fine hair on the body, sleeping problems, poor wound healing, feeling cold all the time or cold feet and hands.
Treating ARFID
Treatment for ARFID includes working with an outpatient medical team including a dietitian, occupational therapist and/or speech therapist, and a psychotherapist. The goal is to slowly integrate a variety of foods back into the diet at the individual’s level of comfort.
Anorexia Nervosa
Anorexia Nervosa (AN) is when a person restricts food to lose weight, experience an intense fear of weight gain, and have an irrational body image. This is also known as body dysmorphia, which is an obsession or fixation on one or more perceived flaws in their appearance. They experience a serious lack of awareness of their current low or declining body weight.
AN is divided into two behavior-based subcategories:
- Restricting type is when an individual achieves weight loss through dieting, fasting, and/or excessive exercise.
- Binge-Eating/Purging type occurs over a span of at least three months, while individuals have engaged in patterns of binging and purging. This may include methods like use of enemas, laxatives, diuretics, or self-induced vomiting as a means of weight control.
Between 0.9% and 2.0% of females experience anorexia nervosa, as well as 0.1-0.3% of males. A recent study found that AN has increased over the last 50 years in girls ages 15-24. The prevalence in males has stayed the same. A subthreshold of 1.1-3.0% of females will experience some symptoms of AN, but not meet the full criteria for diagnosis. However, males do represent 25% of the individuals diagnosed, and are at greater risk of severe medical complications due to late diagnosis.
Signs of Anorexia Nervosa
The following behaviors warrant investigating:
- Weight loss or fear of gaining weight (especially if currently losing weight)
- Missing or irregular menstrual cycles
- Overexercising
- Food obsessions, including hoarding food, collecting recipes, or weighing/counting pieces of food
- Calorie counting on paper or on an app on their phone
- Strange eating behaviors, such as taking tiny bites or cutting food into very small pieces
- Moving food from one side of the plate to the other with minimal eating
- Eating in private or not wanting to eat with the family
Anorexia Nervosa affects every area of the body. Physical signs you may observe include:
- Being constantly cold
- Lanugo or fine body hair all over the body
- Yellowing of the skin or eyes
- Fatigue, increased daytime napping, or trouble waking that is different from normal
- Dehydration
- Belly pain, constipation, frequent complaints of nausea, or lack of appetite
- Dizziness upon standing
- Irregular heartbeat that may be either fast or slow
Other signs of an eating disorder may include:
- Your child may become socially withdrawn, irritable or depressed
- Frequent body checking or perseverating on a particular area of the body
- Avoiding the mirror
- Excessive bathroom trips after meals or throughout the day
- In addition, binge-eating type AN has higher rates of impulsivity and are more likely to abuse alcohol and drugs
Treating Anorexia Nervosa
AN is dangerous due to your child’s body being denied the necessary nutrition needed for optimal growth and development. The goal of treatment is to stabilize weight loss, begin nutrition rehabilitation and replace negative behaviors with positive coping strategies through psychotherapy.
A dietitian will help make a meal plan to restore nutrition and will continue to work with a patient throughout their recovery. Psychotherapy can include a variety of therapy options. Therapy can help the individual identify their triggers, accept the thoughts they’re having, and reframe their mind. Family-based therapy is effective for children under the age of 18. Antipsychotic medication might be useful for weight regain, and an antidepressant may be prescribed for coexisting conditions. Treatment can take place in the hospital or outpatient depending on the stability of the patient and their mental health. The risk of relapse is high in this type of eating disorder and therefore requires long term treatment.
Bulimia Nervosa
Bulimia Nervosa (BN) is characterized as recurrent, persistent binging episodes followed by compensatory behaviors. A binge is when an individual seems to lose control of themselves around food, and eats significantly more in volume or calories than would be typical. This happens over a specific time period, for example, two hours. During this period, the person eats to the point of being uncomfortably or painfully full, and feels guilt, remorse, and shame afterward. For a diagnosis of BN, the occurrence of binge-eating episodes must be accompanied by compensatory or purging behaviors. Purging can include self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications, or practices such as fasting or excessive exercise. The purging behaviors are aimed at preventing weight gain.
Between 1.1-4.6% of females will develop BN, as well as between 0.1-0.5% of males, indicating that it is more prevalent in the female population. Another 2.0-5.4% of females will demonstrate “subthreshold bulimia.” This means they have symptoms of bulimia but do not quite meet the criteria for a formal diagnosis.
Signs of Bulimia Nervosa
Binge-eating is often shameful to an individual; they will likely hide what they are doing. Some signs you can look for include hidden food wrappers in your child’s room or other areas around the house, having frequent or big changes in weight (up or down), skipping meals, eating late at night or wanting to eat alone, consuming a lot of food quickly, or eating in response to stress.
In individuals who engage in compensatory behaviors following binge eating, it is essential to be attentive to certain indicators. These may include frequent visits to the bathroom after meals, signs of vomiting, the presence of laxatives or diuretic packages, an excessive exercise routine, stained or discolored teeth, bloating due to fluid retention, complaints of stomach cramping, and a diminished self-esteem related to poor body image. Bulimia can negatively impact the entire digestive tract due to the binge-and-purge cycle. This can lead to gastroesophageal reflux disease (GERD), electrolyte imbalances, and heart problems.
Treating Bulimia Nervosa
Treatment can include several types of psychotherapy Cognitive behavioral therapy, family-based treatment, and interpersonal psychotherapy, all help the individual to learn healthy coping skills and personal triggers. Antidepressants may also be prescribed to reduce symptoms of bulimia. Additionally, a dietitian can help your child with nutrition education to achieve healthy eating habits and avoid hunger and cravings.
Binge Eating Disorder
Binge Eating Disorder (BED) is similar to BN in that they both feel “out-of-control” while the person is eating, resulting in consuming large amounts of food in a brief period of time. However, individuals with BED will typically not restrict intake and will eat whether hungry or not. They do not engage in compensatory behaviors after eating to avoid weight gain (i.e. vomiting). However, they will still experience shame, distress, and guilt after a binging period.
Unfortunately, BED is frequently undiagnosed, or disregarded, when the individual is considered normal weight, or has overweight or obesity. Nonetheless, BED is the number one diagnosed eating disorder. BED incidence and prevalence statistics are also underreported due to only being a formally recognized diagnosis relatively recently. In recent surveys and combined research material, it was found that between 0.2%-3.5% of females and 0.9%-2.0% of males will develop BED. It was also worth noting that 1.6% of adolescent females will experience symptoms of binge eating but will not meet the criteria for a formal diagnosis.
Onset of BED is usually later than other eating disorders, with average onset being between late teens and early 20’s. However, recently, it has been reported in older adults as well as younger children. In my own experience as a pediatric dietitian, I have worked with many school age young children who engage in bingeing behaviors and try to conceal their eating. The shame and guilt typically do not occur until years later.
Signs of Binge Eating Disorder
Warning signs to look for in your child include fear of eating in public or with others, cutting out entire food groups, evidence of binge eating by large amounts of food missing, disruption of normal eating behaviors such as skipping meals or eating smaller meals at traditional meal times, fluctuations in weight, and lowered self esteem.
To diagnose BED, your doctor may recommend a psychological evaluation and discuss your eating habits. Some health consequences associated with BED are high cholesterol, high blood pressure, heart problems, diabetes, GERD, and sleep-related breathing disorders. Other health risks associated with untreated BED include clinical obesity, diet cycling, and mental health concerns.
Treating Binge Eating Disorder
Treatment for BED includes a variety of psychotherapies. Cognitive behavioral therapy, interpersonal psychotherapy, and dialectical behavior therapy address the triggers for binge episodes, identify how to improve interpersonal relationships, and teach healthy coping strategies for stress and regulating emotions. Furthermore, medications such as antidepressants may be prescribed as part of treatment. Additionally, the use of medications like Topamax and Vyvanse have shown potential in reducing binge eating episodes.
Rumination Disorder
Rumination Disorder (RD) is seen when someone regurgitates food shortly after eating or feeding, and then either rechews and re-swallows it or spits it out. In order to diagnose RD this behavior must occur several times per week, for at least one month. It is often seen alongside another intellectual disability. It can be diagnosed as early as infancy and into adulthood. RD is comparatively less common than other eating disorders. In a study of 2163 children and adolescents, 110 of them fit the criteria for a RD diagnosis. This illness is not associated with anorexia or bulimia nervosa or regurgitation due to medical conditions, such as gastrointestinal tract disorders. Overtime, RD can lead to malnutrition, especially if coupled with restricted eating.
Signs of Rumination Disorder
A child may try to disguise this by putting their hand over their mouth or coughing when eating. This eating disorder can occur in episodes or long term until treated.
The frequency of regurgitation tends to rise in tandem with heightened levels of stress, anxiety, and symptoms of depression in individuals. It is believed that rumination is unconscious due to its sudden and unpredictable onset, however as regurgitation is more common, the voluntary muscle relaxation of the diaphragm can become a learned habit, which could feel similar to the movement of a burp.
Treating Rumination Disorder
Treatment for RD depends on the child’s age, cognitive ability, and whether they are experiencing other disorders. If a patient is experiencing RD as well as an intellectual disability, independent clinical attention will be necessary to treat this condition. Treatment can include biofeedback as part of behavioral therapy, which teaches the individual to breathe from the diaphragm. Thus, patients with RD will be taught how to recognize their symptoms and act to reverse the possibility of regurgitation through breathing techniques and habit reversal. If frequent regurgitation is damaging the esophagus, a proton pump inhibitor might be prescribed to protect the lining of the esophagus. As the regurgitating is controlled, the need for this medication will decrease.
Pica
Pica arises when someone is eating one or more non-nutritive, nonfood substances consistently for at least one month. Examples include ice, dirt, paint, sand, paper, wool, chalk, gum, clay, or starch.
While the onset of this eating disorder can occur at any stage of life, it is most frequently observed in children aged one to six years. Pregnant women, and individuals who are dealing with mental health conditions such as Autism Spectrum Disorder or intellectual conditions may also be diagnosed with pica. Children younger than two years old are rarely diagnosed with pica due to normal development and exploration of senses. After two years of age, if non-food consumption still occurs, your child may be eligible for a pica diagnosis. Pica can be caused by stress and anxiety, learned behaviors, pre-existing nutrient deficiencies, medical conditions, or used as a coping mechanism. Pica becomes less common with age. About 18.5% of children develop pica, but after 12 years old, this number drops to 10%.
Pica disorder can be potentially fatal depending on what is being ingested, or can lead to bowel obstructions, intestinal perforations, infections or poisoning. Pica can also lead to nutrient deficiencies and complications due to the lack of nutrients in the food they are ingesting. Most commonly, these complications include anemia, constipation, lead poisoning, and electrolyte imbalance.
Treating Pica
Treatment for pica will include the practitioner checking for mineral deficiencies and for any infection present from eating toxic substances. Blood, urine, and stool tests will be performed to assess potential poisoning and electrolyte imbalance. Any nutrient deficiencies will be addressed first. Then, mild aversion therapy may be implemented to associate eating non-food substances with a negative response and eating normal foods with positive reinforcement. Occasionally, pica is due to an existing mineral deficiency, such as iron or zinc, and goes away once this deficiency is corrected. Behavioral therapy, as well as differential reinforcement, can be used to teach the patient an alternative coping mechanism if the behavior is due to other reasons. Medications, especially if the disorder is observed alongside an intellectual disability, might help reduce abnormal eating behaviors. In many cases, pica resolves by itself in children and for people who are pregnant.
Summary: Early Action Can Change Everything
Eating disorders are complex, multifaceted conditions that can affect individuals of all ages, backgrounds, and identities. They are not caused by any one factor and often involve a combination of emotional, psychological, genetic, and environmental influences. It’s important to know that eating disorders carry the highest mortality rate of any psychiatric illness, making early recognition and treatment absolutely essential.
If you notice signs of disordered eating in your child, trust your intuition and reach out to your pediatrician right away. Early intervention not only supports your child’s physical health, but also helps lay the foundation for emotional healing and resilience. Children and teens who receive timely treatment are four times more likely to recover than those who don’t receive care.
Your pediatrician can connect you with a supportive care team, which may include dietitians, therapists, psychiatrists, and specialized treatment programs, whether outpatient or inpatient, depending on your child’s needs. If you’re concerned about your child’s eating patterns or behaviors, you don’t have to navigate this alone. Healing is possible, and it begins with one small step forward. Our team is dedicated to providing compassionate care and tailored support for families navigating this journey. We offer resources, guidance, and a holistic approach to help your child heal and thrive. Contact us for support and guidance.
Note: Whole Lifecycle Nutrition requires a release of information to coordinate care with all involved healthcare professionals when working with clients with diagnosed eating disorders. In most cases, we require the patient to additionally participate in behavioral health counseling with a licensed mental health provider.
Medical Disclaimer:
The information provided on this blog is for educational and informational purposes only and is not intended as a substitute for medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as your physician, pediatrician, or a registered dietitian, before making any changes to your or your child’s diet, health routine, or treatment plan.
While we are a medical practice specializing in integrative and functional nutrition, the content shared here reflects general knowledge and holistic guidance, and may not be appropriate for every individual. Reliance on any information provided on this site is solely at your own risk.
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