Tweens with Eating Disorders: Warning Signs and Treatment Options

A 7-year-old states that she is vegetarian because she loves animals, and begins to eat a more restricted diet. A 10-year-old is concerned about starvation in the world and begins to feel guilty about their abundance of food, and slowly begins to eat fewer food choices. An 8-year-old eats less in response to stressful family dynamic and begins to lose weight.

Eating disorders are dangerous at any age, but when the symptoms go unnoticed in a child, it can be catastrophic. Children have lower percentage of body fat, and small amounts of weight loss can be medically detrimental to growth and physical health. Bodies and brains are continually developing at this age and eating disorders can affect development through limiting growth potential and damaging vital organs [1, 5].

Margaret Kelly, a clinical nurse manager at Children’s Hospital Denver, states that their program has had to reduce the admittance requirements to age 9 for eating disorders. She states that the increase in males has gone up in the last decade, as well [1].

5 percent of adolescents are affected by an eating disorder, and at least 10 percent of adults first showed clear symptoms prior to age 10. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), 60 percent of elementary and middle school teachers report eating disorders are a problem.

Further statistics from the National Eating Disorders Association (NEDA) stated that 41 percent of children in first through third grade report they want to be thinner, and 81 percent of 10-year-olds are afraid of becoming fat. A further 51 percent of 9 and 10-year-olds say they would feel better about themself if they were on a diet.

Risk Factors for Children

Children are more vulnerable to eating disorders due to culture and personality traits [1, 3]. Common traits are high levels of anxiety, perfectionism, obsessive-compulsive tendencies, depression, and addiction. Children also have genetic risks that can compound when mixed with personality traits.

Cultural pressures, including messages at school around healthy eating and exercise, can be misheard and misperceived by many children. Magazine ads, commercials, and unhealthy family expectations and pressures all add to the vulnerability of the development of an eating disorder in children.

Sports can also play a role in the development of an eating disorder. Children are participating at a much younger age than before, and involved in competitive levels and/or on various levels of teams. Team uniforms and sports that have a higher emphasis on appearance can also increase the risk of an eating disorder.

Another factor is puberty. This can be a trigger due to rapid growth spurts and weight gain as their bodies change. Both boys and girls may have a wider body prior to the growth spurt, which may result in bullying by peers.

Types of Eating Disorders and Symptoms in Children

In children, eating disorders can overlap [2]. Some children may alternate between periods of anorexia, bulimia, and binge eating.

Children often struggle with feelings of distress around weight gain or mealtime situations, may feel helplessness around the disorder, and struggle with low self-esteem. Developing unhealthy eating habits may seem like an option to tweens to control their feelings or situation.

Physical issues are common with those who have an eating disorder and can lead to serious, sometimes fatal, medical complications.

Early symptoms to look out for in children are:

• Skipping meals or making excuses to eat in secret
• Excessive focus on food or healthy eating
• Persistent worry or complaints of being fat
• Frequent body checking
• Repeatedly eating large amounts of sweets or high-fat foods
• Regularly going to the bathroom after eating
• Eating more than considered normal for a meal or snack
• Expressing depression, disgust, shame, or guilt about eating habits [3].

Anorexia symptoms can include being thin or emaciated yet wanting to diet, being underweight but having an intense fear of becoming fat, menstruation that is infrequent or stops altogether, rapid weight loss, and strange eating habits.

Damage to major organs, such as brain, heart, and kidneys, can occur with significant weight loss. Irregular heartbeat or slowed heart rhythm, lowered blood pressure, pulse, and temperature, sensitivity to cold, and thinning of bones are all common results of weight loss.

The most common causes of death in children with anorexia are cardiac arrest, electrolyte imbalance, and suicide [2, 4].

Tweens can often struggle with fear of weight gain and feelings of distress around body shape and size. Often with eating disorder overlap, a child may overeat and feel a sense of lack of control. This leads to vomiting, laxative use, diet pills, diuretics, or enema use to rid the body of food consumed. Typically, purging behaviors bring a sense of relief to the child, reinforcing the eating disorder. Many times the purging behaviors are done in secret.

Symptoms of bulimia in children can include increased anxiety, binging on large amounts of food or food missing from cabinets and refrigerator, eating in secret, or noticing unusual eating habits.

Excessive exercise with sport, or practicing outside of scheduled games or practices, is also a sign. Some children will excessively play or fidget, as well, after mealtimes. Physical complications include damage and erosion of tooth enamel, inflammation of the esophagus, swelling of salivary glands in cheeks where they look puffy, and lower blood levels of potassium, which can lead to abnormal heart rhythms [2, 4].

Binge eating is similar to bulimia but without the purging aspect. It includes chronic, out-of-control eating of large amounts of food in a short period of time. It often brings discomfort physically to the child and causes guilt, shame, and distress. Typically a binge will occur in secret, is chaotic, and is done in a 2-hour period or less with an out-of-control feeling and inability to stop.

Children who binge eat are often overweight due to consumption of large amount of foods and non-compensating behaviors. These individuals may struggle with managing emotions, such as anger, worry, stress, sadness, or boredom. Depression and anxiety are also common with binge eating. Health problems include heart disease, high blood pressure, high cholesterol, and type 2 diabetes [2, 4].

Treatment of Eating Disorders

The first step in eating disorder treatment is often to have the child assessed by a coordinator of a hospital or higher level of care treatment facility.  Once the assessment is complete, the determination of which treatment option is best will be decided and the child admitted to the program.  

The primary goal, at first, is to restore weight and healthy eating patterns.  If malnutrition is severe, or a concern, the child will be first admitted to hospital for refeeding until medically stable. In these cases, a feeding tube may be required for weight restoration. Psychological treatment may include medication treatment for co-occurring mood disorders, behavioral therapy, group support, psychotherapy and nutritional counseling.

Treatment for bulimia in children is multi-fold. The first step is to reduce and cease the binge-purge cycle. Treatment options may include hospitalization, depending on severity of cycles. It is also important to have the child evaluated by a medical physician who specializes in pediatric eating disorders. Further treatment can include medication for mood disorders, behavior modification, individual, family, and group therapy, and nutritional counseling.

Treatment for binge eating in tweens includes behavioral therapy, such as cognitive behavioral to address negative thinking and unhealthy behaviors, medication treatment, and psychotherapy, as well as nutritional counseling to establish healthy eating habits and cease binging behaviors.

In conclusion, with comprehensive treatment, children and teens can manage eating disorder symptoms and reach full recovery.

It is important to get an assessment and treatment for a child who is struggling. Treatment often includes the family, as both individual and group practices are highly effective. Research shows that early identification and treatment lead to successful results [5].

 

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About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.

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References:

[1] Renkl, M. (n.d.). The scary trend of tweens with anorexia. Retrieved March, 2017, from http://www.cnn.com/2011/HEALTH/08/08/tweens.anorexia.parenting/index.html
[2] Kam, K. (n.d.). Eating Disorders in Children and Teens. Retrieved March, 2017, from http://www.webmd.com/mental-health/eating-disorders/features/eating-disorders-children-teens#1
[3] Teen eating disorders: Tips to protect your teen. (2015, June 02). Retrieved March, 2017, from http://www.mayoclinic.org/healthy-lifestyle/tween-and-teen-health/in-depth/teen-eating-disorders/art-20044635
[4] (n.d.) Retrieved March 2017, from https://www.nationaleatingdisorders.org/sites/default/files/Toolkits/ParentToolkit.pdf
[5] A. (n.d.). Retrieved March, 2017, from https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_families_Pages/Teenagers_With_Eating_Disorders_02.aspx

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on May 4, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on May 3, 2017.
Published on EatingDisorderHope.com