When a child or teenager suddenly starts losing weight, skipping meals, or becoming overly preoccupied with their appearance, it often raises concerns among parents and teachers. While changes in appetite, mood, and body image are common during adolescence, they can sometimes signify more than just a “difficult phase”. Anorexia nervosa is one of the most serious eating disorders and can begin as early as elementary school.
Because children often cannot clearly describe their distress, it manifests itself through their attitude toward food, exercise, and their body. Early recognition of the signs is crucial, as anorexia is a serious disorder that can lead to numerous health complications, including life-threatening ones, if not addressed in time; at the same time, treatment is highly successful when action is taken promptly. This is precisely why it is important for adults to be able to notice changes and respond to them in a timely manner.
What exactly is anorexia in children and adolescents?
Anorexia nervosa is an eating disorder in which a child or adolescent:
severely restricts food intake,
experiences an intense fear of gaining weight,
has a distorted perception of their body,
links their self-worth primarily to their physical appearance.
In younger individuals, anorexia often begins subtly, as a “healthy decision” to eat less sugar, or as a desire for a more athletic physique. Over time, however, the behavior escalates into dangerous self-restriction, excessive exercise, and weight loss, which can seriously endanger health.
Research and clinical practice show that anorexia most commonly occurs between the ages of 12 and 18, though the age range is getting younger. The highest-risk group consists of teenage girls, though boys are increasingly developing anorexia today as well. The underlying causes of anorexia may include peer pressure and social media, perfectionism and high expectations, family dynamics, feelings of inadequacy or loss of control, and traumatic experiences
Anorexia – Signs, Symptoms, and Consequences in Children and Adolescents
The signs of anorexia can vary widely. Some are obvious, others more subtle. Anorexia in children and adolescents can lead to serious physical and psychological consequences, as the body needs energy and nutrients during the growth period. It is important to observe changes in how the child used to behave and how they behave now.
Changes in eating habits may manifest as skipping meals or “forgetting” to eat; drastically reducing portion sizes; avoiding fats, carbohydrates, or “forbidden” and “unhealthy” foods (e.g., sweets, fast food); preparing food for others but not for themselves; obsessively counting calories or weighing food; and excuses such as: “I’m not hungry,” “I already ate at a friend’s house.”
We should also be alert to the following physical changes: rapid weight loss or stunted growth; hair loss, dry skin, feeling cold, and blue-tinged hands and feet; dizziness, fatigue, and fainting; abdominal pain and constipation; in girls, irregular periods or even the absence of periods; and excessive physical activity, even when the child or adolescent is exhausted.
Changes in a child’s or adolescent’s mood and behavior often manifest as irritability, withdrawal, and mood swings; excessive perfectionism; difficulty concentrating and a decline in academic performance; avoidance of social situations, especially those involving meals; negative body image, feelings of guilt or shame; and depression or anxiety.
Since symptoms can vary depending on the type of anorexia developing, it is helpful to understand the basic differences between the various forms of the disorder. There are several forms of anorexia. Restrictive anorexia is the most common. It is characterized by severe food restriction, starvation, or excessive physical activity, without episodes of binge eating or self-induced vomiting. Purgative anorexia involves food restriction along with purging behaviors, such as self-induced vomiting or excessive use of laxatives and other means to “cleanse” the body. There is also atypical anorexia, in which a person meets all the criteria for anorexia but their body weight remains within the normal range (body mass index (BMI) above 18.5). Understanding these differences helps us more easily recognize what is happening, as behavioral and physical signs may vary somewhat between the different types.
When and how should you seek help?
Professional help is needed when:
the child is losing weight or has stopped growing,
the child avoids food or meals,
the child is extremely preoccupied with their appearance,
the behavior escalates and the child can no longer control it,
physical signs of exhaustion appear,
the child withdraws, becomes depressed, or irritable
If anorexia is suspected, it is important not to wait, minimize the problem, or try to handle everything at home.The first steps may include having a calm, non-judgmental conversation with the child; speaking with their teacher or school support staff; visiting a pediatrician to assess any health risks; and seeking family or individual psychotherapy, which is also available through ChildWise Labs experts.
Treatment for anorexia typically includes medical monitoring, psychotherapy (family-based or individual), nutritional support, parental guidance, and, when necessary, hospitalization if the child's health is at risk.
Early intervention significantly reduces the risk of a chronic course of the illness and mortality, while helping the child rebuild a healthy relationship with food and with themselves.