WORKING IT OUT TOGETHER - EATING DISORDERS IN KIDS AND WHAT PARENTS CAN DO
Speaker 1: When it starts to affect their growth and development, that's pretty much when it
qualifies as an eating disorder. There are a lot of other variables associated with when
we consider things to be an eating disorder. It depends on the age of the patient. Other
comorbidities of the patient. Of course, we have the DSM-IV criteria that clearly outline
when you've meet criteria for an eating disorder and usually it needs to be affecting, not
only your diet and not only your nutrition, but also it needs to be affecting other parts of
your life.
The key is, that we really want to catch kids early on in an eating disorder. The problem
we have, that's different from adults, is that kids often times don't meet DSM-IV criteria.
So, we're having to look at how to catch them at an early phase which is a lot more
difficult than adults. So, if we think about an eating disorder on a spectrum, that makes
it a lot easier to catch kids at an early stage. Just like heart disease, blood pressure,
cholesterol, there isn't a specific number where all of a sudden a child has an eating
disorder and below that number they don't. It's on a spectrum. So, you can have mild
cases and severe cases. The severe cases will probably meet criteria for DSM-IV.
If you consider on one end of the spectrum a perfectly healthy child would have
intuitive eating, positive self body image, and on the far end of the spectrum, as far as
severe eating disorders, you would have anorexia, bulimia and eating disorder NOS.
There are several steps in the middle that if we catch on time will help us at least to be
alert that this child is at risk for an eating disorder.
If you see a child dieting. If you see them dissatisfied with parts of their body. If you see
them starting to compulsively exercise. If you see that they are getting obsessive about
these things, as much as it may seem normal for the adult population to always be on a
diet and to always want to exercise and talk about their fat tooshy, in children this is
really pathologic. We need to be aware of when then happens. This really needs to raise
a red flag that this may be the early stages of an eating disorder.
So, as a pediatrician, other than asking questions about how kids feel about food, how
they feel about their weight and their growth, one of the biggest things I look at every
single time they're there is their growth. One important note to make is that if a child is
losing weight, who's supposed to be growing, that's never normal. Even a child who
stays at the same weight, and their BMI is dropping, that also is never normal. You
either haven't found a pathologic problem, or a true organic sickness, or that child has
an eating disorder. It's not just the kids that are losing weight. It's not just the kids that
are very skinny.
As far as asking about red flags and behaviors, again, what seems normal in our society,
in children, really should cause a lot of concern. If they're counting calories. If they seem
to have fear of foods. You know, a five-year-old shouldn't tell you that they're afraid to
eat trans fats. You know? An eight-year-old shouldn't tell you how many calories they
eat in a day. Even a 10-year-old really shouldn't tell you that carbs are bad. So, even if
that seems like learned behavior from their parents or their friends, that's something
that needs to be taken seriously in kids.
So, the final thing to think about when you're looking for kids that may have an early
eating disorder is to really look at the history. So, you need to know the family history.
You need to know if one of the parents or one of the cousins had an eating disorder.
You also want to look at their, you know, even back to their toddler history. If they had
some type of feeding disorder, which may have been extreme pickiness, or decrease in
appetite, not growing because of poor intake. Those are all things that make kids at risk
for an eating disorder. So, if you find a history that's concerning, in addition to any of
those red flags in a child's behavior, that needs to be considered an early eating
disorder.
qualifies as an eating disorder. There are a lot of other variables associated with when
we consider things to be an eating disorder. It depends on the age of the patient. Other
comorbidities of the patient. Of course, we have the DSM-IV criteria that clearly outline
when you've meet criteria for an eating disorder and usually it needs to be affecting, not
only your diet and not only your nutrition, but also it needs to be affecting other parts of
your life.
The key is, that we really want to catch kids early on in an eating disorder. The problem
we have, that's different from adults, is that kids often times don't meet DSM-IV criteria.
So, we're having to look at how to catch them at an early phase which is a lot more
difficult than adults. So, if we think about an eating disorder on a spectrum, that makes
it a lot easier to catch kids at an early stage. Just like heart disease, blood pressure,
cholesterol, there isn't a specific number where all of a sudden a child has an eating
disorder and below that number they don't. It's on a spectrum. So, you can have mild
cases and severe cases. The severe cases will probably meet criteria for DSM-IV.
If you consider on one end of the spectrum a perfectly healthy child would have
intuitive eating, positive self body image, and on the far end of the spectrum, as far as
severe eating disorders, you would have anorexia, bulimia and eating disorder NOS.
There are several steps in the middle that if we catch on time will help us at least to be
alert that this child is at risk for an eating disorder.
If you see a child dieting. If you see them dissatisfied with parts of their body. If you see
them starting to compulsively exercise. If you see that they are getting obsessive about
these things, as much as it may seem normal for the adult population to always be on a
diet and to always want to exercise and talk about their fat tooshy, in children this is
really pathologic. We need to be aware of when then happens. This really needs to raise
a red flag that this may be the early stages of an eating disorder.
So, as a pediatrician, other than asking questions about how kids feel about food, how
they feel about their weight and their growth, one of the biggest things I look at every
single time they're there is their growth. One important note to make is that if a child is
losing weight, who's supposed to be growing, that's never normal. Even a child who
stays at the same weight, and their BMI is dropping, that also is never normal. You
either haven't found a pathologic problem, or a true organic sickness, or that child has
an eating disorder. It's not just the kids that are losing weight. It's not just the kids that
are very skinny.
As far as asking about red flags and behaviors, again, what seems normal in our society,
in children, really should cause a lot of concern. If they're counting calories. If they seem
to have fear of foods. You know, a five-year-old shouldn't tell you that they're afraid to
eat trans fats. You know? An eight-year-old shouldn't tell you how many calories they
eat in a day. Even a 10-year-old really shouldn't tell you that carbs are bad. So, even if
that seems like learned behavior from their parents or their friends, that's something
that needs to be taken seriously in kids.
So, the final thing to think about when you're looking for kids that may have an early
eating disorder is to really look at the history. So, you need to know the family history.
You need to know if one of the parents or one of the cousins had an eating disorder.
You also want to look at their, you know, even back to their toddler history. If they had
some type of feeding disorder, which may have been extreme pickiness, or decrease in
appetite, not growing because of poor intake. Those are all things that make kids at risk
for an eating disorder. So, if you find a history that's concerning, in addition to any of
those red flags in a child's behavior, that needs to be considered an early eating
disorder.
