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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.
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