"What you look for is the same -- they stop eating, they start to restrict food intake or binge," says Dr. Carol Bernstein, associate professor of psychiatry at NYU School of Medicine. Unreasonable amounts of exercise and an obsession with food or weight are also signs that would be similar across the age group. The personality traits that tend to accompany eating disorders in older patients are also seen in children: anxiety, perfectionism and obsessive tendencies.
But because children do not have the mental or emotional maturity of their teen counterparts, Lock warns that they might not even be able to articulate that they are doing these things to lose weight. "Older girls might be able to say, I feel like I'm losing control or I feel scared that I'll gain weight, but like with any child psychiatric issue, you have to look at their behavior," he says, because kids may not be cognizant of why they are feeling or acting this way.
A depressed child will often not recognize that they are sad but will have an unexplained stomach ache or be unable to sleep, for example, so you have to watch the behavior. Thus, parents should watch to see if their child may be displaying behaviors of an eating disorder even if they don't seem weight-obsessed.
Weight loss doesn't necessarily have to be a symptom either, experts warn, because children under twelve are supposed to be putting on weight continually so even a child that is purposefully not gaining weight could be doing his or herself harm.
The American Academy of Pediatrics report, published Monday, suggests that pediatricians screen for eating disorders as part of annual checkups or during pre-participation sports exams. If an eating disorder is suspected, a more thorough history and physical exam should be ordered and possibly assessment for psychological problems.
It's essential to catch these behaviors at an early stage, Kandel says, "because you don't want this behavior to become any more entrenched than it already is."
For parents who are worried that their child might be at risk for developing an eating disorder, experts recommend teaching by doing.
Encourage healthy eating in the home and stay away from using food as a punishment or reward, Kandel says, because this sets up an unhealthy relationship with food. Also stay away from talking about certain foods as categorically "good" or "bad" because this might lead to bingeing, she says.
"They observe and follow us," Bernstein says, so parents should set a good example and be careful not to obsess over food or their own weight in front of their children.