Does My Child Have an Eating Disorder?

Screening for Disordered Eating in Children: Healthy Fuelling vs. Hidden Eating Disorders

While all children and youth are at risk of developing eating disorders due to complex bio-psycho-social interaction and societal pressure to conform to weight and shape standards, some children are more at risk than others. Children with external or internal pressure to perform in sports may be at increased risk to developing an eating disorder, as well as those with high levels of anxiety, perfectionism, or impulsive behaviour. 

Sometimes it can be confusing trying to navigate nutrition for children and teens engaged in sports- is it may kind of make sense that they want to change the way they are eating for their sport. This scenario can be tricky as well-meaning sports nutrition advice focuses on performance, tracking, and optimization. However, in vulnerable youth these exact protocols can accidentally accelerate clinical decline and contribute to the development of an eating disorder. The following checklist can be used to evaluate your child's relationship with food to differentiate between one that is flexible and intuitive, and one that may indicate a severe pediatric eating disorder or relative energy deficiency in sport (REDs). 

✅Flexible eating: Adapts meals easily if schedules change. If hungrier than normal or more active on certain days, will eat more. 

🔴Rigid rules: panics or skips meals if specific foods are missing or added. Will not have spontaneous snacks or meals, or may not want to eat food that they haven't prepared. 

✅Views food as food: Focuses on energy, strength, and recovery, using food to fuel performance.

🔴Obsesses over metrics: Counts calories, macros, or tracks strictly on apps. Focusing on good versus bad foods or neglecting whole food groups (carbohydrates, dairy etc). 

✅Rests when injured: Listens to medical advice or parent requests and rests. Has days without active training regularly. 

🔴Compulsive movement: Exercises through injury, illness, or exhaustion. Moving at times they did not previously- pacing in the house, constantly doing cartwheels, sit ups, or extra fidgety in general. May stand, move, or use a treadmill while doing activities that were previously done relaxed such as watching  a show or reading. 

✅Social eating: Enjoys team meals, school events around food, and family dinners freely. Able to enjoy food for pleasure and fun, not just viewed as fuel.

🔴Isolated eating: Avoids eating in front of classmates, teammates, coaches, or family. May bring their own food to social settings and refuse shared food. 

✅Body acceptance: Focuses heavily on what their body can do in their sport, less on how it looks. 

🔴Body hyper-focus: Distorted focus on body fat, weight, or aesthetic metrics. Firm belief that a lower weight or body fat will increase athletic performance. May make comments about not wanting to grow or gain weight, displeasure with pubertal changes. May have focus on building lean body mass or muscles. 

✅Stable mood: Energetic, competitive, and generally motivated. Typical teenage mood changes included!

🔴High anxiety or mood lability: Irritable, anxious, or depressed, especially around food or changes to plans around food/ movement. 

Subtle Physical & Behavioural Warning Signs

Unexplained Bradycardia: Low heart rate dismissed as "just athletic conditioning" yet getting dizzy when going from sitting to standing.  

Secondary Amenorrhea: Loss of menstrual cycle attributed heavily to "overtraining" rather than under fuelling. Longer times between cycles, shorter and lighter periods. In men and boys, testosterone levels may be lower than expected for age. 

Sudden Dietary Shifts: Cutting out entire food groups under the guise of "clean/ healthy eating," going vegan for performance, or eliminating gluten/ dairy/ sugar. Many youth will reference wanting to ‘eat healthier’ or vague complaints of certain foods causing digestive issues out of the blue as rational to make these changes.

The "Never Enough" Mindset: Dramatic increases in training volume outside of coached practices for those engaged in sports. Might be doing extra workouts secretly at home, or seem unable to settle and sit still during times where the family is relaxing. 

Lack of weight gain from one year to another: children and teens are meant to gain weight well into early adulthood. A child or teen that stays at the same weight from year to year is not eating enough to fuel adequate growth and development- including the ability to think and focus during studies. 

Why does this matter? 

When a child or teen shows signs of the red flags listed above, standard sports nutrition protocols can worsen their condition and prolong accurate assessment of a developing eating disorder. They require specialized clinical ED interventions- early intervention provides the best outcome to prevent long term negative consequences of malnutrition such as growth failure, poor bone mineral density, and hormonal concerns.  

It is essential to work with providers who are well versed in assessing pediatric growth for subtle signs of growth failure. If your clinician does not request or require growth information as part of assessment they may not have the expertise needed to fully address the situation at hand. 

If you feel that your child or teen may be at risk of developing an eating disorder please contact us at novanutritionsk@gmail.com to learn more about how to intervene. 

We offer in person appointments within Saskatoon, or virtual care across the province of Saskatchewan.