The table is set, the company is about to arrive for holiday dinner, and your child has just disappeared into her bedroom with a stomachache. Are you aware that this may be an early warning sign of an eating disorder?

Eating disorders afflict 8–10 million Americans, 90 percent of whom are adolescents and children. Younger children are becoming increasingly vulnerable, as the average age of disease onset has recently dropped from 13 to 17 to 9 to 12. I recently appeared as an expert guest on an Oprah Winfrey show called Girls Who Don’t Eat which featured a five year old who was so frightened of becoming fat that she felt compelled to run around the playground at recess in an effort to prevent fat from overtaking her body. A recent study reported that 40% of first graders surveyed were dieting. Dieting, food fears, the fear of becoming fat, and body image concerns can signal an impending eating disorder in your child. Early detection and effective treatment to nip a growing problem in the bud is essential to a timely and lasting recovery. Primary prevention, however, surpasses even early detection in protecting our children and securing their health and well-being. Both tasks fall to enlightened and caring parents. Parents do not cause eating disorders, but they can and must be instrumental in preventing their onset and detecting early signs.

Holidays can be a tip off
As the leaves turn colors and frost covers the landscape at dawn, Thanksgiving and Christmas are in the air. The upcoming holidays offer families an opportunity for togetherness and joyful interaction; there is no better time to observe a child who may be struggling with food and weight issues, as well as related emotional problems. Eating disorders are the behavioral tip of an emotional iceberg, the misuse of food to resolve emotional problems; it is safe to say that their appearance is an indicator that a child is struggling with problems of self esteem and self control, with accurate self-perception, judgment, and problem solving skills. A child’s dread of family gatherings or reluctance to participate with loved ones in the eating rituals that mark celebratory times may be a dead give away that the child is suffering. These signs must be considered a parent’s call to action. Remember that eating disorders are more likely to show up at home, in kitchens, bathrooms and bedrooms than in doctors’ offices, in physical examinations or in laboratory tests. Like it or not, parents are the most effective diagnosticians.


Early warning signs of eating disorders include:

• Unhappiness with physical appearance
• Depression, irritability, isolation from others
• Fear of eating in front of others
• Refusal to eat what others are eating; demanding alternative meals
• Bringing his or her own special foods to family events.
• Restricting the amounts, types, or food groups eaten.
• Demonstrating food quirks such as drinking lots of water before meals, cutting food up into tiny pieces and pushing them around plate, chewing food and spitting into a napkin, eating the same foods every day, demonstrating rigidity about times to eat or the order in which food is consumed.
• Needing to try on many outfits before finding one that “looks good.”
• Complaining of stomachaches or other physical symptoms before meals.
• Disappearance into the bathroom during or immediately following meals.
• Failure to menstruate monthly.

What Parents should do
Parents and families must understand that the malnourished child afflicted with an eating disorder or the precursors of an eating disorder hasn’t the judgment or accuracy of perception to acknowledge that these concerns exist, nor to assume any degree of self-control in seeking solutions. Many youngsters do not understand what healthy eating actually is. By taking charge of the situation where their sick child is not capable of doing so, parents educate, nourish and prepare their child to eventually take responsibility for himself. Taking charge of a situation is not synonymous with taking control of the child. Do not confuse appropriate parenting interventions with intrusive parenting.

• Parents need to prevent problems by providing nourishing food and meals, and by consistently modeling healthy eating behaviors. Do not skip meals; sit down to eat with your child and family as often as possible. Only 50% of American families enjoy regular dinners together.
  

When a parent senses that a problem exists, he or she should

• Intervene intelligently, knowledgeably. Confront the child with your observations and concerns, with the dangers of ignoring an impending eating disorder. Defining a problem is the first step towards finding a solution.
  
• Know thyself. Parents must understand that own issues regarding food and weight could inadvertently interfere with their ability to accurately assess or respond to a problem in their child.
  
• Don’t be afraid to be your child’s parent.
  
• In seeking professional help, look for clinicians who will welcome you as an intrinsic part of the treatment process and team, who are willing to involve the total family in treatment and in creating and living a healthy lifestyle.