Your adorable toddler has now lost most of her chubby cheeks and chunky thighs. Her limbs are growing long and slender, and you soon realise that she’s become a young lady.

However, while toddlers – and even older children - sometimes experience food preference phases, frequent food refusal can lead to an eating disorder in older kids.

Eating orders – like anorexia nervosa (having an illogical fear of weight gain) and bulimia (excessive eating, then purging) – commonly occur after puberty in females, particularly those aged between 12 and 25, notes Gleneagles Hospital psychiatrist Dr Lim Boon Leng.

“About one in 30 people may be afflicted with eating disorders and it can be genetically linked. Many patients also have psychological problems such as low self-esteem, impulsive or perfectionistic personalities and troubled relationships,” Dr Lim adds.

While you may think your child may be too young to have an eating disorder, do note that kids as young as 7 have been known to suffer from these disorders.

Author Abigail Natenshon writes in her book, When your Child has an Eating Disorder, that “younger children are challenging to diagnose, as only 38 per cent meet the criteria for anorexia nervosa”. For instance, amenorrhea – or missing her menstruation, which is a criteria for anorexia – does not apply to young girls.

We round up nine things that you ought to know about eating disorders in children.

1. It can delay puberty

One study by the Department of Endocrinology at the Children’s National Medical Center in Washington, DC, found that the ability for girls to reproduce could be linked to the amount of body fat they have. This is nature’s way of ensuring that pregnancy will not occur unless there are adequate fat stores to sustain both the mother and the growing foetus. As such, if the child is suffering from anorexia, the proportion of body fat can get unhealthily low, which can cause a delay in puberty.

"She may even develop calluses on the knuckles of her hand, because she “repeatedly scrapes them with her teeth, in order to induce vomiting”.

2. Besides weight loss, there may be other physical symptoms

Common signs of an eating disorder include the child frequently complaining that she looks fat, and worrying about her body image. She may even start exercising excessively in order to lose weight, or start binge eating.

“Other physical symptoms include developing fine body hair or lanugo, dry skin due to dehydration, or an orange tinge of skin from excessive consumption of vegetable with carotenoids,” says Dr Lim. He also adds that she may even develop calluses on the knuckles of her hand, because she “repeatedly scrapes them with her teeth, in order to induce vomiting”.

3. The media and social media play a role

“Media influences and peer pressure to look thin can play a part in tipping a person over,” Dr Lim notes. In addition, when women are portrayed to be desirable only when they’re skinny, it can influence youths to want to look that way, “resulting in distorted sense of body image in impressionable youth,” adds Dr Lim.

4. Certain environments can increase the risk

Simply having a well-meaning relative comment that she’s putting on weight can cause your sweetie to fear being judged or laughed at. “Those who have been laughed at or bullied for being overweight, or been praised for being skinny may also take their dieting to an extreme,” Dr Lim explains. “Eating disorders can also be triggered by the stress of school, and work relationships.”

In certain sports, coaches and parents may encourage the kids to lose weight as well – “athletes, dancers and models are at a higher risk of eating disorders,” says Dr Lim. One mum, Noelle Tham, shared that she was uncomfortable when her perfectly healthy 9-year-old was told by her gymnastic coach to “stop eating so much”. “I had a word with the teacher-in-charge and while my daughter loves the sport, I won’t hesitate to look for another coach if I find that she starts showing unhealthy eating habits,” says Tham.

5. It can lead to death

Since eating disorders are a psychological problem, kids suffering from it may continue to diet even though they’ve already lost a substantial amount of weight. “The consequences are grave,” Dr Lim notes. “Anorexia nervosa has the highest mortality rate of about 6 per cent – the highest in any kind of psychiatric disorder.” Eating disorders are also associated with depression, and a high rate of suicide.

6. It’s not just about eating too little

While eating disorders are more commonly associated with conditions like anorexia and bulimia where the patient fears gaining weight, there are people on the other end of the spectrum, who suffer from a binge eating disorder.

People with this condition feel like they have no control over how much they’re eating, and they can’t stop. While many kids have huge but healthy appetites, there are those who eat in response to emotional stress, or feel embarrassed or ashamed by how much they’ve eaten. Kids who suffer from a binge eating disorder also show an increasingly irregular eating pattern. For instance, they refuse to eat during the day, but raid the fridge in the middle of the night.

Unlike bulimia where the patient vomits after binge eating, these patients are unable to purge the food and are frequently overweight.

7. Teach kids to be in control of their food

You know how some of us have been told to finish everything on our plates, otherwise “our future spouse will have lots of pimples”? Well, that’s not true, and it can actually give your child the sense that she’s not in control of how much she eats. As a parent, you can help encourage her to put healthy things on her plate, but you should leave the amount consumed to her.

"Some parents 'may just see the child’s behaviour as gluttony'."

8. You can’t just snap out of it

Dr Lim stresses that it’s important for parents to seek help if they suspect their child has an eating disorder. “People often think their child will snap out of it. We aren’t catching the cases early enough, and many only surface when the child is in a serious stage,” he says. Many cases aren’t identified, which means these kids don’t get treatment. Some parents may just see the child’s behaviour as gluttony, adds Dr Lim.

Seeking intervention early can help nip the problem in the bud and prevent the onset of a clinical eating disorder.

9. Parents can help prevent it

Create a healthy eating lifestyle – offer healthy foods and eat together as a family often. Don’t skip meals and make sure food from every food group – including fat – is consumed.

Be aware of the impression you are creating of the ideal body image – do you tell yourself that you “look fat” when you look into the mirror? Do you comment on the “fat aunty”, or that your friend is so “beautiful and slim, even after three kids”? Kids pick up on these vibes easily, especially since you’re their role model.

Parents play an important role in helping their children build a healthy self-image. “Let them understand that they are much more than their body image. Emphasise other areas of their strengths like their talents and responsibilities,” says Dr Lim.

Photos: iStock

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