You never talk about weight. You're careful never to mention "diet" in front of your daughter. You teach your son to do his best but never expect to be perfect.
But even avoiding all the traps does not erase the possibility of an eating disorder. There is no single cause: It's a perfect storm of environmental, psychological, and biological factors that drive children as young as 8 to the edge of starvation and sometimes tragically beyond.
The best way to protect your child is to be alert for telltale behavior and move quickly when it's spotted. Daniel Le Grange, director of the Eating Disorders Program at the University of Chicago Medical Center, urges parents to follow their gut instincts. "Too often physicians tell parents that it may be just a phase, that they should wait and see what happens," says Le Grange, who likens this to an oncologist who ignores the earliest signs of cancer. "Parents are nine times out of 10 spot on in their thinking that something is amiss. The sooner you recognize and diagnose the disorder the better the chances of recovery," Le Grange says. Here are 5 signs your child may be at risk.
Weight loss or lack of expected gain. For children at a healthy weight, loss of even 5 to 10 pounds warrants concern. Indications of a looming problem, unfortunately, aren't always as evident. One of the first signs that Harriet Brown, author of Brave Girl Eating: A Family's Struggle With Anorexia, recognized was her 14-year-old daughter's failure to gain weight at her annual checkup. Brown remembers asking, "Shouldn't she have gained weight this year?" She doesn't blame the pediatrician for reassuring her, but in retrospect she regrets not pushing harder. "We're all trained to think doctors know best," she says. "I think there is a bias right now in pediatrics to think that thinner is always better. A doctor is much more inclined to be concerned about a child they feel is too heavy than one they feel is too light."
Sudden change in eating habits. Most children change how they eat over time without developing an eating disorder, but Le Grange advises parents to watch for a meaningful change that seems out of character—swearing off entire food groups like meat or carbohydrates, say. Look for a child who rejects foods that used to be favorites, skips meals (but insists she's not hungry), or continually leaves her school lunch at home. New mealtime rituals that interfere with normal eating may be worrisome: cutting food into tiny pieces, endlessly chewing it, drowning it in ketchup, salt, and pepper to make it "taste better" are a few examples.
Significantly increased exercise or activity. For kids already on sports teams, overactivity is difficult to detect. According to Le Grange, it's anything that goes above and beyond an already busy schedule. At a young age, exercise should be for fun, not a way to shed calories. If you catch your daughter doing 100 sit-ups or push-ups in her room on days she has swim practice or dance class, she may be tipping towards an exercise obsession.
Distorted body image. While "I'm so fat" comments are all too common, especially from 'tweens and adolescent girls, intervening before the thought becomes an obsession is important. How often does she make disparaging comments about her body? How much time does she spend in front of the mirror?
Anxiety. It often goes hand in hand with an eating disorder and may even make your child more likely to develop one. According to the American Journal of Psychiatry, two out of three adults with eating disorders struggled with anxiety when they were children. These feelings may be the most obvious in situations involving food, but Brown first noticed her daughter's angst while on a bike ride. She writes in Brave Girl Eating that about a half a mile into the ride, for no apparent reason, Kitty began to cry hysterically. "It was the kind of thing we did all the time, and suddenly there was a child so anxious she couldn't bike for five minutes without falling apart," she says. In the days that followed she began paying closer attention to her daughter's anxiety. It became clear rather quickly that it wasn't just a teenage mood swing; obsessive thinking was infiltrating her daughter's everyday life. "The bike ride was the day the red flag went up," says Brown. "I just didn't know until later what it was signaling."