Eating Disorders in Children: Growth & Development

Eating disorders can start earlier than many expect — often during key periods of growth and development. In children and adolescents, warning signs can be subtle, which is why early screening and regular growth monitoring are so important. With the help of evidence-based treatment, recovery is possible.

Can a child have an eating disorder?

While eating disorders are often believed to mainly impact young adults, they can also occur in children and teens. Every year, about 14 million people worldwide experience an eating disorder, 3 million of whom are children and adolescents.¹

Research has also shown that 20% of children show signs of disordered eating.² While not every child who exhibits disordered eating will develop an eating disorder, disordered eating can predict the development of an eating disorder and outcomes in early adulthood.²

Eating disorders are seen across age, weight and socioeconomic status in adolescents. The risk of bulimia nervosa, atypical anorexia nervosa and binge eating disorder (BED) are increased in youth at higher body weights.³

It is crucial for parents, caretakers and providers to recognize the signs of eating disorders in children and know how to seek help.

Early Development of Eating Disorders

Eating disorders are developing earlier. In recent years, the age of onset of eating disorders has trended downwards, with the median age of onset around 12 for those with anorexia nervosa and bulimia nervosa.^4-6 At the time of diagnosis, growth chart deviation has typically been going on for 18 months.

Eating Disorder Diagnoses in Children

Eating disorders in children present with a variety of symptoms and behaviors as outlined below.

Avoidant/restrictive food intake disorder

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterized by restriction of food, not due to concerns regarding weight or shape but due to lack of interest in food, avoidance of food based on sensory concerns such as smell, taste or texture or fear of adverse consequences of food intake such as reflux or constipation.⁷

Children and teenagers with ARFID often cannot meet their energy needs because they avoid specific foods, which can significantly affect their growth and development. Food avoidance behaviors often begin in early childhood and may persist into adulthood if not diagnosed and treated.

Early-onset anorexia nervosa and atypical anorexia nervosa

Anorexia nervosa is an eating disorder characterized by an intense fear of gaining weight and behaviors to suppress weight.⁷ The fear of weight gain leads to distorted body image and disturbances in eating behaviors.

Atypical anorexia occurs in someone in a BMI >18.5 who has experienced weight suppression.⁷

There are two subtypes:⁷

• Restricting subtype (AN-R)
• Binge-eating and purging subtype (AN-BP)

AN-R is more common in children and often results in low body weight due to food restriction, compared to AN-BP which involves restricting food intake along with binge eating and purging behaviors.

Anorexia nervosa poses a serious risk to children because restricting nutrients and energy during a key growth period can cause lasting effects on a child’s development.

Other specified feeding or eating disorder

Other specified feeding and eating disorders (OSFED) is a category for eating disorders that do not meet the full diagnostic criteria of other eating disorders despite similar symptoms.⁷ Children may experience fewer and shorter episodes of eating disorder symptoms, but these can still be clinically significant and lead to health problems and impairments when they occur during childhood.

Pica

Pica is an eating disorder where individuals eat non-nutritive, non-food substances like:⁷

• Paper
• Glass
• Clay
• Hair
• Chalk
• Dirt
• Other nutrient-deficient non-food items

Pica is a relatively rare condition most often seen in young children. Although it is uncommon, pica can lead to many medical complications due to nutrient deficiencies from the substances consumed and the dangers associated with those substances.

How do eating disorders affect growth and development?

Not only are children at risk of all the same complications of food restriction and purging behaviors as adults, but some complications of eating disorders in childhood have a lifelong impact on their growth and development

Growth faltering (failure to thrive)

Malnutrition during early childhood can lead to growth faltering. Failure to thrive (FTT), now known as growth faltering, describes insufficient weight gain in children. Growth faltering can be organic from another medical condition, or inorganic, caused by environmental, psychosocial or nutritional factors – like eating disorders.

Stunted growth

Children who are malnourished often experience stunted linear growth (height). Girls whose eating disorder presents earlier in their pubertal development, when they typically experience growth spurts, experience more dramatic effects on linear growth while those who are post-menarchal see less of an impact on their final adult height.⁸

Boys, who have growth spurts later in puberty, often experience the opposite. Boys whose eating disorder presents earlier have additional time to grow in recovery, while those whose eating disorder starts or persists later may not have time to catch up in growth.⁸

Puberty delays

Malnutrition can delay or halt puberty. Low body fat and malnutrition interfere with the hypothalamic-pituitary-gonadal (HPG) axis, decreasing levels of hormones like estrogen and testosterone. This can delay or prevent menstruation, growth and sexual development, effectively postponing puberty.

Low bone mineral density

One of the biggest factors influencing bone health is the age of onset of an eating disorder. Those who develop an eating disorder in childhood face more serious bone health problems than those who develop one later in life.

Altered brain development

Eating disorders in childhood may alter brain development. 11.6% of adolescents with anorexia nervosa and 14.4% with bulimia nervosa report at least one day when they could not perform normal activities.⁴

From childhood to late adolescence, essential developmental tasks occur in the brain related to cognitive, social, and emotional growth. Eating disorders may disrupt this vital developmental period, causing neurologic and developmental delays.⁸

Risk factors for eating disorders in childhood

Multiple risk factors can increase a child’s risk for developing an eating disorder, including genetics, co-occurring mental health symptoms, social pressures and participating in certain sports.

Genetics

Research is still emerging on the role of genetics in the development of eating disorders. Twin and adoption studies, alongside molecular genetic studies have all suggested that a significant portion of risk may be genetic.⁹

Dual diagnosis

Research demonstrates that 55-95% of people diagnosed with an eating disorder also receive a diagnosis for another psychiatric disorder. This is known as dual diagnosis.¹⁰ Co-occurring conditions often share underlying traits like impulsivity and obsessive behaviors, which can exacerbate eating disorder symptoms or cause teens to use disordered eating behaviors to cope.

Weight-based bullying

Weight-based bullying can lead to shame, low self-esteem, and body dissatisfaction among children. Repeated teasing or discrimination may cause them to feel unaccepted or unworthy, which can result in unhealthy weight loss efforts. This emotional distress can increase the likelihood of restrictive eating, binge eating, or purging.

Adverse experiences with food

Negative experiences with food – such as choking or vomiting – can cause fear or anxiety around eating. Children may begin to avoid certain foods or textures, resulting in restrictive eating patterns. Over time, this avoidance may develop into ARFID.

Assessing Children for Eating Disorders

Eating disorders in childhood often go unnoticed because pediatricians may not expect to see eating disorders in their young patients. Continuing education about pediatric eating disorders is vital for identifying children with these conditions.

For younger children, the American Association of Child and Adolescent Psychiatry recommends several assessments.¹¹ These assessments should be used alongside tracking a child’s growth to determine the likelihood of an eating disorder.

Growth in childhood

Growth requires a tremendous amount of energy, but unlike adults, children may not show obvious weight loss when they are malnourished. Instead, children and adolescents have a pattern of loss in weight percentile followed by a decline in their height percentile.¹³

Because children grow predictably, tracking growth, reviewing growth history and comparing to family growth history can help pediatricians identify an eating disorder early.¹³ Typically, after age three, children follow the same percentile curve for height and weight until their growth is complete.^8,13 Shifts across two or more percentiles are uncommon and children follow familial patterns for growth, so deviation from these patterns is often the first sign of an underlying disorder.¹³

The Kids’ Eating Disorder Survey

The Kids’ Eating Disorder Survey (KEDS) is a 14-item self-report screening tool assessing weight dissatisfaction and purging/restriction behaviors designed for children in middle school between ages 11-14.

The Children’s Eating Disorder Questionnaire

The Children’s Eating Disorder Questionnaire (ChEDE) is a semi-structured, interviewer-based instrument aimed at assessing the key behavioral and attitudinal correlates of EDs in children aged 8-14.

The Child-Eating Attitudes Test

The Children’s Eating Attitudes Test (ChEAT) is a 26-item questionnaire used to assess eating attitudes and disordered eating behaviors in children ages 8-15. For younger children it is administered by orally reading items to the child, while adolescents can self-report responses.

The Eating Disorder Inventory for Children

Based on the Eating Disorder Inventory designed for adults, the Eating Disorder Inventory for Children (EDI-C) is a multidimensional self-report questionnaire for children and adolescents used to characterize differences in the symptoms of eating disorders.

Treating Eating Disorders in Children

Early intervention offers the best chance at recovery for children and adolescents.

More frequent checkups

If you suspect a child has an eating disorder, it’s best to have more frequent follow-ups throughout the year rather than annually. This provides more opportunities to discuss treatment options, track growth and restore normal growth.⁸

Nutritional rehabilitation

Providers should take into account The American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines as they initiate nutrition to avoid refeeding syndrome in pediatric patients.

Patients identified as being at risk for refeeding syndrome, excluding young patients with anorexia nervosa, should initially receive conservative calories. They should be closely monitored for electrolyte abnormalities and treated appropriately according to established standards of care.¹⁵

Patients with low electrolyte levels before starting feeding should receive more aggressive supplementation than usual in stable conditions. The severity or speed of electrolyte decline and the risk of refeeding syndrome may influence whether electrolytes should be normalized before beginning any calories or increasing calorie intake.¹⁵

Psychotherapy for Children with Eating Disorders

There are multiple therapies that can help young people recover from eating disorders. Family-based treatment and cognitive behavioral therapy are at the top of that list.

Family-based treatment

Family-based treatment (FBT) is one of the most successful psychotherapy treatments for eating disorders in children and teens. FBT brings effective interventions from higher-level care settings into the home, where parents can serve as agents of change. With love, care and knowledge, families are encouraged to adapt these interventions in a way that suits them and respects the uniqueness of their family and child.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a primary treatment for eating disorders. CBT is a type of psychotherapy that targets challenging and changing cognitive distortions and their related behaviors. It can help children improve emotional regulation, develop effective coping skills and respond to challenges more effectively.

Getting Eating Disorder Treatment for Your Child

Eating disorders are serious medical and psychiatric illnesses that require timely intervention. Eating disorders can disrupt normal development and puberty in children, which can impact them well into adulthood. All eating disorders are treatable with evidence-based care.

References

1. World Health Organization: WHO. (2022, June 8). Mental disorders. https://www.who.int/news-room/fact-sheets/detail/mental-disorders
2. López-Gil, J. F., García-Hermoso, A., Smith, L., Firth, J., Trott, M., Mesas, A. E., Jiménez-López, E., Gutiérrez-Espinoza, H., Tárraga-López, P. J., & Victoria-Montesinos, D. (2023). Global proportion of disordered eating in children and adolescents. JAMA Pediatrics, 177(4), 363. https://doi.org/10.1001/jamapediatrics.2022.5848
3. Mitchison, D., Mond, J., Bussey, K., Griffiths, S., Trompeter, N., Lonergan, A., Pike, K. M., Murray, S. B., & Hay, P. (2019). DSM-5 full syndrome, other specified, and unspecified eating disorders in Australian adolescents: prevalence and clinical significance. Psychological Medicine, 50(6), 981–990. https://doi.org/10.1017/s0033291719000898T
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6. Madden, S., Morris, A., Zurynski, Y. A., Kohn, M., & Elliot, E. J. (2009). Burden of eating disorders in 5–13‐year‐old children in Australia. The Medical Journal of Australia, 190(8), 410–414. https://doi.org/10.5694/j.1326-5377.2009.tb02487.x
7. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
8. Mehler, P. S., & Andersen, A. E. (2022). Eating disorders: A Comprehensive Guide to Medical Care and Complications. JHU Press.
9. Gibson, D. (2025). Genetic factors of eating disorders. ACUTE Center for Eating Disorders & Malnutrition. https://www.acute.org/resources/genetic-factors-eating-disorders
10. Hambleton, A., Pepin, G., Le, A., Maloney, D., Aouad, P., Barakat, S., Boakes, R. A., Brennan, L., Bryant, E., Byrne, S. M., Caldwell, B., Calvert, S., Carroll, B., Castle, D. J., Caterson, I. D., Chelius, B., Chiem, L., Clarke, S., Conti, J., . . . Maguire, S. (2022). Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature. Journal of Eating Disorders, 10(1). https://doi.org/10.1186/s40337-022-00654-2
11. Lock, J., & La Via, M. C. (2015). Practice parameter for the assessment and treatment of children and adolescents with eating disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 54(5), 412–425. https://doi.org/10.1016/j.jaac.2015.01.018
12. Growth charts. (n.d.). https://www.cdc.gov/growthcharts/
13. Weintraub, B. (2011). Growth. Pediatrics in Review, 32(9), 404–406. https://doi.org/10.1542/pir.32-9-404
14. Lock, J., & La Via, M. C. (2015). Practice parameter for the assessment and treatment of children and adolescents with eating disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 54(5), 412–425. https://doi.org/10.1016/j.jaac.2015.01.018
15. Da Silva, J. S. V., Seres, D. S., Sabino, K., Adams, S. C., Berdahl, G. J., Citty, S. W., Cober, M. P., Evans, D. C., Greaves, J. R., Gura, K. M., Michalski, A., Plogsted, S., Sacks, G. S., Tucker, A. M., Worthington, P., Walker, R. N., & Ayers, P. (2020). ASPEN Consensus Recommendations for Refeeding Syndrome. Nutrition in Clinical Practice, 35(2), 178–195. https://doi.org/10.1002/ncp.10474