Children and Adolescents

Early intervention is key

Young people are more likely to medically deteriorate quickly with weight loss compared to adults, so it is important to intervene early.

If there are any red flags, screening or a full assessment of the young person is always warranted.

Take parent or carer concerns seriously. 

Common parental concerns that should raise your concern include: 

• Changes in eating behaviours 
• Skipping/avoiding family meals, eating alone or in secret, cooking own food separately, hiding food, rituals around food prep and eating (cutting small pieces, moving food around plate) 
• Avoidance of particular food groups 
• Vegetarianism/veganism, avoiding high calorie foods (fats, carbohydrates, sauces, dressing) 
• Denial of hunger and reported lack of appetite 
• Increased interest in preparing food for others (but not eating it) 
• Food going missing 
• Frequent trips to the bathroom and evidence of vomit 
• Mood fluctuations (including increased irritability, anxiety, depression) 
• Changes in sleep patterns and activity levels (lethargy, spurts of energy) 
• Gradual social withdrawal (particularly from food-related outings) 
• Excessive exercise and symptoms of exercise withdrawal 
• Baggy clothing 

It may also be appropriate to ask any young person presenting with mental health concerns (in particular anxiety, depression or obsessive-compulsive traits) if they are having any eating related issues. 

Children under 12 years are:

• Less likely or able to articulate that they are afraid of being fat or gaining weight
• More likely to dismiss the severity of their illness
• More likely to present with non-specific somatic symptoms (body symptoms)
• More likely to be diagnosed as having OSFED
• Equally at risk of ED, regardless of gender
• Less likely to engage in vomiting or laxative abuse
• More likely to have lost weight rapidly
• More likely to become sicker quickly with weight loss than adults, so it is important to intervene early

Screening and assessment 

Screen for an eating disorder by asking a few questions about thoughts and behaviours about weight, shape and eating or using a formal tool such as the IOI-S. 

Be aware that young people may not always be forthcoming with this information. Try to build rapport and adopt a stance of curiosity when discussing the young person’s feelings and behaviours. 

Once there is concern that a young person may have an eating disorder, conduct a medical and mental health assessment to: 

• Determine the severity of malnutrition and associated medical risk 
• Treat malnutrition regardless of confirmed eating disorder diagnosis  
• Determine if purging is present (vomiting, laxatives, diuretics) 
• Identify other mental health problems (including suicidality or self-harm) 
• Establish who delivers treatment and the most appropriate care setting - this is crucial to ensure there is a coordinated approach to care from the outset 
• Screen for other potential causes of weight loss 

The following medical tests should be conducted on all children and adolescents at risk of an eating disorder: 

• Pulse 
• Blood Pressure 
• Temperature 
• Blood analysis, including electrolytes (magnesium, phosphate, potassium) 
• ECG 
• Weight and BMI for age and height 

See also: Medical Monitoring: Routine Check-up and Medical Monitoring: Body Systems.

Calculating BMI 

For children and adolescents, after the BMI is calculated using weight and height measurements, it should be plotted on the BMI-for-age growth chart (either boys or girls) to obtain a percentile ranking. 

In this way, individual children’s size and growth patterns can be viewed relative to other children of the same gender and age.