The table is set, the company is about to arrive for a festive 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 once appeared as an expert guest on an Oprah Winfrey show segment 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 percent 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.

The Dinner Table Tip-Off

While family dinners offer families an opportunity for togetherness and joyful interaction; there is also 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.

Warning Signs

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.