Recently, you've noticed your 15-year-old daughter just picking at her food. Your son jokes about her going on another diet, and her grandmother says, "You could use some meat on your bones." She looks down and screams that she ate a big lunch at school and is not hungry. When she gets up suddenly to leave, her baggy clothes, although stylish, look more oversized than usual.

Although you want to just pass it off as a stage of adolescence, you are worried. She's been depressed for a while, and her weight concerns you. But when you try to talk to her about it, you cannot communicate. "You're too thin," you say, and she says, "I'm too fat."

Generally, eating disorders involve self-critical, negative thoughts and feelings about appearance and food, and eating behavior that harms normal body composition and functioning. A person with anorexia nervosa typically starves herself to be thin and experiences excessive weight loss. A person with bulimia nervosa may experience weight fluctuations, but rarely the low weight associated with anorexia. Bulimia nervosa is characterized by binge eating and purging. Both disorders may also be characterized by compulsive exercise. Unfortunately, many teens successfully hide these disorders from their families for months or years.

Different types of emotional stress, such as depression caused by a biological problem or difficulties adapting to problems within the family, may lead to a disturbance in a child or teen's relationship with nutrition.

Sometimes, problems at home may be risk factors for disordered eating behaviors. The eating disorder may be the child's way of coping with the problems encountered in her home life.

Some research suggests that media images contribute to the rise in the incidence of eating disorders. Most women in advertising, movies, TV, and sports programs are very thin, and this may lead girls to think that the ideal of beauty is thinness. Boys, too, may try to emulate a media ideal by drastically restricting their eating and compulsively exercising.

Eating disorders may be diagnosed in children younger than 11 years, but the average age of diagnosis is 14 to 15. Ninety percent of children and teens with eating disorders are girls. Kids and teens with anorexia tend to be perfectionistic and shy, as well as bright and high achievers in school and athletics. Kids and teens with bulimia tend to be more impulsive and outgoing.

Malnutrition in developing girls and boys with eating disorders has serious consequences. Dehydration can occur, as well as other medical complications. In advanced stages, it affects the brain and causes symptoms such as dizziness, fainting, agitation, confusion, inability to concentrate, loss of memory, and impairment of thinking. Anorexia may cause growth retardation, puberty delays, bone mass problems, structural abnormalities of the brain, heart and blood pressure problems, and gastrointestinal difficulties. Bulimia may cause medical complications, such as tears in the esophagus, gastric disturbances, blood pressure problems, and erosion of tooth enamel.

Parents should know the early warning signs and symptoms of eating disorders.

Anorexia danger signs include:

• significant weight loss
• continual dieting (although thin)
• feelings of fatness, even after weight loss
• fear of weight gain
• lack of menstrual periods
• preoccupation with food, calories, nutrition, and/or cooking
• preference to eat in isolation
• compulsive exercise
• binge eating and purging
• insomnia
• brittle hair or nails
• depression with social withdrawal

Bulimia danger signs include:

• uncontrollable eating (binge eating)
• purging by strict dieting, fasting, vigorous exercise, and/or vomiting
• abuse of laxatives or diuretics ("water pills") to lose weight
• frequent use of the bathroom after meals
• reddened finger(s) (from inducing vomiting)
• swollen cheeks or glands (from induced vomiting)
• preoccupation with body weight
• depression or mood swings
• irregular menstrual periods
• dental problems, such as tooth decay
• heartburn and/or bloating
• problems with drugs, or crime

If you suspect your child has an eating disorder, be sure to talk to your child and explain why you need to visit a doctor or dietitian. A medical professional can help you and your child take steps toward healthier eating and nutrition.

The focus of treatment for eating disorders is helping kids cope with their disordered eating behaviors and thinking. Treatment includes medical supervision, nutritional restoration, and behavioral therapy, which addresses beliefs about body size, shape, eating, and foods.

Whatever the reason for the eating disorder, if parents and children can work together to understand the problem, the results will be more favorable.

Generally, the earlier the intervention, the shorter the treatment period. If a parent can discover an eating disorder before malnutrition or continual binge-purge cycles occur, the duration of treatment is shorter.

Your behavior as a parent may help your child to avoid eating disorders. Encourage, don't belittle, your child daily. By focusing on your child's strengths, you will build self-esteem.

In addition, your own body image may influence your child's body image. If you constantly say "I'm fat," complain about exercise, and practice "yo-yo" dieting, your son or daughter may feel that it is normal and acceptable to have a distorted body image.

Finally, illustrate what a healthy lifestyle is to your child. Involve your child in the preparation of healthy, nutritious meals on a regular basis. Let your child know that it's OK to eat when you're hungry, and refuse food when you're not. Also, make exercise a fun and rewarding family activity, as well as a regular one. If you have healthy attitudes about food and exercise, your child will have a good example from which to learn.