In these early back-to-school days, parents may notice children acting strangely self-conscious – a daughter dressing in baggy long-sleeve shirts despite warm temperatures or a son wearing two shirts, one on top of the other. Attempts to hide evidence of a changing body you suspect. Maybe you observe your child seems nervous about the school locker room scene or find that clothes shopping, which you once enjoyed together, is now a painful ordeal.

For confident kids, dressing for school might not prompt a second thought. But for those who aren’t quite comfortable in their own skin, it can stir a whole pot of insecurities, which when left unchecked can lead to what experts call “disordered eating” and eating disorders.

Is it possible to help kids feel good about themselves? Or does body image need to come from within? We asked some local experts for their thoughts on imparting healthy messages to kids.

Disordered Eating

“Many teenagers diet but only a small percentage of teens develop an eating disorder,” says Esther Dechant, M.D., a child and adolescent psychiatrist with the Klarman Eating Disorders Center at McLean Hospital in Belmont. “There are some kids who go to school and don’t eat any lunch. … Sometimes we see kids who start losing weight and then they go into their annual physical and they are down 20 pounds.”

Disordered eating, Dechant explains, “means having low-grade symptoms of an eating disorder, but the symptoms don’t last for a very long period of time or progress into a full eating disorder.” Sometimes disordered eating precedes an eating disorder, she says.

Dechant cites the following as signs of trouble:

• weight loss (especially rapid or severe);

• strict or inflexible dieting;

• calorie counting;

• cutting out food groups, such as carbs, and viewing them as taboo foods;

• excessive exercise;

• preoccupations about weight and shape, food or eating;

• vomiting or using laxatives; and

• eating large amounts of food (often at night or in secret).

“Young athletes merit extra caution,” Dechant notes. “These kids should not only not diet, but they need to eat more to meet their caloric needs.”

Parents who have concerns should involve their child’s pediatrician and seek consultation with a nutritionist or counselor.

Focus on a Healthy Body

Parents can help promote positive feelings in children about their bodies at various ages. According to Dechant, this generally involves attending to the emotional issues kids face because disordered eating stems from some of these issues. Dechant offers the following advice:

Toddlers and Preschoolers

“Take advantage of young children’s naturally good relationships with food, which is to eat when hungry and stop when full. This sets the stage for good eating habits. Provide lots of healthy nutritious food. Limit less nutritious food, but avoid labeling food as ‘good’ and ‘bad.’ Provide opportunities for play and motor development. Modeling is even more important than what you say at this age. Thus, parents should examine their own relationships with food and their bodies and set good examples of healthy eating and activity.”

Elementary Schoolers

“Focus on healthy eating and activity for the whole family rather than what weight should be or how one should eat. Field questions about bodies by saying, ‘Bodies come in all shapes and sizes.’ Elementary school-age children might make comments about their bodies, which might reflect negative body image, concerns about self-esteem or stress from home or school.”

Middle & High Schoolers

“Looking under the surface of how a child is doing is important. Often children who appear to be doing well (for example, succeeding in sports and school) may have a different internal experience. … Bullying and teasing may appear at this age, and body talk is common at school. While eating disorders are uncommon at this age, disordered eating, which may precede full eating disorders, may appear.

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“Preteens often try diets and exercise routines. Parents should continue to model and promote healthy eating and activity rather than talk about bodies or dieting. Pubertal development is quite varied at this age, earlier for girls than boys. This may make for an awkward time for a young girl, who might be self-conscious about her body and may feel emotionally much younger than she looks.”

Talking about Appearance

“I can’t tell you how many times I’ve heard young female clients say that they were never told they were pretty, or the opposite – that the only type of positive reinforcement they received was for their looks,” says Martha Smeallie, a nutritionist and eating disorder specialist with MassGeneral Hospital for Children at the North Shore Medical Center in Salem.

Parents should tell a girl she’s pretty, Smeallie says, “but they should also tell her she’s kind and intelligent, and should mention all the other qualities that make her the person you adore.”

This applies to boys, too, she says.

Watch Negative Talk

“While adults sometimes do need to change their food habits for health reasons, it’s how you talk about your food and your nutrition that matters,” says Smeallie. “Using that four-letter word ‘diet’ has become synonymous with the punitive state of deprivation. Instead parents can say something like, ‘I’m really trying to change my food habits. I’ve got some goals in mind to improve my health.’”

“If you were walking down the street behind two girls and one was 13 years old and the other was 20, even if they were of the same height and both were fit, you would be able to tell from behind which one was 13 and which was 20,” explains Smeallie. “Women’s bodies change with age and that is a scientifically healthy thing. Talking to kids about biology and science and less about appearance is a helpful way to get your message across.”

7 Tips for Encouraging a Healthy Body Image

“When it comes to raising a child to have a healthy relationship with food and his or her own body, parents need to model positive behaviors,” says Stacey M. Rosenfeld, Ph.D., a clinical psychologist and the author of Does Every Woman Have An Eating Disorder? Challenging Our Nation’s Fixation with Food and Weight (Siena Moon Books, 2014). “While eating disorders have genetic components and can be influenced by kids’ character traits and by peer groups and media exposure, parents can certainly help – or worsen – the situation.”

Rosenfeld offers the following suggestions for encouraging healthy habits:

1. Avoid topics like counting calories, cleansing, dieting and talking about what foods to avoid to be able to fit into a pair of jeans. Avoiding these topics should be as important as avoiding other inappropriate conversations you don’t want to have in front of your children.

2. Throw out your scale and stop weighing yourself. Your child sees everything you do and seeing you weigh yourself has a significant impact on his perception of weight and body.

3. Limit access to television, magazines and other places where unrealistic images of how girls and women should look are often presented.

4. Talk about foods with regard to how children can nourish their bodies rather than their effects on weight. Focus on health – not on calories or fats.

5. Encourage physical activity for the sake of health rather than weight control.

6. Never judge your body in front of your child. Do not say negative things about your body or even glance in the mirror in a critical way.

7. Focus on all of your child’s strengths outside of her body, but make it a point to tell her how beautiful she is.

Mary Alice Cookson is associate editor of Boston Parents Paper.