Swimming outdoors, playing with the family pet and enjoying an ice cream cone -- that is the summer life of a typical 9-year-old girl.
Not for Sarah Smith. As a child, Smith (whose name has been changed to protect her privacy) formed habits that would eventually lead her to develop both bulimia and anorexia nervosa, both of which she is still dealing with today.
Smith remembers her parents using food in a reward-punishment system. When she was good, she got treats; if she was bad, snacks were forbidden.
"I think there was a mixture of ... intentionally restricting my food and then going to try to find the food my parents were hiding," Smith said. "Even in childhood, it became sort of obsessive."
When Smith was born in 1989, child eating disorders were a rarity. Today, they are far more commonplace.
A study conducted by the Agency for Healthcare Research and Quality showed that hospitalizations for eating disorders in children under 12 increased by 119 percent between 1999 and 2006. More recent numbers are unavailable, but experts say the problem isn't getting any better.
Children will come in to her office already showing signs of malnutrition, dietician Page Love says. They often have low energy levels and low iron counts and are reporting hair loss because of their extreme weight loss.
Most, like Smith, do not recognize that their restrictive habits are actually an eating disorder that could ultimately be fatal.
Dina Zeckhausen is a psychologist and founder of the Eating Disorder Information Network. She sees kids in third and fourth grade who are already worried about being fat.
"There is so much emphasis on obesity," Zeckhausen said, "that there's a danger that we are going to produce a lot of anxieties in kids around weight."