To examine child and adolescent differences in the clinical presentation of eating disorders (EDs) at referral to a specialist pediatric program. This study compared cognitive, behavioral, and physical and medical features of children (≤12 years) and adolescents (13–18 years) with EDs presenting to a state-wide specialist pediatric ED service over two decades (N = 656; 8–18 years; 94% female). Significant differences were found between the groups. Children were more commonly male (p .05). The clinical presentation of EDs differs among children and adolescents, with eating pathology and behavioral symptoms less prominent among children. Frontline health professionals require knowledge of these differences to assist with early detection, diagnosis, and prognosis.