Eating disorders in children: What to do if you’re concerned about disordered eating patterns in children

eating disorders in children
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Today I wanted to talk about a difficult topic, but one that I feel passionately needs to be spoken about more openly among parents and that is eating disorders in children. NHS data on eating disorders shows a fourfold increase in the number of children and young people waiting for urgent care. With more young people than ever before receiving treatment for eating disorders, and almost 10,000 children and young people having started treatment between last April and December with record demand for services (an increase of a quarter compared to the same period the year before and up by almost two thirds since between the pandemic), this is clearly something we need to be concerned about as parents.

Although we tend to associate eating disorders with teens, the reality is that eating disorders in children can start taking root before the age of 12. I have been particularly concerned with some of the language being bounded around recently relating to body image and “being fat” (their words, not mine) which has been circulating amongst my daughter’s age group at only eight to nine years old.

As with all things, early detection and prevention are key, and with more young people than ever before receiving treatment for eating disorders in the first instance, it’s important for parents to be aware of any warning signs before getting to the stage where they might need to seek help.

Here, Dr Alison McClymont – leading child psychologist with over a decade worth of experience at the forefront of children’s mental health – shares her insights on how to pick up on any early warning signs of eating disorders in children, and what parents can do if you are concerned about potentially disordered eating patterns in their children.

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Everybody knows and relates to the stress of having a “picky eater” a “fussy eater” a “particular eater”- whatever you want to call it. Many of us have endured toddler years of only white pasta, nothing orange, no circle-shaped food, nothing touching other food, or things only served on square plates… this is all normal and a developmental stage that many toddlers go through in order to exercise control in an otherwise controlling world. There is nothing in this behaviour that raises (or shouldn’t do!) clinical eyebrows or exhibits any kind of disordered eating concerns.

Eating disorders in children vs other behavioural patterns

However, this does become a slightly trickier area when we factor in sensory issues and the conditions that have these attributes as part of their diagnostic profile- such as autism spectrum disorder, ADHD, and tic disorders. This is also true for profiles that have behavioural patterns that centre on control and reward such as OCD or Oppositional Defiant Disorder.

In both of these clusters, there may be divergence and similarity in the intention behind the eating pattern- for example in OCD, the behaviour may be very focused on eating in a certain order or avoiding certain sensations- not dissimilar to sensory disorder motivations. In ODD we may see eating patterns being used as a means of control or food used as an area that involves or promotes conflict (refusing to eat, refusing to sit down, throwing food, not observing table manners etc).

There is a lesser but more serious group of disordered eating seen in children- and that is those who suffer from anorexia, bulimia, or orthorexia. Please note, however- eating disorders in children under the age of 10 are rare – less than 10 per cent of anorexia sufferers are thought to be under the age of 10, and bulimia is thought to be even less.

Eating disorders in children and the role of body image

Whilst both of these mental illnesses have varied motivations and beginnings – there is general attention paid by both patient groups to body image and a desire to “be thin”, this is a thought process sometimes but uncommonly seen, in young children.

Food-related concerns are more likely in this age group to come from sensory concerns and may be seen as Avoidant/Restrictive eating disorder– where the child avoids food, attempts to avoid swallowing, may express fear of stomach aches or vomiting after eating and usually result in significant weight loss. Pica is a rarer type of disorder where the child will consume non food stuff- this, however, must fall outside of developmentally expected stages- for example this would not be appropriate to diagnose in toddlers or babies who commonly “taste” things as a way of exploration.

So now we have a better idea of what the diagnostic landscape looks like – let’s get into the nitty-gritty. I want to stress, however- eating issues are common in children they do not necessarily suggest a latent or later eating disorder, nor do they necessarily suggest any kind of psychiatric condition. Children commonly use food to control and express emotions.

Signs that MIGHT be cause for concern

  • Negative body image and reducing or restricting food as a result
  • Consuming non-edible or uncooked foods (after age 5)
  • Repetitive secretive eating behaviours such as hiding food, binging, purging
  • Intense distress related to consuming certain foods
  • Intense distress surrounding food/meal times
  • Unexplained “stomach aches” after eating
  • Fear of choking/vomiting/stomach ache after eating
  • Refusal to eat solid food and only consuming liquids
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What should you do

  • Talk to your child, mention your concerns and ask them to explain to you why they are choosing to eat/ restrict food in this way
  • Meal times together are essential. Regardless of your child’s thoughts or beliefs around food- modelling healthy attitudes to food, such as “meal time is family social time”, and “food keeps us healthy and strong” is absolutely imperative. Do not allow your child’s eating pattern to dominate the family meal time
  • Look for other forms of control you can offer your child, think of ways to offer them greater independence and a sense of agency
  • Ask them to help you cook dinner, encourage your child to become interested in the preparation of food and also allow them a marginal amount of control around what is consumed by the family – maybe they pick a dish one night, and you do the next or maybe they choose the side dish.
  • Explain where developmentally appropriate that restrictive eating can have detrimental effects on our health overall
  • If your child is also showing signs of other mental health concerns alongside their eating patterns, such as anxiety or depression consider reaching out to a mental health professional to help talk to them about their emotions

If you feel triggered by your child’s eating pattern

  • Remain calm. Strange eating patterns in an 8 year are very rarely the prediction of a later eating disorder. Children use food to control- this is common.
  • Try not to get angry- remember this is likely an internalised display of anger on your child’s behalf, your anger.. will not help.
  • Do not force feed or completely give in to them. Some bargaining is going to be necessary here but do not back down entirely and do not impose your will completely- this is likely a battle of wills, they need to feel they have some sense of agency here or this is likely to get worse
  • If you find eating in a restaurant or outside the home too challenging. Don’t. That will happen- but maybe it’s not going to happen now.
  • Find strategies together on how to navigate stressful situations such as allowing your child to bring their favourite snack if they are concerned about the food on offer in the place they are going to

Remember that childhood eating concerns are rarely lifelong, but it can be frustrating, exhausting and at times demoralising when you are in the midst of it. Don’t set yourself battles you won’t win – such as telling a picky eater they must consume everything on their plate at a restaurant they don’t like and don’t blow up your concerns into something that is not in front of you – such as an adult eating disorder diagnosis or a severe health condition.

Children’s food struggles are almost always about control, so look for ways to offer them a sense of independence and choice,  and look for fun things you can do together that don’t involve food to keep your relationship on an even keel. Try not to make every conversation about food, and try to show an easy-going attitude to your child’s idiosyncrasies (though it is hard!), keep up with family meal times and remember that this too shall pass.

Image credits pvproductions, freepik

4 comments

  1. This is such a sensitive subject. You really have some good advice as I wouldn’t know where to even begin addressing this.

  2. We are teaching my nieces and nephew not to be a picky eater. They actually eat everything that’s on the table. We just make sure they have a proper vitamins.

  3. It is worrying with all the pressure on everyone to be thin and look great. I will be watching me daughters careful as it really is something I’m concerned about.

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