Eating disorders in children and teenagers

Written by Dr. Joshua Harwood

Josh is a chartered clinical psychologist specialising in working with children and families.

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The relationship children and teenagers have to food often changes and fluctuates over time. Experiences such as trauma, bullying, stress and body image issues can all have impacts on their appetites and eating habits. This can include over or under eating, avoiding particular types of food and trialling dieting plans. It is common for eating habits to change and does not necessarily mean there is a cause for concern. 

If you are worried that your child may be struggling with an eating disorder, it is important to seek appropriate professional support, even if you are unsure. Getting help as early as possible is vital, as eating disorders can cause significant damage to a child’s mental and physical health. You may also find it helpful to learn a bit more about eating disorders and some tips and tools you can use to help support your child.

When might it be a problem?

In some cases, changing eating habits can be used as coping strategies for intense feelings such as anxiety, sadness, guilt or stress. Eating disorders are often not about the food itself, but instead about the underlying feelings. Children may feel fearful of gaining weight and express dissatisfaction with their body shape and size which can lead them to restricting their food intake. Others may change their eating habits as a way of feeling more in control. 

Eating disorders can present themselves in different ways. The two most common types of eating disorder are: Anorexia Nervosa (Anorexia) and Bulimia Nervosa (Bulimia). 

Anorexia - characterised by extremely low weight from restricting the consumption of food, often because of concerns over body image. 

Bulimia - appears as a cycle of consuming large quantities of food followed by a purging period where they compensate for their food intake by over-exercising or making themselves vomit. 

There are other recognised eating disorder diagnoses, which are less common and will not be the focus of this article. These include Avoidant Food Restrictive Intake Disorder (ARFID), Binge Eating Disorder, Pica and Rumination Disorder.

Causes of eating disorders in children

There are many reasons why your child could have a difficult relationship with eating. Eating disorders are very complex and are unlikely to have one singular cause.

There are certain factors that may mean your child is more likely to develop an eating disorder, including:

• A family history of eating disorders or other mental health issues 
• Being criticised for their eating habits or body shape
• Having a fixation on being slim 
• Having an existing mental health disorder such as anxiety
• Having perfectionist or obsessive tendencies 
• Experience of physical, sexual or emotional abuse 
• Experience of being bullied
• Having hobbies that encourage certain physiques such as dancing or athletics 

Signs to look out for

There are many different signs of eating disorders and your child may not present with all of them. 

As eating disorders have a big impact on physical wellbeing, you may notice more visible signs of an eating disorder, such as:

• significant weight loss
• fatigue and exhaustion 
• light-headedness and fainting
• chills
• stomach pains
• bad breath
• stunting of growth and development
• poor skin 
• hair loss
• sensitive or damaged teeth
• irregular periods.

There are also many psychological signs of eating disorders that you may notice:

• Obsession with their appearance and body image, they may suggest that they look fat even if they are not
• Expressing guilt after eating 
• Preoccupation with a fear of gaining weight
• Increased stress at mealtimes
• Decreased self-esteem
• Increased depression and anxiety
• Mood swings and anger
• Changed or deteriorating relationship with friends 
• Difficulty sleeping 
• Thoughts about harming themselves or taking their life 
• Withdrawing from friends and family

You may also notice certain differences in their behaviours, particularly around eating and weight gain:

• Excessive levels of exercise in an attempt to lose weight
• Choosing to eat alone or in secret as they will find it easier to skip meals or eat less without pressure, they may then lie about how much they have eaten 
• Cutting food into very small pieces to make eating slower
• Vomiting after eating, you may notice they frequently go to the toilet shortly after eating
• Checking their weight on scales repeatedly
• Wearing baggy clothing to hide their weight loss
• Counting the calories of the food they consume

When to seek more urgent help 

If your child is demonstrating any of the following, you need to seek professional help more urgently:

• Thoughts about suicide or harming themselves
• Withdrawing completely to their room
• Rapid deterioration of symptoms 
• Rapid weight loss
• Using drugs or alcohol 
• Frequent risk-taking behaviours and accidents
• Refusal to eat anything or even small amounts of food
• Extreme malnourishment
• Very low heart rate 
• Low body temperature 

If you believe your child is in danger, you should seek emergency professional help. This includes getting an emergency appointment with your GP, phoning 111, calling 999 or taking them to the nearest emergency department. For more information and advice from the NHS go to their website at: Where to get urgent help for mental health¹

What can you do?

It can be scary and upsetting to see that your child is struggling with their eating. It may feel frustrating at times because it can be difficult to understand. There are, however, many useful tips available that you can use to help support your child. Remember these are not a substitute for seeking urgent professional support, but are there to offer you some tools to help support your child, alongside their therapist:

• Show openly your unconditional love and care for your child.
• It is important that you steer clear of discussing their weight or food intake, even if you mean to use it positively. For example, avoid praising weight gain as this may make your child more conscious of their body shape and size. Eating disorders are about the underlying feelings, so weight gain does not necessarily mean they are getting better. Instead focus on the more emotional signs, for example say ‘I’m worried about you, you seem unhappy’ as opposed to ‘You seem to have lost a lot of weight recently’. This helps to avoid making food and weight the central issue.
• When planning meals, it is important that you encourage your child to have mealtimes together. Be clear about what time you plan to eat and what food you will be having and how large the quantity will be. Keep meals reasonable and balanced with sensible portion sizes. Avoid making any last-minute changes to this as it may cause your child to feel more stressed and panicked, which may make eating even more difficult for them.
• During mealtimes it is important that you do not focus on your child and how much they are eating, try to keep up a positive, light-hearted conversation and avoid any discussion about portion sizes, calories or other aspects of the meal. Refrain from pressuring your child too strongly to eat more than they feel comfortable doing, this will only make it harder for them. You can offer gentle encouragement and let them know you are aware how big an effort it is for them. 
• If you find it difficult to maintain a conversation when you are worried about your child, try switching on the TV or listening to the radio to provide a distraction. After mealtime encourage a family activity that you can do together, this may help to distract them from their negative thoughts about their eating and lower the risk of them purging.
• If your child becomes very stressed during mealtimes encourage them to use certain techniques to help calm their body and their mind. For example, going outside for fresh air, splashing face with cold water or practicing controlled breathing. 
• Eventually it will be important that your child makes their own decision about whether life is better with or without an eating disorder. You can help them with this by getting them to map out their life for the next six months with one line being their life if they continue their eating disorder and the other if they commit to positive change to overcome it. They should write the pros and cons for making changes and decide for themselves which path they wish to follow. You’ll want to make sure to be doing this alongside your child’s therapist.
• Your child may also benefit from being reminded that only they care how thin they are or how much they eat. It is important that you do this in an empathic way and do not trivialise how they are feeling. For example, try saying something along the lines of ‘I understand how difficult and important this feels for you right now but I want you to know that your body size has no effect on how I or others feel about you’. Remember not to try and rationalise their feelings, although it is difficult for you to understand, it will feel extremely overwhelming and distressing for your child. 
• Encourage your child to take part in activities, hobbies and social events that do not revolve around eating. It can help to distract them from thinking about their weight and help fill their time. They do not have to be big events, even gentle walks or watching a film together could help. 
• Talking to your child about their eating disorder may not always be easy. There will be times when they are feeling very overwhelmed and logical discussions will not be possible. Remember to stay calm and support them, you can have a serious conversation at another time when they feel more able to talk. When they are ready, try not to criticise them, even if you do not understand the eating disorder. Recognise and praise their changes, no matter how small, just make sure not to focus the praise around weight gain. 

What to do next?

If you would like to read more about eating disorders and how to manage them, here are some reliable resources:

Websites:

• Beat Eating Disorders (charity)
• The NHS - Advice for parents – Eating disorders
• Eva Musby (who has lived experience of having a child with an eating disorder) 
• Family mental wealth – Spot the signs 

Books:

• Lacey, H., Bamford, B. & Brown, A. (2010) Bulimia, Binge-eating and their Treatment.
• Schmidt, U. & Treasure, J. (1993) Getting Better Bit(e) by Bit(e).
• Fairburn, C. (1995) Overcoming Binge Eating (new edition 2013).
• Treasure, J., Smith, G. & Crane, A. (2007). Skills-based Learning for Caring for a Loved One with an Eating Disorder. London: Routledge. 

Beat Eating Disorders’ list of recommended books.

Apps:

Healthline recommended apps for eating disorders.

Looking after yourself as a parent:

It is important that you accept what is happening with your child, don’t avoid or deny it. It is not your fault and you shouldn’t blame yourself.

It is not always easy caring for a child with an eating disorder and it is important that you take care of your own well-being too. Remember not to be too harsh on yourself, it is likely you will make a mistake occasionally as it is impossible to get it right all the time. There are organisations available that offer support to carers of children with mental health difficulties. You may find some of these helpful:

● Mind - Parenting with a mental health problem  

● Young Mind Parent Helpline

References

1. NHS - Where to get urgent help for mental health

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