What is Disordered Eating in Childhood?
Disordered eating in childhood is habitual unhealthy eating patterns such as: eating too much, eating too little, or eating an unhealthy or extremely limited diet. In more extreme cases, children will develop eating disorders like Anorexia or Bulimia.
Eating is a primary function in life. We think of food, clothing, and shelter as primary to survival, yet eating is also a significant concern for many parents. Every child needs to develop and maintain a healthy relationship with food.
Disordered eating can take on many different forms. Some children forget to eat, don’t notice they are hungry, or can’t sit still long enough to eat even the smallest meal. Some refuse certain smells or textures or even food presentation, saying, “my beans are touching the potatoes!”
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Symptoms of Disordered Eating in Children
- Restricting or binging: Not eating enough or eating too much
- Purging: Gagging or throwing up after eating
- Selective eating: Refusing fruits and vegetables
- Junk food eating: Only eating foods like fries, pizza, and fruit snacks
- Sensory sensitivity and eating: Appearing to be extremely sensitive to the texture, smell, or presentation of food
- Picky and argumentative eating: Asking that you cook at least 3 different meals at dinner
- On-the-go eating: Not sitting down or stopping to eat a meal
- Missing sensory cues: Failing to recognize cues of hunger, getting “hangry” (hungry and angry) without being able to identify the hunger
- Body shaming: Criticizing their body physically on a regular basis which may cause unhealthy or even dangerous eating patterns
Causes of Disordered Eating in Children
Anxiety: with children and teens the need for control and need for predictability may be due to anxiety or social insecurities. Eating disorders include a significant need for control over one’s own environment. Human beings can control eating and expelling waste at the fundamental level. While other aspects of life may be out of control, they can control their eating.
Poor body image: with children and teens eating disorders can also be related to poor or distorted body image. Individuals with anorexia may think that they look too heavy or even normal, when others see them as drastically too thin. Often, extremely thin children with anorexia may think they have more weight to lose. They do not tend to see how thin they are and do not believe they have a problem. Anorexia can be deadly and requires inpatient treatment because of the severity of symptoms and the tendency to deny the problem.
Sensory differences: another reason children and teens may struggle with eating could be related to a sensory sensitivity. Children who are not in tune with their bodily cues, a struggle for some children with autism, may not realize that they are hungry and need to eat. Sensory sensitivities can create “picky” eaters with drastically reduced diets. Autism Spectrum Disorder, by definition, includes sensory impairments. Some children refuse so many foods that they are reduced to a short list of 5 to 10 items that they will eat.
Trauma: children and teens who have been through trauma may hoard food or refuse to eat because of significant emotional symptoms. One symptom of depression is a significant change in appetite, either eating less or eating more than the typical amount.
Medical complications: some medical conditions may impact a child’s and teen’s appetite, their ability to tolerate certain foods and even the way they take in nutrients. It can be hard for children to resume a more typical diet after medical events or procedures. Feeding difficulties may be the result of these medical complications.
Activity level: some children and teens may be too active to sit still long enough to eat, which could be a severe form of ADHD Hyperactive Impulsive Type. Stimulant medications that are prescribed for ADHD can drastically reduce appetite, meaning a child who already can’t sit still now has no appetite for food.
Rigid behavior: when children and teens need things just so and are not flexible to try new things, eating a variety of foods can be difficult.
Self-esteem: children and teens with a low sense of self may focus on their body image and restrict their eating.
What to Do about Disordered Eating in Children
DO these steps for mild eating issues
At home, if these symptoms are mild at home but you have a few concerns, try these tips.
- First and foremost, lighten up. Most food issues are about control. If you are nervous and controlling, your child’s problems will worsen.
- Make mealtime fun. For example, play a trivia game at the table, watch a cool video, and share compliments with each other. Do not make dinnertime negative.
- Provide choices for food, and make options available that your child will eat.
- Offer the tiniest bites of new and unfamiliar foods, and reward trying new things.
- Do not restrict access to food at other times.
- Have healthy fruit and vegetable snacks available all the time.
- Have protein bars or other snacks that include needed nutrients.
- Make sure this food is accessible anytime, day or night, if your child needs to gain weight.
DO these steps for overeating
If your child needs to lose weight, follow these steps.
- Offer healthy options and keep anything that could be binged on (like honey, chips, or spaghetti noodles) out of reach or out of access.
- Don’t have food in the house that you aren’t okay with your child eating.
- Provide choices, but also exercise portion control at meals under the guidance of a nutritionist.
DO these steps for picky eaters
If your child is a picky eater, introduce them to new foods using the following steps. Check that your child can do each step as you move forward.
- tolerates food
- interacts with food
- smells food
- touches food
- tastes food
- eats food
You might first simply require your child to tolerate the food on their plate and then interact with it several times before actually eating it. Many children need to try a new food 12-20 times before deciding that they like it. Don’t give up.
When introducing new foods, the SOS model encourages playing with your food and doesn’t view this play as a bad thing. This approach never forces children to eat food. It also encourages fun activities prior to a feeding session such as the following:
1) Gross motor movement (swinging, obstacle course)
2) Oral motor activity (blowing bubbles or using whistles)
These suggestions are just a few tips; it is important to seek professional help for significant eating issues, so do not delay.
When to Seek Help for Disordered Eating in Children
Eating is a problem if you have an ever-dwindling list of foods your child will not eat. A child who lives primarily on Cheetos, eats only white foods, or refuses all meat, vegetables, and fruit has a restricted diet that can profoundly affect their health.
Some children hoard food in their bedrooms or in the couch cushions. You may find rotting food in your child’s room regularly and hear the excuse, “Oh, I was going to eat that,” or “I didn’t put that there.”
Other children and adolescents actively avoid food to restrict caloric intake and control something fundamental to their being. These children may appear underweight, may have a distorted body image, or may resort to vomiting or laxatives to purge themselves of unwanted calories. An obsession with body shape may impact this child’s eating.
Other children and adolescents may overeat. This behavior may happen during emotional times or may be a compulsion. Overeating and binge eating may result in sudden weight gain. Weight may skyrocket; your child may feel ashamed and start to eat in secret.
While all children have unique needs and eating styles, significant challenges with eating might be warning signs of an eating disorder. Overeating, binging and purging, and restricting calories substantially leading to extremely low body weight or cardiac arrhythmias, are all symptoms of eating disorders.
Eating Disorders are very serious and can be life-threatening. First and foremost, seek support from your pediatrician, and get a referral to work with a specialist.
If your child has more sensory challenges, consider Feeding Therapy, a systematic treatment for expanding your child’s diet.
This approach may need to be reinforced with ABA therapy (Applied Behavior Analysis) at home to work on implementing strategies aimed to increase food intake.
For anorexia, inpatient treatment is necessary as this eating disorder is a life-threatening illness. Your child needs around-the-clock care and support.
Bulimia often requires significant therapy and care from a psychologist, nutritionist, and physician. It is important to take all forms of eating disorders very seriously.
For trauma and depression, outpatient support from an eating disorder clinic and perhaps a nutritionist can help.
Psychotherapy is recommended to treat emotional symptoms in older children or adults, and play therapy can help with the little ones.
Professional Resources for Disordered Eating in Children
Psychotherapist or play therapist: to treat emotional symptoms and provide opportunities for control within the therapeutic structure. Cognitive Behavioral Therapy could help an older child set eating goals and reinforcers while play therapy may be best for the younger age group if there are emotional considerations to eating. Otherwise, a feeding therapist would best serve a young child. Outpatient treatment is not recommended for anorexia. Inpatient treatment is best, but continuing to have psychotherapy when symptoms are in remission can be helpful.
• Psychologist or neuropsychologist: to consider a full assessment to examine symptoms in a mental health context and to determine diagnoses and recommendations. Eating challenges need to be treated differently based on the diagnosis
• Inpatient treatment center with a variety of professionals in one place: For more severe challenges, having psychiatrists, psychologists, social workers, nurses, and internists working together can create a comprehensive treatment plan
• Feeding therapist or occupational therapist (perhaps with ABA): to work to reduce sensory sensitivities by gradually introducing food into the diet. Working from a behavioral perspective to make mealtime more pleasant and working to meet sensory needs
• Pediatrician or child psychiatrist: to manage medications (noting possible side effects of reduced appetite or when medication is treating another underlying problem, such as depression), to check for any medical causes like growth hormone deficiency or oral motor challenges that could be impacting the ability to eat
Similar Conditions to Disordered Eating
- Rigid behavior: children who need things just so and are not being flexible to try new things may have disordered eating
- General anxiety or socializing issues: children who have a need for control and need for predictability may be due to anxiety or social insecurities
- Self-esteem: children with very poor sense of self may fixate on body image and restrict their eating
- Sensory sensitivity: children with an under or oversensitivity to stimuli leading to a lack of awareness of hunger or significant sensitivity to food texture or smell
- Attachment: children reacting to unstable environmental situations may try to execute some level of control over their lives
Resources for Disordered Eating in Children
These resources are based in Colorado.
 For Sensory Processing Related Eating Challenges: Children’s Hospital of Colorado- Swallowing www.childrenscolorado.org/doctors-and-departments/departments/ears-noseand-throat/clinics/fees/
 Kay A. Toomey PhD Individual Practitioner, Feeding Specialist Denver Colorado
 Star Institute Occupational Therapy, Denver https://www.spdstar.org/
 For Eating Disorders in Colorado: Referral at Eating Recovery Center would depend on insurance, but they offer outpatient services, nutrition, psychiatry, and individual and group therapy http://www.eatingrecoverycenter.com/programs/colorado/levels-of-care/
 Eating Disorder Center of Denver http://www.edcdenver.com/treatment-options/denver/outpatient-services
 Kaiser Permanente Eating Disorders Program. Eating disorder program (outpatient) at Highline Clinic and their Hidden Lake Clinic in Westminster.
La Luna Center is in Ft. Collins and Boulder. http://www.lalunacenter.com/boulder.htm
Book Resources for Disordered Eating in Children and Teens
Nelson, Tammy (2008) What’s Eating You?: A Workbook for Teens with Anorexia, Bulimia, and other Eating Disorders.
Muhlheim Lauren (2018) When your Teen Has an Eating Disorder: Practical Strategies to Help Your Teen Recover from Anorexia, Bulima, and Binge Eating.
Taylor, Julia (2014) The Body Image Workbook for Teens: Activities to Help Girls Develop a Healthy Body Image in an Image Obessed World.
Resch, Elyse (2019) The Intuitive Eating Workbook for Teens: A Non-Diet, Body Positive Approach to Building a Healthy Relationship with Food.
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