When Young Children Have Eating Disorders

By Abigail Natenshon,
MA, LCSW, GCFP
June, 2010

Although anorexia nervosa typically appears during adolescence, a disturbing number of cases have been appearing in young children as early as age 7 or 8. In young children, eating disorders are significantly associated with depression as well as obsessive-compulsive symptomatology. According to Dr Barton J. Blinder, a Mayo Clinic study of 600 anorexic patients of all ages found that three percent were prepubescent anorexics.

"Young children are challenging to diagnose, as only 38 percent meet the criteria for anorexia nervosa. For example, children with poor growth in height as a result of malnutrition may have an "expected" weight that is falsely low; amenorrhea as a criterion for anorexia does not apply to young girls (or boys); younger children present at a lower percentage of ideal body weight and lose weight more rapidly." (Natenshon, 2009, P.128) In a suite101.com article (Ellison, January 2000) entitled Childhood Anorexia, Dr. Blinder argues that a 15 percent weight loss, rather than the usual 25, should be a criterion for diagnosis. Childhood-onset anorexia can delay puberty, physical growth, and breast development. A warning sign of an eating disorder in a young child that is more common than food restriction is a child's inability to control and regulate his or her eating.

It is important that parents learn to distinguish the difference between a clinical eating disorder and other highly prevalent forms of eating dysfunction in infants and small children. These might include selective eating disorder or picky eating syndrome, whose origins stem from sensory integration disturbances which lead to an aversion to certain tastes and textures in the mouth (research has shown that for some taste buds, vegetables take on a distinctly metallic taste.) More severe, neurologically-based feeding disorders are often the result of trauma (choking) or early tube feeding and typically accompany other syndromes such as autistic spectrum disorder. Pediatricians invariably fail to acknowledge or diagnose the less extreme eating dysfunctions, as most children with picky eating habits tend to be of normal weight and do not present with physiological problems. The current "wisdom" is that these aversions, which affect approximately 30 percent of children, represent benign preference or immaturity that will be outgrown; the growing number of picky eating adults refutes this prognosis. Children with picky eating syndrome and more severe feeding dysfunctions may suffer stunted growth, poor bone development, sociability problems, and overweight in adulthood; intolerant of new foods, these individuals invariably have difficulty adapting to novelty and change in other life spheres, as well.

Parents are clearly not the cause of their child's clinical eating disorder, anorexia, bulimia, or eating disorder not otherwise specified, EDNOS, with the possible exception of those who have been physically or sexually abusive to their child. The origin of these disorders lay in gene clusters, in temperament, in a family history of eating disorders, addictions, mood disorders, etc. Parents, however, are largely responsible for educating their child about what healthy eating is, and for shaping a child's healthy eating lifestyle. Parents who are themselves preoccupied with body image and weight gain, who are fearful or rigid about their own approach to food and cooking and/or who do not prepare family meals on a regular basis in the effort to foster a healthy eating lifestyle in their children could possibly increase the ranks of childhood anorexics in those instances where there is a genetic propensity for the onset of an eating disorder. At the very least, such parents might foster disordered eating habits which could eventually morph into a clinical eating disorder where there is genetic susceptibility. Dr. W. Stewart Agras cited a study that showed that children of anorexic mothers were already more depressed, whiny and eating dysfunctional by age five.

Enlightened parents who are good communicators and sensitive to the child's developmental needs and concerns can do a great deal to detect early signs, preventing the onset of a clinical eating disorder, or nipping the problem in the bud.
 

What parents can do:

• If there is a concern that a child may be restricting certain foods, food groups or portion sizes, it is wise to first consult a medical doctor to rule out physiological problems.

• Create a healthy eating lifestyle at home and expect your child to comply with the family's eating patterns. Offer your child healthy foods, prepare or oversee at least three nourishing meals a day, and be sure to eat those meals together with your child and family as often as possible. Your child learns by imitating your behaviors. As nourishing as a family dinner is the sharing and comradery that accompanies it.

• Never skip meals. Remember that breakfast is the most important meal of the day. Know what healthy eating is, that it involves eating three meals daily… diverse, balanced and nutritious meals, consisting of all the food groups and consumed without fear. Healthy eating is not fat-free eating.

• Keep your own lifestyle active and expect your child to do the same. If children are too sedentary, turn off the television and encourage a walk with the dog or biking to the library.

• Spend quality time with your child. Listen to what they say and to how they feel. Know what their concerns are.

• Encourage your child to become aware of her feelings and to express them freely. Communicating through the use of words diminishes the odds that anxious feelings will be expressed through food-abusing behaviors.

• Be aware that girls typically reach puberty as young as age 9. Explain to them that it is normal (and essential) that they gain weight at the onset of puberty in order to stimulate a healthfully functioning reproductive system that will allow them to bear their own children one day.

• Become aware of your own personal attitudes about eating, body image, and weight control. Do you encourage your son to eat so that he can grow big and strong, yet caution your daughter against becoming fat?

• Never force your child to "clean her plate," giving her a sense of not being in control of her own food. The parent should determine the menu and the child should determine the amounts of food consumed.

• Do not criticize your own or your child's weight, shape or size.

• Don't tolerate casual derogatory comments about other people's weight and physical appearance. Children take to heart and personalize what you say.

• Be aware of how your responses to your child's problem may be affecting your child's behavior and feelings.

• Beware of your child's sudden decision to become vegetarianism, particularly if very young. More often than not, the underlying motives may be weight loss, and result in a less than healthy eating lifestyle in the child who does not understand the complexities of healthy and balanced vegetarian eating, of creating proteins, etc.

Remember that too much of a good thing is no longer a good thing. Don't allow your child to overdo athletics or dance activities; to shop too much or to watch TV or Facebook too much; to talk on the phone or play video games too much; to eat too much or too little, to study too much or too little, to sleep too much or too little, etc. Moderation and balance in life reflects a healthy lifestyle.

If your child is engaged in competitive sports, be aware that food restriction, the use of hormones, and extreme workouts are not uncommon practices for participants in certain of these sports. Stay involved as parents, and aware of what the coach or teacher is asking of the team and of your child; always be prepared to intervene where you believe requests may have become extreme or unhealthy. A study (Davison, Earnest, Birch; Participation in Aesthetic sports; International Journal of Eating Disorders April 2002 pgs. 315-316) demonstrates that in comparison to girls who participated in non-aesthetic sports or no sports, girls who participated in aesthetic sports reported higher weight concerns at ages 5 and 7.

If you believe a problem exists, be certain to seek out expert professional help. When children are young, you may consider consultation with a therapist or nutritionist first, before bringing in the child. There is a tremendous amount of good that can come of parents making changes within the family system; in some instances, that alone might be enough to adjust whatever might be troubling your child.

Reference:
Natenshon, Abigail MA, LCSW, GCFP Doing What Works: an Integrative System for the Treatment of Eating Disorders from Diagnosis to Recovery 2009 NASW Press Washington. D.C.