Eating Disorders in children; what to look for and how to help

22 February 2016

If you mention the words eating disorders, most people would describe the typical sufferer as an anorexic teenage girl struggling with self esteem issues and her own self image.  However, eating disorders are far more complex and wide reaching than this and cover a much wider age group than just teenagers.  

It is important to understand that eating disorders are not a choice made by a child but are a group of life threatening psychiatric and medical conditions that affect boys, girls, men and women.  They have emotional impact all aspects of the sufferer’s life; their health, emotional wellbeing and relationships with their peers and family.  

As a foster carer of predominately teenagers, I have tried to educate myself on the warning signs of eating disorders but my only experience was an 11 year old Looked After Child, who was showing worrying signs of being obsessed with food.  I would find food wrappers under his bed, which is not unusual with children, but these were wrappers from food that I had readily available in the house.  He would hoard sweets and crisps behind the wardrobe, in his drawers and wedged in between furniture in his room.  Family sized bags of crisps, food and cakes expected to last the week would disappear and wrappers would later be found in odd places including my flower pots outside.  This 11 old boy had always been quiet so it was hard to know whether he had withdrawn more than normal but when he asked me several times a week if his tummy showed in a t-shirt or did I think he was fat, I realised the child I should be worrying about wasn’t any of the teenagers in my house but a very vulnerable little boy.  He struggled talking about anything to do with his family circumstances and preferred to pretend it wasn’t happening.  He never used the words ‘foster’ and hated it if anyone else did, found reviews of any kind traumatic, not because of the social workers or other professionals but because it was a reminder that he was in care.  He bottled things up; his feelings about his family, the guilt he felt surrounding events that caused him to come into care and this led to him trying to control his emotions anyway he could.  I wish there was a happy ending but the reality is that he was only in my care a short time while court cases were completed and he moved on to a long term foster carer.  My concerns were taken seriously and I believe he had a period of time in a specialist eating disorder residential unit. 

What is an eating disorder?

An eating disorder can start in some children with an anxiety about how they look compared to their peers and in others as a way to control and cope with complex emotions or painful feelings.  Whilst children as young as five can be sufferers, teenagers are at a high risk due to the increased stress of school, social media, friends, body image and wanting to conform to the picture perfect images in the media.  Looked After Children can be vulnerable to eating disorders as one of the most common comments they make are they feel they have no control over their life and their wishes are not listened to.  They will have often faced very difficult family circumstances which heighten their stress levels to any emotional situations, leaving them to try to self-regulate or control their emotions anyway they can.  Children suffering with an eating disorder will become obsessed with their weight, with food and their own image.  If left undiagnosed or untreated the disorder can quickly become dangerous or life threatening. 

Types of Eating Disorders

  • Anorexia nervosa.  This is a life threatening eating disorder indentified by a very low weight, fear of weight gain and an obsession with food, fat and calories.  There are different types of Anorexia Nervosa.  Approximately 90% of sufferers are female and it usually starts in adolescence
  • Bulimia Nervosa is also life threatening and is characterised by a cycle of compulsive eating, binging and purging
  • Binge Eating Disorder (BED).  Sufferers consume very large amounts of food, usually quickly, in secret and it is associated with depression and an increased suicide risk.  It is hard to diagnose and can be misunderstood by health professionals and the media
  • Other Eating Disorders.  These can include Night Eating, Purging (without the binging) and other types of Anorexia or Bulimia

What are the warning signs of an Eating Disorder?

  • Rapid weight loss (Anorexia Nervosa), a growing obsession with food, their weight, how much food they are consuming (or not) and a preoccupation with fat grams, calories, sugar and other ingredients
  • Withdrawing from their friends and family and not wanting to do their normal activities
  • Feeling compelled to exercise, at any time of day or night, regardless of how much exercise they have already done or the weather conditions
  • The disappearance of large amounts of foods, finding hidden wrappers and eating in secret
  • Signs of purging either by vomiting or laxatives, the smell or evidence of vomit and disappearing to the bathroom after meals
  • Finding excuses to miss meals, complex excuses and comments such as I ate at school, at a friends’ or not feeling well enough to eat

Treatments and recovery

Children and adults can recover from an eating disorder and it is recognised by experts in this field that the best chance of a full recovery is early identification and treatment.  If the eating disorder has not yet led to serious or life threatening health problems treatment can be outpatient based and include therapy, medical monitoring and supervision alongside individual and family counselling.  However if the child’s health has been compromised or there is a risk to life then hospital based treatment is recommended in a specialist residential unit where psychologists, medical professionals and therapists work together with the child to find the best treatment.  Addressing the underlying issues is important and understanding that treatment is often long term is necessary.

Recovery can be slow and it is not always successful.  The UK’s eating disorder charity BEAT suggests that approximately 45.5% of Anorexia and Bulimia sufferers recover while approximately 30% of sufferers considerably improve.  With Anorexia Nervosa having the highest death rate of any mental health condition as well as the highest suicide rate, it is important that the symptoms are recognised early so treatment can begin.

If you have concerns about an eating disorder, speak to your doctor.  You can also contact Beating Eating Disorders (BEAT) on 0345 634 1414 and Youthline on 0345 634 7650.


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