Fussy Eating vs Disordered Eating
A 'fussy' eating stage can be a normal part of children's development. They may not like the taste, shape, colour or texture of particular foods. They may like something one day but dislike it the next. They may refuse to eat vegetables or to try new foods.
It's a way of exploring their environment and asserting their independence, and their appetites can go up and down depending on how much they're growing and how active they are.
What is disordered eating?
Disordered eating is not just about food. Eating disorders are serious, complex mental illnesses affecting people of all ages, genders, ethnicities and backgrounds.
Eating disorders can cause serious harm both physically and emotionally, and they have the highest mortality rate of any mental illness.
Statistically, eating disorders affect more females than males, and early signs can begin when a child is 8 years old or younger. Eating disorders can take over a child's life and have an immense impact on home life, school and social life, whilst also affecting the whole family. With the right help and support, children can make a full and lasting recovery. Early diagnosis, intervention and treatment is critical.
What causes disordered eating?
There is a complex range of factors, including genetics, biology, psychology and surroundings. Disordered eating can be a way of coping with feelings or situations that are making the child unhappy, angry, depressed, stressed or anxious. It may also be coupled with specific anxiety disorders such as obsessive-compulsive disorder (OCD).
Food becomes a problem when it is used to help cope with painful situations or feelings, or to relieve stress — perhaps without the child even realising it. Disordered eating is often symptomatic, suggesting there is an underlying issue that needs to be identified, understood and treated.
What are the first signs?
The most obvious sign of a problem is weight loss, but changes to physical appearance may not be apparent right away. In fact, many children with eating disorders look perfectly healthy.
Some general signs that may be associated with disordered eating include:
- Low self-esteem
- Irritability and mood swings
- Tiredness
- Feeling cold
- Poor concentration
- Social withdrawal
- Delay in sexual development
- Feelings of shame, guilt and anxiety
- Obsession with their appearance
- Wearing baggy clothes to hide their body
- Preoccupation with and/or secretive behaviour around food
- Self-consciousness when eating in front of others
Other signs may include:
- Cutting out lunch at school
- Saying they've already eaten, or that they're not hungry
- Hiding food
- Food going missing from the fridge
- Being more secretive
- Wanting to be alone
- Going to the toilet immediately after meals
- Making themselves sick
- Self-harm
- Obsessive exercising
- Loss of monthly menstruation
Types of Eating Disorders
Anorexia nervosa
Children with anorexia tend to have a distorted view of their bodies. They have an intense fear of weight gain and deliberately eat very little. First signs might be increased rigidity around eating — being much more selective about the types of food or the times of day, and laying down rules about what they can and cannot eat. These restricted eating patterns may not result in noticeable weight loss until further down the line.
ARFID – Avoidant Restrictive Food Intake Disorder
This is an umbrella term to describe clinically significant food avoidance where, unlike anorexia, concern about weight and shape is not a factor. Instead, ARFID may be driven by sensitivity to taste or texture, a response to a distressing experience with food (such as choking), or a general lack of interest in eating.
Bulimia nervosa
It's quite common for children to find it difficult to stop eating in certain situations — party food, for example. With bulimia nervosa, this starts to become a source of shame. A child at a party who has eaten a lot of cake might start to be more secretive about it, and in more serious cases may feel a need to compensate — for example, by vomiting.
A certain level of maturity is needed before children begin to experience social emotions such as shame and guilt. However, teasing about weight and self-consciousness about being overweight can start young and be a risk factor for disordered eating.
Binge eating
Unlike bulimia, binge eating does not involve purging. There is a sense of loss of control: eating faster than others, eating until uncomfortably full, and eating large amounts when not hungry. Food may offer feelings of calm, comfort or stress relief — but a binge can also have the opposite effect, causing anxiety, guilt and distress.
OSFED – Other Specified Feeding and Eating Disorders
There is often overlap between different types of eating disorders. If a child's symptoms don't exactly match those of anorexia, bulimia or binge eating, they may be diagnosed with Other Specified Feeding and Eating Disorders.
When should a parent, carer or teacher seek help?
Seek help as early as possible. The earlier a child gets help, the more likely they are to recover successfully. Talk to your child — ask them if they're OK and whether there's anything they'd like to talk about. They may not feel ready to open up, or may not see their behaviour as a problem. In any case, let them know you are there to help.
Where to get help
Start by contacting your GP, or speak to the Special Educational Needs Co-ordinator (SENCO) at your child's school. It can be helpful to make notes about your main concerns before the appointment. Your child may be in denial, so it will help if your concerns are clear and specific. Your child can then be assessed and, if appropriate, referred for specialist help.
Note: in some areas there may be a long waiting list for specialist services. Don't let this deter you from seeking help.
What are the main treatments?
Treatment varies depending on the type of eating disorder and the child's symptoms. Options include family therapy, cognitive behaviour therapy (CBT), personalised eating plans and out-patient supervision. In more serious cases — where a child has lost a dangerous amount of weight or other treatments have not been effective — they may be treated in hospital or in a specialist unit for children and young people.
Further reading
- Anorexia and Other Eating Disorders: how to help your child eat well and be well — Eva Musby (anorexiafamily.com)
- Boys Get Anorexia Too: coping with male eating disorders in the family — Jenny Langley (boyanorexia.com)
- Caring for a Loved One with an Eating Disorder: The New Maudsley Skills-Based Training Manual — Jenny Langley, Janet Treasure et al (Routledge, 2018)
- How to Help Someone with an Eating Disorder: A Practical Handbook — Dr Pamela Macdonald (Welbeck Balance, 2021)
