Children under 11 can present a wide range of other food difficulties in addition to the classic eating disorders. These include:
- Food refusal
- Restrictive eating
- Selective eating
- Food phobia
- Food avoidance emotional disorder
These difficulties are not all well understood and are commonly misdiagnosed. It’s important also to remember that many children will experience difficulties that don’t fit neatly into one category or another, but these classifications will help you to gain some understanding of the range of behaviours you could encounter.
- Food refusal is commonly found in pre-school children, where the refusal of food can be used as a way to get other things.
- However, this can persist in slightly older children, where the main feature is an inconsistent refusal of food.
- These children will tend to eat their favourite foods without any problem at all.
- They may refuse food only when they are with particular people or in a particular situation – for example, refusing to eat at school but eating normally at home.
- Worry or unhappiness underlies the food refusal in many cases.
- These children are usually of normal weight and height, and this problem does not usually pose a threat to the child’s health.
- These children eat smaller amounts of food than they should do for their age.
- Their diet will be normal in terms of the range of food eaten and the nutrients that it contains.
- These children are often thin and their height tends to be low, but otherwise they generally seem healthy.
- It almost seems as if restrictive eaters are ‘programmed’ to eat less and to be thin but healthy.
- Often, other members of the family will have a history of the same pattern of food intake.
- The most obvious feature of this condition is the narrow range of food that is eaten. This can persist for months or even years.
- These children are very unwilling to try new types of food.
- The behaviour of these children is usually normal, unless they feel that they are being forced to eat a wider range of foods than they feel comfortable with.
- Problems may start to occur when the child is about eight years old because the selective eating causes difficulties over going to birthday parties or staying at a friend’s house.
- Children who eat only a restricted sugary diet may also have problems with their teeth.
- The weight of these children does not give much of an indication as to whether there is a problem – they may be of low, normal or high weight.
- These children are usually very resistant to eating and drinking, which can cause a great deal of concern.
- They may avoid foods that have certain textures because they are frightened of swallowing.
- They are usually frightened of choking, gagging or being sick, and some children say that eating and drinking hurts. This means that meals often turn into a battleground.
- Some children may be fearful and anxious of eating new or disliked foods.
- The majority of these children do, however, seem to grow and develop because the food and drink that they will have provide enough calories and nutrients.
Food Avoidance Emotional Disorder
- These children often wish that they could eat more and are concerned about being thin.
- The loss of appetite is usually associated with depression or anxiety.
- In food avoidance emotional disorder there is a more general disturbance in behaviour that does not centre on food and mealtimes.
- The child may experience a loss of appetite, problems with sleeping, poor concentration, tearfulness and a general sense of hopelessness.
- These children may actually say that they feel sad, and this sadness can be seen in their posture, the way they move, their facial expression and their tone of voice.
- They also may avoid school and contact with their friends, and want to stay at home.
In addition to this, some under 11s will also suffer with one of the three major eating disorders – anorexia, bulimia or binge eating disorder. These are all very serious conditions which are worth understanding despite their relatively low prevalence with this age group as early intervention is key with these children to ensure they make a full and lasting recovery.
If you’d like further support, I can provide bespoke face to face training to help you sport and support eating difficulties in younger children. I can also provide one to one consultancy via telephone or skype. Email email@example.com or call 07590446791 for further information.
There is a whole language around eating disorders that sounds like Greek to a lot of us:
Pro-ana – website that promotes anorexia
Pro-mia – website that promotes bulimia
Thinspiration / Thinspo – images to inspire weight loss
Fitspiration / Fitspo – images to inspire exercise / body building
In this post we’re going to consider pro-ana and pro-mia sites, who uses them, why they’re dangerous and what parents and schools can do to decrease they’re impact on the young people in their care.
What are pro-ana and pro-mia sites?
Pro-ana and pro-mia sites are websites that promote anorexic and bulimic lifestyles. Set up by people with eating disorders looking to validate their illness and seeking suppo
rt to continue with their eating disorder from fellow sufferers these sites vary hugely in their precise content. They are often a forum for people to exchange pictures and weight loss or purging tips and to encourage one another’s weight loss.
Who uses pro-ana and pro-mia sites?
These sites are often a refuge for people suffering from eating disorders. It’s common for sufferers to feel quite isolated having pushed away their family and friends preferring to seek out like-minded individuals online. There are over 500 such sites and the latest studies predict that they attract more than 500,000 unique visitors a year of which the majority are teenage girls and one in five are aged between six and eleven. Read the rest of this entry »
Whilst most parents will be keen to support the school in helping their child receive appropriate support for their eating disorder, some parents will respond negatively thinking that you are trying to blame them for the problem, that you are blowing things out of proportion or that the school has no business being involved.
Below, I’ve outlined 3 of the most common negative reactions you’re likely to encounter from parents and how to respond.
Parents think you’re blaming them for their child’s difficulties
It’s quite common for parents to think that you’re pointing the finger at them and that’s why you want them to be involved.
You should accept that the news may come as a horrible shock to parents and calmly explain that no blame is intended. You think they are good parents, which is why you’re seeking their support and help.
Useful phrases include:
“No one is to blame for Amy’s illness, not Amy, not us and not you.”
“You are clearly very supportive parents, that’s why we called you.”
“Amy is very lucky to have supportive parents such as yourselves.”
“We’re not interested in attributing blame, we just want to help Amy get better and we’re sure you can help.” Read the rest of this entry »
Never promise confidentiality
Of course, we all know that if there is any possibility of a pupil doing themselves harm then we simply cannot keep their confidentiality – it could put both the pupil, and your job, in jeopardy. However, you can be sure that if a pupil does build up the courage to talk to you about their eating disorder, then one of their first pleas will be ‘Please don’t tell anyone!’
It can feel frustrating not being able to succumb to this caveat and it always feels entirely possible that you will lose the pupil’s hard-earned trust if you refuse, but being upfront and honest now will pay dividends in the long run. If you promised to keep their trust then broke that promise, the fall-out would be far greater than if you tell a few difficult home truths now.
Involve the pupil
In order to retain the pupil’s trust you need to involve them in the process of informing others – always consider who, what, why and how with the pupil before you disclose details of their difficulties to anyone else. Read the rest of this entry »
If a pupil at school is particularly unwell with their eating disorder, their healthcare practitioners may decide that inpatient care at a paediatric or eating disorders unit is the best treatment option for them. It can be difficult for schools to know what level of contact is appropriate or helpful for the pupil – we explore the main things to consider here.
Get to know their healthcare practitioner
The school should appoint a key person who is responsible for liaising with the unit where the child is resident – this could be the head of pastoral care or the child’s form tutor. That person should make sure they have the full contact details of the key person who is assigned to the child’s care at the unit and make themselves known. Arrange a meeting if possible, and if not then speak on the phone. The aim of the meeting is to make it clear that:
- Who the main point of contact is at the school and how to get hold of them
- The school is keen to support the child’s recovery in any way possible – ask for guidance on this
- The school is happy to coordinate the provision and marking of academic work if appropriate
- The school would like regular updates about the child’s recovery
- You would like to know what it is appropriate to tell staff and pupils about the student’s absence
- You would like the child to know you called and that you / staff / friends are thinking of them Read the rest of this entry »
The PE department need to be involved in the recovery of any young person with an eating disorder whether they are overweight, underweight or within an acceptable weight range. Here we focus on working with young people who are recovering from anorexia as this is an area that school staff often feel unsure about.
Over-exercise and anorexia nervosa
If left unmonitored young people suffering from anorexia nervosa will often choose to exercise hard for many hours a day in order to burn calories. This level of activity is clearly unacceptable during recovery, but removing the ability to exercise or participate in sport at all can be detrimental to their long-term recovery. It is important that pupils who habitually over-exercise learn to form a more healthy relationship with exercise in the same way that they must improve their relationship with food.
The social aspect of school sport
There is a certain extent to which it is important to try and include a pupil recovering from an eating disorder in as many normal school activities as possible – and sport / PE is no exception. Exempting a pupil from PE quickly marks them as different which can feel stressful for them and lead to questioning and sometimes teasing from their peers. Read the rest of this entry »
If the school becomes aware of a pupil’s eating disorder before the parents then it’s important to invite parents on board to work with you to support their child’s recovery.
Once you have overcome any objections from the pupil, you should aim to organise a meeting with the parents as quickly as possible.
This post looks at how to organise the meeting and how to ensure it runs effectively
Think about location
With the help of the pupil, decide where the meeting should be held – at school, in their home or on neutral territory. You should do whatever you think will make the pupil, and their parents, feel most comfortable.
Who should attend?
Obviously the pupil and their parents should be present, the pupil may also like to bring a friend along for support and you might decide to have a couple of different members of staff present – for instance the head of pastoral care and the pupil’s form tutor. Again, you should check with the pupil about what they’ll feel comfortable with and try not to set up a scenario which will be too intimidating for the parent.
Read the rest of this entry »
It’s always preferable to inform a parent of their child’s eating disorder in a face-to-face meeting where you can read and respond to body language. However, it’s not always possible and you may end up having to have the conversation on the phone. In which case the following points are worth bearing in mind:
Choose the most appropriate parent
Ask the pupil which of their parents would be better to speak to. They are likely to have a good idea about which of their parents is most likely to supportive, understanding and comfortable discussing such a sensitive issue.
Plan what to say
Make a list of the points you want to cover beforehand – it can be very easy to become flustered on the phone if the conversation is difficult, or to fail to mention certain things if the conversation goes off in a different direction than you’d planned for.
Call at a good time
Pre-arrange a good time to call so that both you and the parent have time to talk. This is not a conversation that can be rushed. Read the rest of this entry »
This can be adapted to help you adopt the correct approach when talking to pupils recovering from bulimia or binge eating disorder as well. A great degree of sensitivity is needed when interacting with a young person recovering from any form of eating disorder. Their self-esteem is very low and they are in a very vulnerable position where they will believe and blow out of all proportion even the slightest negative comment (or even positive comments which they may reinterpret as negative). Here are some key flashpoints to avoid.
Avoid commenting on the pupil’s appearance
During the recovery process, it can be very easy for eating-disordered thoughts to be triggered by someone saying or doing the wrong thing, even if they mean well. Almost any comment on appearance can be reinterpreted by the pupil as, ‘You’re fat’.
Well-meaning comments such as. ‘You’re looking healthy’; ‘It’s great to see some colour in your cheeks’; ‘You must feel better now you have more energy’ are all open to misinterpretation. It’s best to avoid any comment at all on a pupil’s appearance.
Consider lesson content
It’s also important to be sensitive to tasks in class that may be difficult for the recovering pupil and to consider altering your scheme of work as necessary. Any tasks involving food, healthy eating and exercise, weighing or measuring the body in any way, or discussion of eating disorders are best avoided. If this is not possible, show the pupil all of the materials beforehand and allow them to opt out if they prefer. Read the rest of this entry »