Disordered Eating

Is your child:

• Eating too much or not enough?
• Gagging or throwing up after eating?
• Refusing fruits and vegetables?
• Eating only these food groups: French fries, pizza, and fruit snacks?
• Appearing to be sensitive to the texture, smell, and presentation of food?
• Requiring you to cook at least 3 different meals at dinner?
• Not sitting down or stopping to eat a meal?
• Failing to recognize cues of hunger, getting “hangry” (hungry and angry) without being able to identify the hunger?
• Criticizing her body physically on a regular basis?

Eating is a primary function in life. We think of food, clothing and shelter as primary to survival, yet eating is also a significant area of concern for many parents. Many types of eating concerns are reflected above.

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 “my beans are touching the potatoes!”

This level of picky eating is a problem if you have an ever-dwindling list of foods your child will eat. A child who lives primarily on Cheetos or eats only white foods, or refuses all meat, vegetables and fruit has a restricted diet that can have a profound implication in health.

Some children hoard food in their bedrooms or in the couch cushions. You may find rotting food in your child’s room on a regular basis 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 as a way of restricting caloric intake and controlling 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.

Other children and adolescents may overeat. This behavior may happen during emotional times or may be a compulsion. Vomiting or restricting food at other times may or may not be an issue for your child. Overeating and binge eating may result in sudden weight gain. Weight may skyrocket; your child may feel ashamed and may start to eat in secret.

Challenges with eating might mean your child has an eating disorder. Overeating, binging and purging, and restricting calories substantially leading to low body weight are all symptoms of an eating disorder.

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, eating can be controlled.

Eating Disorders can also be related to poor or distorted body image. Individuals with anorexia may think that they look fine. Even 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.

Another reason children may struggle with eating could be related to a sensory sensitivity. Children who are not in tune to 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.

Children 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 would be typical.

Finally, some children 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.

For mild eating issues: At home, if these symptoms are mild 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 get worse.

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.

For overeating: If your child needs to lose weight, again 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. Again provide choices, but also exercise portion control at meals under the guidance of a nutritionist.

For picky eaters, a guide is provided for introducing new foods in the sensory sensitivity article.  These suggestions are just a few tips; it is important to seek professional help for eating issues, so do not delay.

For 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, impatient treatment is necessary as this eating disorder is a life-threatening illness. Your child needs around-the-clock care and support. 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.

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

• Rigid behavior: needing things just so and not being flexible to try new things
• General anxiety or Socializing: 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 (Moving & Sensing): under or oversensitivity to stimuli leading to a lack of awareness of hunger or significant sensitivity to food texture or smell. For picky eaters, a guide is provided for introducing new foods in the sensory sensitivity article
• Attachment: children reacting to unstable environmental situations may try to execute some level of control over their lives

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this information does not serve as a diagnosis in any way. See the ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

• Anorexia: significant loss of body mass, restricted eating, distorted body image (this eating disorder is life-threatening)
• Bulimia: using binging (eating a large amount of calories in one setting) and/or purging (use of excessive exercise, vomiting or laxatives) as a means of control or in response to emotional stimuli and/or poor self-esteem
• Overeating Disorder: excessive binge eating without purging in response to stress or emotional concerns
• Anxiety: excessive worries and nervousness. Children with serious eating issues often have significant issues with anxiety
• Obsessive-Compulsive Disorder: compulsive ritual behaviors used to alleviate anxiety. Children with eating problems often have co-occurring OCD
• Depression: depressed mood, or, in children, irritability that is pervasive; decreased interest in activities that used to be enjoyable and fluctuation in appetite that is a marked change
• ADHD: impulsivity, hyperactivity, and/or inattention. Often, prescribed medication can reduce appetite. Sometimes, hyperactivity can impact your child’s ability to join the family for mealtime, creating a stressful family climate
• Attachment Disorder: emotional symptoms like anxiety and depression as well as rigidity and extreme behaviors that stem from challenges in attachment to primary caregivers (death of a parent, change of caregivers, abuse in the home), could include hoarding food and/or refusing to eat
• Autism Spectrum Disorder: deficits in social communication and restricted interests or behaviors that may lead to a preference for routine and repetitive. ASD often has significant sensory symptoms that could impact variety in diet and lead to very restrictive eating or low awareness of hunger or feelings of being full
• PTSD: reaction to a traumatic situation with fear and need for things that are predictable and comfortable, may seek to control food

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

• CLEAR Child Psychology: to obtain a customized profile of concerns for your child or to consult ‘live’ with a psychologist
• 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 while play therapy may be best for the younger age group. Outpatient treatment is not recommended for Anorexia, but when symptoms are in remission continuing to have psychotherapy 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
  • Denver Health Acute Care: http://www.denverhealth.org/medical-services/acute-center-for-eating-disorders/eating-disorder-specialists
• 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 problems, 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

These professionals may recommend or administer the following tests for this symptom:

• Roberts, BASC-3, Clinical Interview, RCMAS, CDI-2, Human Figure Drawing, Brief Projective Measures: projective assessment and emotional assessment through drawing tasks, questions, interviews, rating scales, and sometimes storytelling
• WISC-V: a test to establish a baseline of intellectual abilities, which can help us understand your child’s emotional knowledge and symptoms and determine what interventions may work best (Psychological or School Psychological evaluation)
• ADOS-2: for related concerns indicating an autism diagnosis should be considered
• TOVA: for assessment of ADHD, which could have an impact on eating patterns

[1] For Sensory Processing Related Eating Challenges: Children’s Hospital of Colorado- Swallowing  www.childrenscolorado.org/doctors-and-departments/departments/ears-nose-and-throat/clinics/fees/

[2] Kay A. Toomey PhD: Individual Practitioner, Feeding Specialist Denver Colorado

[3] Star Institute Occupational Therapy, Denver https://www.spdstar.org/

[4] 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/

[5] Eating Disorder Center of Denver http://www.edcdenver.com/treatment-options/denver/outpatient-services

[6] Kaiser Permanente Eating Disorders Program. Eating disorder program (outpatient) at Highline Clinic and their Hidden Lake Clinic in Westminster. https://healthy.kaiserpermanente.org/health/care/poc/!ut/p/a1/dY_BToNAEIafpQeOZQbWEvQGmJoFUWtti3sxQJdlI7Jku5bw9gKphyY6t8l8_zf5gUEGrM3PUuRGqjZvpp15H-t4-xyGToAYxjdI0-DpdRXHiOhADEw0qpjRd1enUSqAdbmpl7KtFGSdKqdLbUx3Z6GFVV7KRppheZSal0bpwUJg8giZg7hynQkO2oL4o0bzimuu7W892ifDaVb0fW8LpUTD7VJ9jfE_IrU6GciuSTgAu67j78g90l20jrwNHf_jBUBCNzPw8OIhUj95S_a3CUF0f4F_JkDoPlkxkOb8WG2pCBaLHx6-pVU!/dl5/d5/L2dBISEvZ0FBIS9nQSEh/pw/Z7_FJSOBB1A00BJ40IMANR5JJ00G2/ren/p=id=100521/p=_rvip=QCPjspQCPFacilityDirectoryHome.jsp/p=dptId=101389/p=_rap=facilityCtrl.viewDeptList/p=com.ibm.faces.portlet.mode=view/p=javax.servlet.include.path_info=QCPjspQCP_rlvid.jsp/=/

La Luna Center: in Ft. Collins and Boulder http://www.lalunacenter.com/boulder.htm

Image Credit:
Description upset young girl at meal time, palm to forehead refusing to eat her vegetables
Stock Photo ID: #103471487 (Big Stock)
By: Daxiao Productions
Child-eating-disorder-treatment
Previously Licensed on: November 19, 2016
Stylized by Katie Harwood exclusively for CLEAR Child Psychology

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