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How do I help Adolescents and Children with Eating Disorders?

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Young Children with Eating Disorders

How do I help my young child with an eating disorder?

  • First, rule out medical and psychological illnesses.
  • Create a healthy eating lifestyle at home and expect your child to participate within it. Offer your child healthy foods, prepare at least three nourishing meals a day; be sure to eat those meals together with your child and family as often as possible. Your child learns by imitating your behaviors.
  • Never skip meals.
  • Read on for more...

Articles: Click on the titles below to read the articles

When Young Kids Have Eating Disorders By Abigail Natenshon, LCSW

Although anorexia nervosa usually develops during adolescence, a disturbing number of cases have been appearing in young (sometimes very young) children. According to eating disorders specialist Barton J. Blinder, M.D. anorexia has been observed in children as young as four. He cites a Mayo Clinic study of 600 patients of all ages, which found that three percent were prepubescent anorexics.

In a suite101.com article (Ellison, January 2000) entitled Childhood Anorexia, Dr. Blinder noted that children, most of whom are girls, have less body fat than their adolescent counterparts, so they become skeletal more quickly. He argues that a 15 percent weight loss, rather than the usual 25, should be a criterion for diagnosis. Childhood-onset anorexia can delay puberty, growth, and breast development.

Parents are largely responsible for shaping a child’s body image and eating lifestyle. Mirror-Mirror webmaster Colleen Thompson believes that parents who are themselves preoccupied with body image and weight increase the ranks of childhood anorexics. 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.

Along these same lines however, enlightened parents who are good communicators and sensitive to the child’s developmental stage can do a great deal to prevent eating disorders even in the face of a child’s genetic or environmental susceptibility.

What parents should do:

First, rule out medical and psychological illnesses.
Create a healthy eating lifestyle at home and expect your child to participate within it. Offer your child healthy foods, prepare at least three nourishing meals a day; be sure to eat those meals together with your child and family as often as possible. Your child learns by imitating your behaviors.
Never skip meals.

Keep your lifestyle active and expect your child to do the same. If children are too sedentary, turn off the television and encourage activity.

Spend quality time with your child. Read together; go for walks.

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 current responses to your child’s problem may be affecting your child’s behavior and feelings.
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-related behaviors.
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. Food restriction, the use of hormones, and extreme workouts are not uncommon practices for participants in certain competitive sports. Be involved and aware of what the coach or teacher is requiring of the team and your team, and be prepared to step in where you believe things have become extreme and therefore, unhealthy. A recent 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 and girls who participated in aesthetic sports at ages 5 and 7 reported the greatest concern about their weight at age 7.

If you believe a problem exists, be certain to seek out professional help. When kids are young, going for treatment yourself, and or with your spouse or partner first, is always a good place to start. In some instances, that alone might be enough to adjust whatever might be troubling your child.
Click HERE to learn more about Ms. Natenshon

Invest in Your Child's Self-Esteem By Abigail Natenshon, LCSW

Self-esteem and healthy eating. What does one thing have to do with the other? Everything.

Children rely on eating disorders to serve as coping tools, as “solutions” to what would otherwise feel like insurmountable problems. Children who are adept problem-solvers, who have access to their feelings and needs, and who can demonstrate the capacity to get their needs met have no use for an eating disorder in their emotional repertoire. The confident child who experiences self worth, and who is capable of valuing and effectively caring for herself is also the least likely candidate to succumb to peer and media pressures, food fears, body image concerns, and disordered eating, all of which could become precursors to the onset of eating disorders in the susceptible child.

A child’s poor self-esteem is evident in the tendency to be overly self-critical, perfectionist or concerned with appearance and body image, or an unresponsive to the challenges and requirements of life and living and the emerging self.

Building self esteem in your child:

Self-esteem comes from making a contribution to the world around one, to the community of the home and of the greater world beyond its borders. It comes from developing interests and passions, from being valued, respected, heard, and accepted. It comes from a fearless acceptance of interpersonal differences, and the fearless capacity to work them through, beyond conflict to compromise. Self-esteem comes from a sense of belonging and a loving connection to other human beings.

Creating a healthy sense of self in a child is a process that begins for parents at the moment of their child’s birth and that continues, in various forms, throughout the child’s development. It is never too late to nurture self-esteem in the insecure child. The following are ways to convey to your child just how unique and exceptional you feel she is. Through such activities, kids learn what pleasure you derive from spending time with them, and grasp a vision of the culture of the greater world extending beyond themselves, beyond their own personal concerns, beyond their physical appearance and tummy size.

Twelve ways to build self esteem through interaction with your child:

1. Connect with your child and spend quality time, finding substantive ways to interact and engage with him or her.

2. Provide your child with meaningful life values and genuine connectedness. Spend a weekend morning volunteering together at a neighborhood nature preserve.

3. See a play together and discuss it afterwards, distribute meals at a center for the homeless, take a course together at your local planetarium. Attend church or synagogue services together.

4. Emphasize enjoyment of the activity, rather than performance.

5. Encourage your child to take control of important aspects of her life and to make her own decisions where appropriate. Do not be afraid to provide limits appropriately and consistently throughout your child’s growing up years and into her adolescence; your child will eventually internalize these external controls, enabling her to develop a sense of authenticity and freedom. Given too much autonomy too soon, a child becomes fearful, tentative and uncomfortably over-powerful.

6. Model healthy, balanced, and meaningful living and problem solving. Do not shy away from conflict or individual differences, as these are the stuff of life, an inevitable aspect of intimate relationships. There is no better time for a child to observe and practice successful conflict resolution, to feel accepted and heard, than within the safety of home and family.

7. In sitting around the dinner table with your child, find out what he or she has been thinking about, how he or she is feeling, what she is up to, what her priorities may be today. Eating together is a great way to get to know your child and her concerns, not to mention how he or she is feeling about food and eating. Never model behavioral (food or exercise related) extremes of any kind.

8. Listen for any negative comments your child may make about body shape or size. If you hear concerns, don’t negate them, but rather initiate discussion about how she feels she might look better and why her concerns.

9. Educate your child about the wise reliability of well cared-for bodies. . . how normal it is for girls to put on 20% of body weight in fat during puberty, how certain aspects of our body image qualities lay within our control (such as good nutrition and exercise) and others do not (genetics and heredity), and how dangerous dieting can be.

10. Be careful not to complain about your own weight and body image concerns in front of your child.

11. Develop in your child a critical “immunity” to media messages. Teach her to see through the subliminal and subversive messages. Cancel your subscriptions to fashion magazines and weight- focused women’s magazines. Turn off the television, especially during meals.

12. Respect your child’s hunger and satiety. Eliminate the “clean plate club.” Though you as a parent are responsible for providing nutritious and varied foods and for expecting your child to eat them, do not attempt to limit or control the amounts your child eats. Compared with mothers of girls with no eating problems, mothers of girls who become bulimic tend to restrict what their daughters eat, encourage them to diet and exercise to lose weight and to perceive them as overweight, according to a 1993 study at the University of Missouri.

Do not succumb to the commonly held and misconceived fear that kids are born spontaneously competent and that parental input as the child matures becomes superfluous and interfering. Your child needs you as much in her adolescence as she did as an infant, if not more. Though the quality and nature of the parent/child attachment will change through time and life stages, the connection must never fail.

Psychotherapist Abigail H. Natenshon has specialized in the treatment of eating disorders with individuals, families, and groups for the past 31years. She is the author of When Your Child Has An Eating Disorder, A Step-by-Step Workbook For Parents And Other Caregivers, Jossey-Bass, 1999. Based on hundreds of successful outcomes, this book shepherds concerned parents step-by-step through the processes of eating disorder recognition, confronting the child, finding the most effective treatment for patient and family, and evaluating and insuring a timely recovery. A guide to eating disorder prevention, this book is useful to parents, health professionals and school personnel alike in countering the pervasive epidemic of unhealthy eating and body image concerns, and destructive media and peer influences.


Eating Disorders: Early Intervention is Key by Judy Scheel, Ph.D., Director of the Center for Eating Disorder Recovery


When it comes to our middle school children, perhaps we should not be waiting until high school to address eating disorders and body image. High school is typically too late for eating disorder prevention and education about food, weight, body image and proper nutrition. Prevention and education need to occur in elementary and middle school, long before the eating disorder symptomatology becomes entrenched in the psyche of a child.

In a survey of Iowa fourth graders, almost half of the girls wished they were thinner and almost one third worried often about being fat. By high school, 40-60 percent of American girls feel overweight. Hispanic-American and Asian-American girls and women report levels of body dissatisfaction comparable to that of Caucasian girls and women. African-American girls and women tend to have a more positive body image. In one survey, eighth- and ninth-grade girls described the "perfect" girl as 5'7" tall and weighing between 100 and 110 pounds. This weight is more normal for a girl of 5' to 5'2". Puberty moves girls away from the thin, long-legged 'idealized' body and toward a normal adult female body. During puberty, the average girl gains about 22 pounds. Over 50 percent of eighth-grade girls in a large national survey reported that they had dieted at least once during the past year. At the other end of the continuum, there is an increase in childhood obesity. It is estimated that 25 percent of elementary school children meet the criteria for obesity.

Anorexia nervosa, bulimia nervosa and compulsive eating are psychological disorders. Anorexia nervosa is characterized by the loss of 15 percent of one's body weight, refusal to gain weight or continued weight loss, fear of gaining weight, loss of menstruation for a minimum of three consecutive months or irregular menstruation due to weight loss. Bulimia nervosa is characterized by routine purging—typically, by vomiting or laxative abuse. The attempt is to rid oneself of the food ingested. Many bulimic individuals are of normal weight. Compulsive eating is characterized by continued and frequent episodes of binging or patterns of "graze" eating, despite not feeling physically hungry, without the use of purging.

There are many factors that contribute to the development of each of these disorders, including psychological, familial, social, cultural, and bio-chemical; and there are many theories, which attempt to explain their etiology. The psychoanalytic model explores the struggle around sexuality, aggression and maturity. The developmental and relational theories examine conflicts around separation and autonomy. Attachment theory examines issues concerning connection with family, emotional safety, security and dependency in relationships. Other explanations focus on the individual's inability to experience, describe and articulate emotions. Some theories examine depression and other bio-chemical explanations.

The eating disorder is primarily a symptom of deeper psychological conflict. It serves to alleviate and/or protect against psychological conflicts and vulnerability. Anorexic thinking is such that if I do not eat, I do not feel – life and emotions slip off me like Teflon. Bulimic sufferers often eat and then purge away all the negativity they feel to be true about themselves, such as self-loathing or uncomfortable feelings like anger, shame, sadness, longing and neediness. The compulsive eater eats to suppress negative emotions and uses food as a comfort. Food becomes more reliable and safer than people. It doesn't disappoint, reject or hurt the way people and relationships can.
Eating disorders are primarily disorders about relationships – the relationship with oneself and with others. The food acts as a metaphor and is split into good versus bad (salad is good, chocolate cake is bad). The psychological message expressed via this metaphor is that only 'good' feelings (like happiness) are acceptable. Other normal emotions, such as anger, hurt, envy and sadness, are viewed as unacceptable or 'bad.' If I eat only 'good' foods, I will feel only 'good' feelings. The reality is, however, that just as there are no good or bad foods, there are no good or bad feelings.

Eating disorder sufferers often report feeling empty inside, unable to define and express any emotion. They are typically people-pleasers, wanting everyone to like them. The perfectionism so typically associated with eating disorder sufferers is really a defense at feeling vulnerable.

Eating disorders are not caused by the media. A child who goes beyond a reasonable and healthy weight for her/his body size and type, and develops an eating disorder has been experiencing psychological vulnerability long before the first eating disorder symptom presented itself. When a child is psychologically vulnerable, the pursuit of thinness becomes a way out of distress. Most children destined for an eating disorder begin to show signs of anorexia nervosa around age 13 (though there are rare cases appearing in children ages 10-12). Bulimia typically does not begin until age 15 or older, although there are cases in children as young as 12 or 13. Compulsive eating more often shows up during the elementary school years, although it can occur at any age.

Only ten percent of all eating disorder sufferers are boys, though the numbers for male anorexia and bulimia are increasing. Most of the issues surrounding the development of an eating disorder are similar in boys and girls. The overt distinction, however, is that where girls claim the eating disorder enables them to be thin, boys typically state their goal is to achieve or maintain a muscular but thin physique.
The road to recovery is a long one. Once an eating disorder has taken hold, it can take 5-10 years of treatment for recovery.
What can middle school parents do?

There are certain key 'ingredients' which we find absent in children with eating disorders. Here are some thoughts toward prevention. Eating disorder sufferers experience a profound lack of self-respect. Children require respect and value for who they are, even if who they are does not meet your expectations or they are different from what you had expected. Eating disorder sufferers cannot describe or articulate how they feel. Help them put words to their behavior and feelings. You do not necessarily have to fix a problem, but rather encourage your child to talk about how s/he feels.

Teach your children to tolerate frustration and negative emotions. Teach them tolerance for their mistakes and imperfections. Respect their boundaries. For instance, do you knock on their door and wait for them to invite you in? Trust them. You have instilled your values in them. Often you need to sit back and allow them to implement these values without your control. Know when to interfere. Know the difference between setting limits and controlling who they are. Have realistic expectations. If you have concerns about their eating habits, never say they are getting fat. Explain about healthy eating and proper nutrition. If you suspect they are eating to comfort feelings, talk to them about how they feel. Explain that we all come in different shapes and sizes. Do not focus on one body part. Look at the whole person.

An eating disorder can develop in a child where eating patterns are normal in the household. But deal with your own issues about food and body image. Children learn more from what they see in your behavior than from what you say. Eat pizza with your kids. Get help for yourself if you suspect you have disordered thinking about food or your body. If you suspect the beginning of an eating disorder, do not wait. Get help. Children who grow up with a healthy sense of themselves will be most likely able to weather the pressures of our American culture regarding weight and body image, and to reject messages that are unrealistic and perfectionistic.

Daily nutritional recommendations for the middle school child (S. Escott-Stump, Nutrition and Diagnosis-Related Care, 4 th ed.): 3-4 cups milk or equivalent source of calcium, 2-3 servings of meat or equivalent, 6-12 servings from bread group, 2-4 servings fruit or juices, 3-5 servings vegetable group. Adequate zinc for growth and sexual maturation; calcium for bone growth; iron for menstrual losses.
Typical daily caloric needs: Boys ages 11-14 years need 55 calories per kilogram of body weight. Girls ages 11-14 years need 47 calories per kilogram of body weight.

Books for parents and children: J. Bode, Food Fight: A Guide to Eating Disorders for Preteens and Their Parents; K. Cooke, Real Gorgeous: The Truth About Body and Beauty; M. Adderholdt-Elliot, Perfectionism: What's Bad About Being Too Good? Books for Educators: M. Levine & L. Hill, A Five-Day Lesson Plan on Eating Disorders for Grades 7-12.

Dr. Judy Scheel is the Director of Center for Eating Disorder Recovery (CEDaR) located In Northern Westchester County, New York.

In Partnership with the American Eating Disorder Association- -SINCE 1999