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Beyond Picky Eating
Help for Pediatric Eating Disorders
by Marlaina Donato

Beyond Picky Eating, vadim guzhva/AdobeStock.com
vadim guzhva/AdobeStock.com

Most kids go through food phases and bouts of fussiness during mealtime, but more serious problems can lurk beneath the surface of such all-too-common behaviors. Eating disorders are often associated with teen and adult females, but children of any gender under 12 can be afflicted with anorexia nervosa, bulimia and other conditions unique to younger kids.

“Eating disorders used to be primarily a college-aged issue; now eating disorders show up in young teens and even children as young as 5 years old,” says Marcia Herrin, a dietitian and nutritional counselor in Lebanon, New Hampshire, and author of Nutrition Counseling in the Treatment of Eating Disorders and co-author of The Parent’s Guide to Eating Disorders.

Consequences of childhood eating disorders can include permanently stunted growth, impaired immunity, hypoglycemia and delayed puberty, but healing from an eating disorder can occur with early detection, quality care and proactive efforts by the family. Current research has broadened the medical definition, allowing earlier diagnosis and prevention, reports the New York City-based National Eating Disorders Association.

More than Body Image
While eating disorders are fueled by many factors, each child is an individual, and so any child’s struggles around food will be particular to them. Herrin, the founder of the Dartmouth College Eating Disorders Prevention, Education and Treatment program, says, “It is important for parents to know that the main risk factor for developing an eating disorder is genetic. This means some children are genetically at risk and others are not.”

The fires of predisposition can be fueled by “body dissatisfaction, dieting and involvement in activities that favor thinness, such as dance, gymnastics and running,” says Herrin, adding that the disorder defies stereotypes. “Because a child is male or has always been on the heavier side doesn’t mean that child is immune from developing an eating disorder.”

Being repelled by foods with certain colors, tastes, textures or smells and having phobias around vomiting or choking are often catalysts to disorders. “Extreme picky eating that leads to restricting food intake is now considered an eating disorder in its own right, called avoidant/restrictive food intake disorder (ARFID),” says Herrin. “The main difference between the child restricting food intake because of anorexia nervosa and the child with ARFID is that those with ARFID don’t care about weight or have body image issues.”

For Cassandra Lenza, an eating disorder therapist and the owner of Healing on Hudson, in Hoboken, New Jersey, the lasting imprints of a pervasive “diet culture” cannot be ignored. “The main and persistent risk factor for the development of eating disorders is early dieting,” she says. “Children under 12 who are dieting or exposed to dieting in their environment are more susceptible to the development of eating disorders than children who are not.” It is imperative, she says, that parents model healthy eating and provide a child with the tools for success.

A Whole-Child Approach
Cognitive behavioral therapy, mindfulness training and yoga have been shown in studies to help both children and adults to process critical emotions, thoughts and eating patterns. Lenza attests to the effectiveness of holistic, multidisciplined care for reversing the common effects of eating disorders like exhaustion and gastrointestinal, hormonal or cognitive impairment. “We recommend a three-pronged treatment approach for all children which includes working with a therapist who treats eating disorder behavior, a registered dietitian who can help nutritionally and a pediatrician who can monitor the child medically,” she says.

Habits and bonds within the family unit go a long way toward prevention. “Having a family dinner most days of the week substantially reduces the risk of a child developing an eating disorder,” says Herrin. For recovery, she advises, “The most effective treatment for children up to age 19 is family-based treatment (FBT). In FBT, clinicians show parents how to help their child eat enough to restore health. The type of eating that is most effective is good old-fashioned meals with plenty of calories from carbs, fat and protein.”

With observant parents and quality care, children have a brighter future. “The early signs are often subtle,” counsels Herrin. “Trust your intuition.”

Marlaina Donato is an author and composer. Connect at WildflowerLady.com. 

Kids’ Eating Disorders
Some common disorders in children 12 and under include:

ANOREXIA NERVOSA: Signs and symptoms include weight loss (often dramatic), distorted body image, intense anxiety/fear of weight gain and other behaviors that prevent weight gain.

AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER (ARFID): Signs and symptoms include extreme pickiness; lack of interest in food without body dissatisfaction; aversion to specific tastes, smells, texture and appearance of foods; avoidance of certain foods/food groups or habitual eating of only a few foods; fear of swallowing; anxiety about getting bellyaches or getting sick; weight loss and/or stunted growth from insufficient nourishment and malnutrition.

PICA: Signs and symptoms include eating non-edible substances such as crayons, paper, grass, rocks, feces, hair, paint chips, cleaning powders or clay; health problems such as constipation or diarrhea, intestinal obstruction or infection, anemia or lead poisoning. It is often seen in children on the autism spectrum that have a history of abuse or neglect, or mental health conditions like schizophrenia, anxiety or obsessive-compulsive disorder. It can also be caused by a zinc deficiency.

SUBTLE WARNING SIGNS FROM CASSANDRA LENZA INCLUDE:
• Child discussing dieting, food obsessions or weight-control measures; discussing exercise with greater interest, especially if she/he has not discussed exercise or movement before
• Social confinement and isolation
• Increased body dissatisfaction
• Changes on child’s growth chart

OTHER SIGNS: delayed puberty, eating smaller food portions, weight changes, thinning hair, hiding food, digestive problems, downy hair growth on body, severe mood swings or tantrums, excessive movement

TIPS FOR PARENTS FROM MARCIA HERRIN INCLUDE:
• Avoid labeling food as good or bad. It is better to serve all kinds of foods in moderation.
• Avoid talking about dieting, weight or judgments about different body types or sizes.
• Never tease a child about their weight or changing body.

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