Many children go through phases of refusing to eat, being ‘faddy or fussy’ eaters, or having other eating problems. This is often quite a normal part of growing up, but when should you worry and how can you support children with more serious eating issues?
Eating disorders are serious mental illnesses. Sometimes, when self-worth is low or things feel emotionally out of control children focus on something they can control and change, such as a dislike of their body; managing it through controlled eating or bingeing.
Eating disorders are rare among key stage 1 school children, but they can start to emerge as an issue between the ages of nine and twelve, and often when children transition to secondary school.
Although some associations exist between body image and eating disorders, there is no clear cause and effect. Eating disorders are complex and multifaceted and are often prompted by a combination of genetic, psychological and environmental risk factors.
Risk factors for eating disorders
These tend to cluster and include:
- A poor sense of self
- Feeling overwhelmed by difficult emotions and circumstances
- Body image concerns and dissatisfaction
- Over exposure to popular or distorted media ideals of body image
- Involvement in sports or activities where body image and low weight are important.
Spotting the signs
Some possible signs of an eating disorder include:
- Social isolation.
- Avoiding eating around others.
- Difficulty concentrating.
- Low confidence and self-esteem.
- Baggy clothes or clothing that is skin tight yet in a small size.
- Obsessive and/or rigid behaviour.
- Compulsive exercise.
- Frequent trips to the toilet.
- Perfectionism and setting unreasonably high personal standards.
- Changes to weight – either gaining or losing weight, or experiencing fluctuating weight.
- Having a distorted view of themselves as being fat (body dysmorphia).
Find out more about eating disorders
MindEd is a free educational e-learning resource for professionals on children and young people’s mental health. The following sessions aim to help staff better understand how eating disorders affect children:
Be alert and spot early signs.
Maybe a child is missing school meals or avoiding eating, or telling people that they have already eaten, or they will eat later, or focusing on body image and describing themselves as fat.
Talk to them.
If you are concerned about a child, talk to them. Don’t be afraid to ask them if they are worried about themselves or if there is something worrying them.
Share your concerns.
Without overwhelming the child, share your concerns about any other changes you’ve noticed, e.g. depression, anxiety or isolation. If a problem is developing, the sooner they get support the better.
Be prepared for denial and anger.
Your ability to be calm, caring, non-judgemental and tolerate their distress is one of the most powerful tools you can muster. Build trust and talk to the child about your worries.
Express your concerns clearly and with minimal emotion.
Try something like ‘I’m concerned when I see you running to the toilets after dinner’. Many children with an eating disorder will not understand the seriousness of their illness. Don’t be put off if they don’t ‘buy-in’ to the idea of needing support straightaway.
Talk to parents/carers.
A team approach will be key, but has to be handled carefully, especially if parents feel they are being blamed in any way. If you have serious worries or concerns, speak to your pastoral care lead/SENCO and refer to specialist services.
What schools can do
- All children are likely to benefit from schools delivering good quality teaching programmes supporting children’s social and emotional skills, helping children understand and recognise thoughts and feelings and helping develop effective coping strategies, promoting self-esteem and resilience. Like self-harming, eating disorders can often be a survival strategy in the face of overwhelming emotions and difficulties – so teaching effective ways of dealing with thoughts and feelings from early on is likely to be important.
- At primary school level, it’s important that the focus is on body image and healthy eating and living.
- Teaching children, through PSHE, to be happy with who they are and to celebrate diversity and difference. It is also important to help children develop skills to recognise when they are being sold idealised images or misleading advertising images.
- Catching problems early is crucial for young children. School staff are ideally placed to identify children early and early treatment improves the chances of recovery. Positive relationships in the classroom/school that are built on trust, safety and security promote pupil wellbeing and help children open up and talk.
Some children will also need a little extra help either through school pastoral/counselling support. Most young people with eating disorders present for help very late on – yet early help is important. Talk to your school nurse to get help with community-based support.