Eating difficulties in younger children

and when to worry

Dr Pooky Knightsmith

www.inourhands.com | @PookyH

Eating Disorders

Food, weight or shape are used

as a way of coping with

difficult circumstances or

emotions

Eating Difficulties

Younger children display a wide range of eating problems – not all are cause for concern. Some are behavioural

issues.

Age Distribution

Mostly over 11

• Anorexia nervosa• Bulimia nervosa• Binge eating

disorder

Mostly under 11

• Food refusal• Restrictive eating• Selective eating• Food phobia• Food avoidance

emotional disorder

Are they hungry?

Are they growing?

Do they seem Happy and healthy?

Is it a problem?

Sele

ctiv

e E

ati

ng

Extreme faddiness

May last months

Behaviour otherwise normal

Can cause social difficulties

Weight varies

She would only eat biscuits or crisps

and NOTHING else. It had been going on as long as we could remember.

• Encourage family mealtimes• Play down fussiness• Make no assumptions• Praise small steps• Suggest supplements if needed• Monitor if needed• Dental support may be needed• Look at practical issues – e.g. parties

Selective Eating – How to Help

Poor appetite

Eats less than peers

Often slim & short but healthy

Family may have similar food intake

Normal range of foods

Rest

rict

ive E

ati

ng

He just didn’t seem that interested in food. He ate a wide range, just in very

small amounts. Apparently his Dad was the same and had the

same short, lean stature.

• Monitor if concerned• Reassure family / school• Ensure teasing is not a problem• Watch out for low self-esteem / body

confidence

Restrictive Eating – How to Help

Food

Refu

sal

POWER!

Eats favourite foods

Physical health okay

Underlying worry

Certain places / people

She wouldn’t eat or drink anything at

school and made a huge fuss if we forced

the issue but ate normally at home.

• Support, not anger• Need to work out WHAT are they

trying to tell us• Draw and talk• Play therapy

Food Refusal – How to Help

Highly resistant to eating & drinking Food

Ph

ob

ia

Tend to be frightened of:• Choking• Gagging• Vomiting

May say eating hurts

Mealtimes become a battleground

Ever since she’d choked on a piece

of chicken, she was refusing any solid

food in case it happened again.

• Need treatment for PHOBIA not eating disorder

• Small steps – okay to return to purée• Teach calming techniques

Food Phobia – How to Help

No fear of weight gainFo

od A

void

ance

Em

otion

al D

isor

der

General behaviour disturbance: • Sleep problems• Poor concentration• Tearfulness• Hopelessness

Associated with depression and anxiety

May isolate themselves / avoid school

After his Grandpa died he just completely lost

his appetite. He understood he was too thin and was

worrying people but couldn’t manage to

eat.

• Often follows trauma or bereavement

• Needs support processing• Support for depression / anxiety• Family may need support• GP may prescribe nutri-drinks

Food Avoidance Emotional Disorder – How to Help

May refuse to walk, talk, eat, drink or take care of themselves

Angry / determined / scared

History of family issues

May indicate abuse

No physical cause

Perv

asi

ve

Refu

sal

Syn

dro

me

She wouldn’t walk, talk or eat and was

eventually hospitalised and tube fed. It later

transpired she had been being abused by her

father.

• Rapid risk assessment • Do not assume abuse • Multi agency approach• Recovery is slow• Pressure may further regression• Family involvement in therapy can

prove helpful in sustaining recovery

Pervasive Refusal SyndromeHow to Help

Need more support?

Dr Pooky Knightsmith specialises in mental health and emotional well-being in the school setting. She can provide training sessions or workshops for school staff, parents or students on a variety of topics, including self-harm, anxiety, body image and eating disorders.

For further information and free resources visit www.inourhands.com

For details of CWMT funded sessions for staff, parents or students visitwww.inourhands.com/CWMT

Email: pooky@inourhands.com Twitter: @PookyH LinkedIn: linkedin.com/in/pooky