When Very Young Kids Have Eating Disorders
By Abigail Natenshon, MA, LCSW, GCFP
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.
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. Her work can be reviewed further at www.empoweredparents.com and www.empoweredkidZ.com, www.treatingeatingdisorders.com.
