In-depth look at Treatment for Eating Disordered Children
Eating disorders generally involve self-critical, negative thoughts and feelings about body weight, food, and eating habits that disrupt normal body function and daily activities. Research completed by the Agency for Healthcare Research and Quality found that hospitalizations for eating disorders in children under the age of twelve increased by 119% between 1999 and 2006 .
The Types of Eating Disorders Among Children
Anorexia Nervosa and Compulsive Eating are the most common among young children, but there are cases of Bulimia being reported. It has been estimated that 40% of Nine-year-olds have already dieted and there are reports that four and five-year-olds feel the need to diet. Other research has found that 46% of nine to eleven year-olds are “sometimes” or “very often” on diets, and 82% of their families are also “sometimes” or “very often” on diets .
Experts have blamed the trend on a celebrity culture which glorifies size zero figures, leaving an increasing number of young girls struggling to cope with their growing bodies and thus more eating disorders in children. Other factors might include peer pressure, as well as performance pressure from certain sports that emphasize body shape, such as gymnastics, dancing, etc.
The Factors Contributing to Eating Disorders in Children
A number of factors combine to trigger eating disorders:
- Biology and genetics
- Cultural pressures, including the media
- Peer pressure to be abnormally thin or muscular
These factors seem to be influencing younger children much more over the past decade. It appears young girls feel increasingly frightened by the prospect of gaining weight in puberty.
Watching T.V. sitcoms geared towards this age group have displayed exceptionally thin actors and actresses looking extremely attractive, making this seem like the new normal. An average commercial geared towards children not only tells them what they need to wear but how they need to look wearing these clothes.
The Origins of Eating Disorders in Children
According to research, one in five children diagnosed with an eating disorder have a history of early feeding problems, such as “fussy or picky” eating though this has not been identified as a direct cause of an Eating Disorder .
Almost half of those diagnosed with disorders by the age of 12 had a close family member with a mental health problem such as anxiety or a mood disorder.
The combination of biological factors, family history, and environmental issues, like peer pressure, or psychological stressors, including trauma, can also increase a child’s susceptibility to developing an eating disorder. Other factors that may increase risk for an eating disorder may include low-self esteem or behavioral issues.
The Serious Consequences of Eating Disorders in Children
Eating disorders are serious and have serious consequences. A child who suffers from anorexia nervosa, bulimia, or any other eating disorder could suffer from a variety of physical, emotional and psychological consequences, including but not limited to:
- Slowed growth
- Gastrointestinal distress
- Bone loss
- Fainting, fatigue and overall weakness
- Cognitive distortions
- Body dysmorphia
- Injuries to the internal organs
Other medical complications such as:
- Heart problems
- Kidney failure
- Stagnation in the physical development
In extreme cases, eating disorders can lead to death. Studies have shown a range of mortality rates from 5 to 18 percent, with anorexia having the highest mortality rate of the mental health disorders .
How Could These Eating Disorders Happen?
Now, this begs the question: how is recovery inspired and transpired in children ages 8 to 11 years?
The significant way recovery can start in this age group is via the parents and change in the psychosocial environment.
Generally, the earlier the intervention, the shorter the treatment required. Parents need to provide their children with unconditional love regardless of the ongoing psychosocial stressors.
Encouraging and supportive parents help build their children’s self-esteem. Parents being healthily involved in their children’s lives by spending time with them and giving them the special attention they crave and need.
It is important to emphasize that parents should not be “blamed” for the development of an eating disorder in their child.
Eating disorders, as described above, are complex psychiatric illnesses that result from a multitude of factors. Parents play an invaluable role in their child’s treatment and recovery process and should be involved whenever possible. It is important for parents to know that they are not alone as well, and that a plethora of resources and professionals are available to support them through this journey that can feel overwhelming at times.
Setting a Good Example
To help a child recovery from an eating disorder, parents also need to set a good example for their children, which means that the parent themselves should be involved in healthy eating and exercise patterns. If dieting was frequently discussed in the home, or parents were previously chronic dieters, this is a good time to examine these behaviors and determine how to create a more supportive environment for the child.
Kids getting the message that they are great as they are and that their bodies are healthy and strong is the best gift a parent can give their children. Parents can also exemplify this through how they treat their own bodies, and the manner in which they talk about themselves.
Tackling the Whole Problem, Not Just the Physical Symptoms
For children whose symptoms are severe enough to require hospitalization, they need to be stabilized medically, nutritionally and emotionally. It is often therapeutic to get them away from their physical environment to get them started in recovery.
It is best to look for a facility that is particularly well-versed in a simultaneous:
- Psychological, and
- Social interventions
in a holistic manner such as we have at the Remuda Ranch treatment facilities. For this age group, given where they are developmentally, hospitalization occasionally helps the child recognize the significant danger of an eating disorder and motivates them to pursue health.
I have seen more spontaneous recovery with the really young children with eating disorders. Being away from home, occasionally for the first time, being around others that are just as sick causes realization of how awful the disease it and most of them never want to be hospitalized again. They are also more amenable to following their parents’ guidance with regards to eating appropriately.
Treatments Available for Eating Disorders in Children
Biologically, while some children do not need psychotropic medications, the majority of children that meet criteria for an anxiety or a mood disorder will benefit from initiation of a psychotropic medication as treatment of these disorders help facilitate the treatment of the eating disorders.
Children that do not have comorbid mood or anxiety disorder may also benefit from as-needed anti-anxiety medication at the initial stage of the re-feeding process, as this decreases anxiety during meal times and allows the child to overcome the fear of eating.
How the Parents Are Involved with Treatment
It is extremely important once again that for children ages 8 to 12 years, that home environment changes and most psychosocial interventions are started with the parents. Parents should be a full partner in any treatment paradigm and they should be fully incorporated as part of the team.
There should be frequent family therapy throughout the duration of treatment and significant amount of time spent on psycho-education about eating disorders.
Parents often struggle with feelings of guilt, and this feeling should be eased by the therapeutic team. They have the duty to be as non-judgmental as possible in their approach to addressing family conflicts. It may be helpful for parents to become involved in a support group with other family members as a therapeutic form of guidance during the time of treatment.
Divorcing parents would benefit from counseling on how to co-parent appropriately as this decreases stress for the child. Parents should be strongly encouraged to address any of their own mental health problems. Building parenting skills may be useful for some parents that lack these skills.
Each Child Is Unique When It Comes to Treatment
Once again, given their developmental stage, children ages 8 to 12 years old with eating disorders respond to behavior therapy and parents should be fully versed with behavior modification techniques by the time the child returns home. Parents should be educated and given the tools on how to modify their pre-adolescent child’s behavior using positive reinforcements.
Children are also made to realize both positive and negative consequences of their behavior regarding food and parents learn to decrease over-expressed negative emotions while addressing feeding problems with their children.
Also, because many of these kids place different foods into “good food and bad food” categories, Cognitive Behavioral therapy is useful to address cognitive distortions that cause anxiety and serve as triggers to their abnormal eating behaviors, such as:
- Binge eating
- Ensuring Long-Term Recovery for Eating Disorders in Children
Lastly, a good and comprehensive outpatient team is extremely important in the treatment of eating disorders in children. This team should consist of :
- A child psychiatrist if the child is on psychotropic medication or has significant co-morbid psychiatric disorder
- A pediatrician
- A family therapist
- An individual therapist and a nutritionist
Parents are the most influential part of the team. This needs to be emphasized, as the child is emotionally and physically dependent on them and whatever intervention that helps make the parents feel capable and confident in helping their child is beneficial to the child.
: Agency for Healthcare Research and Quality, “Hospitalizations For Eating Disorders from 1999 to 2006”, https://www.hcup-us.ahrq.gov/reports/statbriefs/sb70.pdf Accessed 7 June 2017
: Gustafson-Larson, A. M., & Terry, R. D. (1992).Weight-related behaviors and concerns of fourth-grade children.Journal of American Dietetic Association, 818-822.
: American Academy of Child and Adolescent Psychiatry, Facts for families, 2008
: Colleen Thompson, Eating Disorders in Children. EDSA Canada Mirror Mirror, 2011
: Kaplan and Saddock, Synopsis of Psychiatry. Behavioral Sciences/Clinical psychiatry-9th Ed 2002.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on July 13, 2017.
Edited And Updated By: Crystal Karges, MS, RDN, IBCLC.
Reviewed By: Jacquelyn Ekern, MS, LPC on July 13, 2017.
Published on EatingDisorderHope.com