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 Ea
tin
g
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
Res
tric
tive
Eat
ing
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
Foo
d R
efu
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
Foo
d P
ho
bia
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
Avo
idan
ce
Emo
tio
nal
Dis
ord
er
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
asiv
e R
efu
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 inthe school setting. She can provide training sessions or workshops for schoolstaff, parents or students on a variety of topics, including self-harm, anxiety,body image and eating disorders.
For further information and free resources visitwww.inourhands.com
For details of CWMT funded sessions for staff,parents or students visitwww.inourhands.com/CWMT
Email: [email protected]: @PookyHLinkedIn: linkedin.com/in/pooky
