Worried Your Child Has An Eating Disorder This Pediatrician Has Advice
As a pediatrician, Ive seen how the pandemic has deeply affected our youth they are suffering from depression and anxiety as they were pulled from routines, school and peers for a year. But one effect Ive seen that has been surprising: the number of tweens and teens who are suffering from eating disorders, probably brought on by this isolating time.
With the increase in coronavirus vaccinations, the relaxation of strict guidelines and the return to school in some communities, its easy to think that the worst of this pandemic is behind us. But the pandemic has given rise to a mental health crisis of monumental proportions among our youth.
The number of new referrals, along with the amount of hospitalizations for eating disorders, has doubled at the hospital over the last year, says Lisa Tuchman, chief of adolescent medicine at Childrens National Hospital in D.C.
As a pediatrician, I see the surge myself, and Ive spoken to many parents about the issue.
So, as we dream about a return to our normal routines and lives, what do teens, parents, caregivers and educators need to know about detecting and battling eating disorders? Here are questions Ive heard from parents and my answers, so we can address this growing health crisis among young people.
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Understand Whos Most Likely To Recover
There are a lot of misconceptions about eating disorders. One of the most common is that people think that once someone has an eating disorder, they will have it for the rest of their lives. This is not true. Many people completely recover from anorexia and go on to be happy and healthy. The people who have the best chance of recovering are younger, receive treatment quickly, and restore weight and health quickly.
The longer a child struggles with eating disorder symptoms, the more serious the illness and its consequences become. It is also important to find providers with training in specialized eating disorders to provide the best care for your child. Our specialized team provides evidence-based care that has been shown to be the most effective in helping youth recover.
What About People Obsessed With Clean Eating Healthy Eating Or Body Building
I describe a few conditions that are similar to eating disorders and that can be just as serious here. They include diabulimia, orthorexia, drunkorexia, and muscle dysmorphia, also called bigorexia or reverse anorexia. Some of these, especially orthorexia, can be precursors to a diagnosable eating disorder like anorexia.
Hear more on how these are related to eating disorders in Bitesize:
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How Much Should I Feed My Child
If you’ve been told the risk of refeeding syndrome is not an issue in your case, if your child has lost weight you’re aiming at a gain of 0.5 kg to 1 kg a week. Or more. Do not tip-toe around weight gain: your child needs nutrition. Studies show that fast gains in the first few weeks predict better outcomes. So unless your clinicians tell you otherwise, go for it.
I’m Confused How To Talk About Weight Body Shape And Healthy Eating
Join the club! Most of us parents evolve in our own attitude, fat-phobias, healthy-eating guilt trips and so on, because we see the world through different eyes when our child has an eating disorder. Our current society is slightly mad and we’re all bathing in that corrosive juice! You can find some sensible talk from many experts in The Full Bloom Podcast.
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Early Indications Of Developing An Eating Disorder
1. The sufferer starts to comment about their weight, body shape, and size.
Many individuals start having concerns about their body during their pre-teen and teen years, specifically around the age of 9 or 10 . During this time, people start to become more conscious about their body shape/size and may notice differences from the status quo.
They may wonder what their body is supposed to look like, what they should weigh and question how their body compares to their peers. Often this is where it starts. When you hear your child or teen repeatedly compare his or her physical self to others, it may be a matter of concern.
2. The persons eating patterns change noticeably.
Oftentimes, when a teen starts to engage in disordered eating behaviors, it begins with diet patterns and behavior. You may notice a shift in meal choices, whether they say they want to start being vegetarian or they want to start eating healthier.
These individuals may show a heightened interest in diet and weight loss. They could be scared of the effects of specific foods and believe that they can lose weight if they follow a particular diet.
This might be an opportunity to arrange a meeting with a nutritionist and/or therapist in order to provide a discussion of weight, nutrition and body image with a trained professional who can provide unbiased guidance to your teen or child.
3. The individual starts exercising excessively.
4. The sufferer is caught hiding or hoarding food.
I Felt Ashamed For Enjoying Food
Imagine being excited for Thanksgiving and your dadâs amazing sweet potatoes, only to feel totally disgusted for eating them. Overindulgence is never good, but we all get a pass on the holidays, right? I canât remember a celebratory meal that didnât end in me hating myself, whether I ate too much or not.
Knowing this about myself, I am very tuned in to how my kids feel about food. I want them to enjoy it, and listen to their bodies to tell them how full they are. I invite them to slow down when they eat, so they can really taste their food, especially dessert, and savor it. When you are ashamed about eating, you tend to eat fast . So even as I binged, I wasnât registering any enjoyment I was just eating to stop time so I wouldnât have to deal with something in my life at that time.
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Dealing With Eating Disorders In The Home
As a parent, there are many things you can do to support your childs eating disorder recoveryeven if they are still resisting treatment.
Set a positive example. You have more influence than you think. Instead of dieting, eat nutritious, balanced meals. Be mindful about how you talk about your body and your eating. Avoid self-critical remarks or negative comments about others appearance. Instead, focus on the qualities on the inside that really make a person attractive.
Make mealtimes fun. Try to eat together as a family as often as possible. Even if your child isnt willing to eat the food youve prepared, encourage them to join you at the table. Use this time together to enjoy each others company, rather than talking about problems. Meals are also a good opportunity to show your child that food is something to be enjoyed rather than feared.
Avoid power struggles over food. Attempts to force your child to eat will only cause conflict and bad feelings and likely lead to more secrecy and lying. That doesnt mean you cant set limits or hold your child accountable for their behavior. But dont act like the food police, constantly monitoring your childs behavior.
Do whatever you can to promote self-esteem. in your child in intellectual, athletic, and social endeavors. Give boys and girls the same opportunities and encouragement. A well-rounded sense of self and solid self-esteem are perhaps the best antidotes to disordered eating.
Can I ‘hide’ Ingredients In The Food
I’m fascinated that some therapists say that’s an absolute ‘No’. That can make refeeding very hard and slow, given that most of our children fear just about any high-calorie food. The illness drags on as we try and be ‘honest’ and agree to tell them how many grams of butter is in the pasta.
Meanwhile, it seems to me that we strengthen their eating-disordered obsessive thinking, as they agonise over ingredients and quantities.
Most parents I know, who have succeeded in supporting their child to recovery, are very comfortable with adding cream, butter, oil to all kinds of food.
When your child asks, you say, “Darling, I can see how you would think it’s helpful to know what’s in the food. And at the same time, we know it makes things harder. So for a while, we’re not going to discuss ingredients. Trust us to serve you what you need. I’ve heard of a great new series on Netflix, by the way, would you find it for us?”
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I Think My Daughter Has An Eating Disorder: 10 Signs
Eating disorders are complex and potentially life-threatening conditions that affect an individuals health and relationships. According to NationalEatingDisorders.org, approximately 20 million women in the United States suffer from a type of eating disorder. These disorders often begin early on in life with concerns about body shape and weight. In fact, approximately 40 to 60 percent of girls between the ages of six to 12 are concerned about weighing more than is socially acceptable. This concern can continue throughout their life.
How Long Should I Persist With A Meal
I am not a fan of simple, one size-fits-all rules like ‘Life Stops Until You Eat’ or ‘100 percent nutrition, 100 percent of the time’. It depends on your child’s mental state, on whether you’re about to do harm by finally losing your temper, on what you have learned works with your child, on your aims .
If you have a meal to serve right now, think ‘compassionate persistence’.
If you have 20mn, watch my video, which talks you through your options.
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My Child Isnt Progressing As Fast As Others Whos To Blame
Several possibilities:
- Your child isnt getting the best treatment available, or the treatment isnt delivered by skilled, experienced clinicians. Or there is some loophole you are missing for instance whats happening with your childs eating in school? Check out my resources and work it out.
- The treatment your child is getting is not suited to his/her particular needs . Discuss it with his or her team.
- Eating disorders affect different people with different levels of severity, they are tough illnesses and treatment is still in its infancy. Perhaps you are all doing the best that can be done with our current knowledge, and your child would be more ill otherwise. Keep going. And if therapist is blaming you or your child for lack of progress, find another.
- Perhaps comorbids need addressed sooner rather than later, for instance OCD or particular needs related to autism or to an earlier trauma. Perhaps your child needs more targeted help with depression or anxiety, or with volatile emotions as in borderline personality disorder . Perhaps there is a biological component that is maintaining the illness, as in gut microbiota and in basal ganglia encephalitis , which I say more about on this page.
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Do ‘consequences’ And Bribes Work
My book and Bitesize are packed with guidance for you to connect using compassionate persistence . I believe this is the most risk-free, productive way, of guiding your child, step by step, to manage a meal, to refrain from throwing their plate at a wall, to stay in the house when they were going to run away, to speak politely.
Compassionate persistence is more rational than ‘taking away privileges’. Your child doesn’t choose to find eating terrifying. Your child doesn’t choose for their nervous system to be in such a state of threat that they become unrecognisable.
Your greatest strength, in getting done what needs to be done, is in your connection. And if you’re wondering “Is it the eating disorder speaking, or the stroppy teenager?”, I suggest that is irrelevant. The use of ‘consequences’ is a poor tool, whatever is driving any kid.
The carrot and stick approach gets far too big a airing on TV parenting shows, starting with ‘the naughty step’ for toddlers. Yet is only one method in a vast toolbox in my view it’s the most risky, the most likely to backfire, the most shaming and disconnecting, the least likely to promote thriving and wisdom.
Listen, it has worked for some, and on forums it’s what you will hear of the most. If it can save a life, it has a place in your toolbox.
If this is strange to you, and you’re wondering how to bring up any child or teen without carrot or stick, you’ll find lots more in my resources.
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Seek Expert Help Early And Don’t Wait
If you sense that your child might be developing an eating disorder, Dr Lewis says early intervention is imperative.
Ms Morgan agrees: “If you can treat at an early stage, you can be much more effective at closing it down.”
Meryl says she wishes she’d known to get started earlier on assembling an expert multidisciplinary therapeutic team which may include specialists such as a nutritionist, GP, psychologist, psychiatrist and paediatrician so she could start working with them to learn skills and the dialogue to support Julie’s recovery.
How To Talk To Your Daughter About An Eating Disorder
If you have a daughter who you suspect might be struggling with an eating disorder, its hard to know where to start the conversation. It can feel as if youre walking on eggshellson one hand you want to address the problem, and on the other, you fear that you could say the wrong thing and exacerbate it.
Nothing hurts worse than seeing your child suffer, regardless of her age. Most parents would do or give anything to help their child recover from an eating disorder.
It is important to remember that bringing up the subject of an eating disorder with a person who is suffering from one can be a tremendous help. It plants the seed about your concern for what she is doing and brings her focus to the issue. Even though it may be difficult, saying something is better than ignoring a dangerous and painful behavior.
This tip page is designed to guide you through the process of discussing your concerns with your daughter. One day, when she is recovered and healthy once again, she will thank you for the role you played in her recovery.
Dr. Lynda Brogdon, Founder of Canopy Cove Eating Disorder Treatment Center has 25 years experience providing treatment to those with Anorexia, Bulimia, Binge Eating Disorder, and associated Eating Disorders. Below are her suggestions for talking with your daughter.
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How Do I Find A Treatment Center Or Therapist
Find a treatment center or an eating disorder specialist who takes your insurance in the Psychology Today Therapy Directory. Referrals from doctors or friends can also be helpful in this process.
Parents will want to research a clinic or therapist beforehand. It can be helpful to ask questions about credentials, experience, past patient outcomes, treatment strategies, how progress is measured, and insurance plans and payment options.
What If My Child Has An Eating Disorder
If you think your child has an eating disorder:
Get help early. When an eating disorder is caught early, a person has a better chance of recovery. Make an appointment with your child’s doctor or an eating disorders specialist.
Talk to your child about your concerns. Be calm, direct, and caring. Let them know you will help. Ask them to tell you what it’s like for them.
Go to all appointments. Treatment takes time and effort. Work with the care team to get the help your child needs. Ask questions any time you have them.
Be patient and supportive. Learn what you can do to help your child. Try to keep your relationship with your child strong and positive. Make time to listen, talk, and do things that you both enjoy.
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How To Do Exposure To Fear Foods
Sadly the only method that consistently works to get rid of a fear, is to do the fearful thing. The brain goes, ‘Oh, that wasn’t so bad’ and after some repetitions, it gets retrained, desensitised, ‘rewired’, so it doesn’t send our poor children down the fear route’.
Then there’s more help in Chapter 9 of my book: ‘How to free your child of fears: exposure therapy’.
It’s Not Working What Can I Do
- If you’ve not read chapters 7 to 9 of my book, then do that.
- Reading may not be your thing and it’s probably useful for you to hear this stuff too: that’s what my Bitesize audios are designed to do.
- Ask your clinical team to give you coaching. Many teams don’t do it, presumably because they themselves don’t have that particular expertise. A few think it’s better for parents to work it all out by themselves I think that’s a very weird theory of empowerment, so keep asking.
- I offer coaching by video call and I also offer online workshops.
- Ask your clinical team to send you help at home some places have home feeding teams.
- If your child cannot eat enough to regain weight, then it may be necessary to use a day unit or an inpatient unit to kick-start a change, and/or to tube feed and monitor their health.
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Why Would Our Child Accept Our Help When They Don’t Want To Get Better
You will help your child one meal at a time, even one bite at a time. Your confidence and your kindness will make it possible. The beauty of a family-based treatment approach is that your child can recover without every having decided they want to.
Hear more on this, and other ‘taking charge’ questions, in Bitesize: