Beyond Picky Eating: Recognizing Disordered Eating in Children
Go to any pediatrician’s office, and you will likely hear common-sense advice based on years of medical experience and research: introduce new foods several times; model healthy eating; trust that your child’s tastes will expand over time; and do not force a child to eat.
The doctor may also discuss your child’s body mass index (BMI)—even at very young ages. And while this medical wisdom is often spot-on, there are times when picky eating is not simply developmental but may be an indication of an eating disorder. The most common eating disorders in children who are limiting their food intake are ARFID and Anorexia.
ARFID
A common eating disorder that is often confused with picky eating in children is Avoidant/Restrictive Food Intake Disorder (ARFID). While all children have food preferences and may refuse certain foods, ARFID is more severe and leads to insufficient nutritional intake. In ARFID, the child is not restricting food based on body image or a desire to control weight (as in Anorexia). Instead, the child may lack interest in food or experience anxiety, sensory sensitivities, strong aversions, or fear of choking or other adverse consequences of eating.
The child often has a short list of “safe foods,” which can look like typical “kid foods.” Over time, this list typically shrinks. If left untreated, ARFID can lead to digestive issues, vitamin deficiencies, extreme weight loss, stalled growth, and other symptoms of malnutrition.
Anorexia
Many people assume that Anorexia is a “teenage girl thing,” but eating disorders are increasingly affecting younger children and a broader range of populations. Unlike children with ARFID, children with Anorexia restrict food because of concerns about their weight, body size, shape, or appearance.
The social and psychological pressure to be thin can begin early, even in elementary school. Anorexia is marked by extreme rigidity and restriction around food, calories, and food groups. Children with Anorexia may appear emaciated and can develop serious medical issues such as irregular heart rate and rhythm, skin and hair problems, and bowel dysfunction. Anorexia has the highest mortality rate of any psychiatric disorder not related to substance use.
What Should I Do If I Suspect My Child Has an Eating Disorder?
The good news is that there are research-based approaches to help children recover their eating habits, nutrition, growth, and mental health. Because eating disorders are both medical and psychological conditions, treatment often requires a collaborative approach involving the child, their parents, mental health professionals, physicians, and dietitians. One effective treatment is Family-Based Therapy (FBT), which empowers parents to take an active role in their child’s recovery.
Some Strategies for Parents
Talk to your child’s pediatrician about any behaviors or symptoms of an eating disorder. Don’t assume that a normal or high BMI means everything is fine. A child can be medically compromised even with a normal BMI. If your concerns aren’t taken seriously, seek a specialist.
Model healthy and intuitive eating. This includes being flexible and adventurous with food and rejecting rigid diets. Avoid labeling foods as “bad” or referring to eating as “cheating.”
Promote positive body image. Avoid commenting on your child’s or anyone else’s body shape or size. Focus on what bodies can do—like moving, playing, creating, and expressing.
Address underlying mental health conditions such as ADHD, anxiety, or OCD, which may increase the risk of developing an eating disorder. Learning healthy coping strategies can help children avoid using food as a form of control.
Foster open communication and a safe emotional environment. Work on conflict resolution skills and your ability to talk about hard things together.
Get support if you're struggling. If you face challenges with your own body image or eating habits, model what it looks like to seek help and practice self-care.
Facing an eating disorder can feel daunting, but you are not alone. Whether you need help for yourself as a parent or for a child who is struggling, support is available—and recovery is possible.
Here at Atlanta Wellness Collective, we want to help. For support, contact us or schedule an appointment online.
This blog post was written by Jennifer Oswald.
This blog is not intended to substitute professional therapeutic advice. Talk with your healthcare provider about your health concerns and before starting or stopping therapies. No content on this site, regardless of date, should ever be used as a substitute for direct professional advice from your doctor or other qualified clinician.
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