Does my child have an eating disorder? Warning signs and advice

According to Beat eating disorders charity, approximately 1.25 million people in the UK have an eating disorder, with children as young as 6 being affected.

We've spoken to a range of experts to offer advice on how you can tell if your child is living with an eating disorder - and how  you can you help them.

What's the difference between anorexia and bulimia?

Anorexia is a serious mental illness where people are underweight as a result of limiting their energy intake. It can affect anyone of any age, gender or background. Individuals will develop compensatory behaviours such as over-exercising and some may experience cycles of bingeing (eating large amounts of food at once) and then purging. Sufferers will have a distorted perception of how their body looks, seeing themselves as a lot bigger than they really are and they will be terrified of gaining weight.

READ MORE: Study reveals shock rise in the number of children with anorexia

Bulimia is much the same as anorexia, except, instead of restricting their calorie intake, they are caught in a cycle of eating lots of food and then trying to get rid of it by vomiting, taking laxatives or diuretics (a substance that increases the need to urinate), and fasting. Bingeing should not be confused with ‘over-indulgence, instead those with bulimia do not feel in control of how much or how quickly they are eating.

What are the warning signs and symptoms?

You can’t tell someone has an eating disorder just by looking at them, whilst some are extremely thin, many are not, and those suffering with bulimia can often be within a normal weight range. Signs someone has an eating disorder are usually shown in how they behave and interact with food or the subject of food and weight loss.

Chloe Copping, a deputy ward manager of an eating disorder unit says the following could be signs that your child has an eating disorder:

• They may become secretive and dishonest about the food they have eaten and go to great lengths to avoid meals, particularly eating with others.
• Loss of interest in others – avoidance of social situations involving food- i.e. meals out, family dinners at home, parties. If they do eat with family, they may start to hide food in their pockets or drop it on the floor.
• Controlling what other people eat, especially family members.
• Taking small bites of their food, playing around with it (mixing all food groups together/squashing it down, separating food groups- eating veg first, then protein etc), pull non-existent fat from meat, drinking lots of water before meals to fill up
• Frequent visits to the bathroom immediately after eating may be a sign of purging. Excessive exercise- always choosing to walk instead of using the bus or other means of transport, even for very long distances. Isolation – spending long amounts of time alone in their bedroom Easily tired. Grades and ambition dramatically dropping, loss of interest in usual hobbies, unable to sit still long enough to watch a film or tv show, unable to concentrate to read a book and study.
• Covering up their bodies with layers, even during the summer
• Very critical of themselves and others, not just their bodies but their intelligence, success, number of friends etc.

Sue Young, specialist eating disorder dietitian, also says to look out for discussions about food intolerance and exclusions, which haven’t been medically diagnosed such as, coeliac and dairy.

READ MORE: Bake Off’s Steph Blackwell opens up about her eating disorder

What can you do?

'In general, there are things you can do to encourage a good relationship with food for your child,' says Dr Sophie Edwards, chartered health psychologist.

She suggests that you:

• Talk positively about different body shapes and sizes, and emphasise that you can be healthy and happy in a bigger body.
• When discussing healthy eating and exercise, do it with a focus on how these behaviours make you feel, rather than their ability to help you lose weight.
• Steer clear of 'diet talk' around your children and be assertive and ask that your family members do the same.
• Try to give compliments that are not based on their looks, such as, "You are really kind", rather than, "You are really pretty." This will help them build their self-worth around their character, rather than their appearance.
• Do not label foods as 'good' or 'bad' and try not to use food as a reward or bribe.
• Make meals as stress-free as possible; young children are really good at knowing when they are hungry and when they are full, and having a battle over them finishing the last piece of cold broccoli can lead to negative associations around food. Approach meals as an exploration, when they try new foods ask them about the smell, texture, taste and look.

Talking to your child about an eating disorder

If you are worried that your child may be showing signs of an eating disorder, ‘Early identification and therefore, early support, can significantly increase the success of any intervention,’ says Sue.

It may be best to talk through your concerns with a healthcare professional before you approach your child, so you are emotionally prepared.

'Talk to them at a time when you are both calm and in a safe space, at home, for example,' says Dr Edwards. 'Do not focus on their weight, but on their feelings and emotions, but do have some information on eating disorders handy for them to look at afterwards.'

It is also important that you do not label them or place any blame on them, or try to make them feel guilty. 'Try to avoid saying things like, "Your dad is very stressed about this", as this can make them withdraw even more,' says Dr Edwards.

Seeking professional advice

The first step is making an appointment with your child’s GP. The National institute for Health and Care Excellence (NICE) has guidelines on the treatment of eating disorders, and they clearly state that the GP should refer anyone they think has an eating disorder, to a specialist for further assessment or treatment immediately. This will come from the Community Eating Disorders Service for Young Children and People (CEDS-CYP), they take referrals from GPs, healthcare professionals, as well as schools and other services such as mental health teams.

‘My advice for parents is the same as it is for nurses, teachers or healthcare works who might be concerned that somebody is suffering from an eating disorder,’ says Dr Jaco Serfontein, Consultant Psychiatrist in eating disorders. ‘Don’t be afraid to talk about it and ask for help. Even if you have tried to talk about it without success before, try again.

'There are many sources of help available ranging from self-help, to national resources and local eating disorder services for both people suffering with eating disorders as well as those who care for them.’

Dr Serfontein suggests BEAT and FEAST for further information and online support. You can also seek advice from Anorexia and Bulimia Care.

Types of treatment

'Once they have a referral, they will contact you very quickly to assess whether your child is at high risk- this is usually 24 hours,' says Dr Edwards. 'If they don't think there is any immediate danger, they will invite you in to have a full clinical assessment and decide upon a treatment plan. They will also screen for other mental and physical health problems that are common in eating disorders.'

'The majority of children are treated in the community and this will usually consist of family therapy with a focus on the eating disorder,' says Dr Edwards. 'You may also have input from a dietitian, but this would be along with psychological therapy.'

'If your child is found to need a more intensive level of treatment, they may offer some support to you at home or ask your child to come into day programmes,' says Dr Edwards. 'In rarer cases, if they think your child is at immediate risk, they may recommend a stay in hospital to stabilise your health before they come home and start community treatment. This is always done in a very sensitive way and your child with be with children their age.'

'The team will do their best to keep your child on track with school work and generally make the stay as comfortable as possible,' says Dr Edwards.