eating difficulties in younger children and when to worry dr pooky knightsmith | @pookyh
TRANSCRIPT
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Eating difficulties in younger children
and when to worry
Dr Pooky Knightsmith
www.inourhands.com | @PookyH
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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.
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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
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Are they hungry?
Are they growing?
Do they seem Happy and healthy?
Is it a problem?
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Sele
ctiv
e E
ati
ng
Extreme faddiness
May last months
Behaviour otherwise normal
Can cause social difficulties
Weight varies
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She would only eat biscuits or crisps
and NOTHING else. It had been going on as long as we could remember.
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• 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
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Poor appetite
Eats less than peers
Often slim & short but healthy
Family may have similar food intake
Normal range of foods
Rest
rict
ive E
ati
ng
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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.
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• 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
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Food
Refu
sal
POWER!
Eats favourite foods
Physical health okay
Underlying worry
Certain places / people
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She wouldn’t eat or drink anything at
school and made a huge fuss if we forced
the issue but ate normally at home.
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• Support, not anger• Need to work out WHAT are they
trying to tell us• Draw and talk• Play therapy
Food Refusal – How to Help
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Highly resistant to eating & drinking Food
Ph
ob
ia
Tend to be frightened of:• Choking• Gagging• Vomiting
May say eating hurts
Mealtimes become a battleground
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Ever since she’d choked on a piece
of chicken, she was refusing any solid
food in case it happened again.
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• Need treatment for PHOBIA not eating disorder
• Small steps – okay to return to purée• Teach calming techniques
Food Phobia – How to Help
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No fear of weight gainFo
od A
void
ance
Em
otion
al D
isor
der
General behaviour disturbance: • Sleep problems• Poor concentration• Tearfulness• Hopelessness
Associated with depression and anxiety
May isolate themselves / avoid school
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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.
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• 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
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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
asi
ve
Refu
sal
Syn
dro
me
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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.
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• 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
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Need more support?
Dr Pooky Knightsmith specialises in mental health and emotional well-being in the school setting. She can provide training sessions or workshops for school staff, parents or students on a variety of topics, including self-harm, anxiety, body image and eating disorders.
For further information and free resources visit www.inourhands.com
For details of CWMT funded sessions for staff, parents or students visitwww.inourhands.com/CWMT
Email: [email protected] Twitter: @PookyH LinkedIn: linkedin.com/in/pooky