My favourite food is Peperami.
Lasagne.
Pizza.
My favourite food is steak.
Spaghetti.
Oreos.
My favourite food is Cupcakes!
Don't like Celery.
I really don't like strawberries.
Onions.
Mushrooms.
Baked Beans.
I don't like Cauliflower, it's disgusting I guess.
Fussy eating is a relatively normal thing among children.
I often think of it a bit like wetting the bed,
all children wet the bed up to a certain age
and fussy eating is no different in that it's one of the tasks
of developmental learning is to learn to manage
food in your mouth, to learn to process textures,
and that can often manifest as fussy eating.
Food is a vehicle that children use to explore their environment
and to explore ideas around independence and control,
so because it's one of the ways that they interact
with their caregivers, it's also a way of expressing
frustration and anger and distrust and so on.
So you can also get periods of temporary fussy eating
when a child is upset or angry so it can be an
expression of emotion in that sense and also
of kind of learning to control the self and others.
So when we start to call something an eating disorder,
is when those feelings and eating behaviour have got tangled
up with each other to the extent that it's starting
to influence somebody's physical and emotional wellbeing.
So what happens in Anorexia Nervosa is somebody becomes
very intensely fearful of being fat and of weight gain,
and become quite determined to lose weight
in quite a deliberate way, so it's not a loss of appetite,
it's a determined losing of weight.
And obviously, that can become quite dangerous,
so the reason that people might know most about
Anorexia Nervosa is that unfortunately in some situations that
can become life-threatening, and require a young person to need
to be in hospital.
In Bulimia Nervosa, there are a lot of the similar
thoughts and feelings to when a young person has
Anorexia Nervosa. The difference is there's a tendency
in people with Bulimia Nervosa to overeat and
sometimes that can be exacerbated by emotions, so
if somebody's feeling particularly upset or angry that
may lead them to overeat more.
What happens in Bulimia Nervosa is there comes a time
when the overeating might be associated with feeling guilty,
feeling bad and feeling ashamed of your eating behaviour,
and that might lead a young person to decide that they
need to eliminate that food. And that can include forms of
purging, such as making yourself sick
but it might also include things like starving yourself
to compensate for the fact that you haven't eaten
or forcing yourself to do excessive amounts of exercise to
compensate for the fact that you feel that you've overeaten
and those feelings of shame and guilt are what drives that
vicious cycle between overeating and purging behaviours.
Binge Eating Disorder is what it sounds like,
it's Binge Eating behaviour
but without the purging and the compensatory behaviours.
It sort of follows on from Bulimia Nervosa
in that, it again describes behaviour in which
a young person, a child has lost control
over their eating behaviour.
ARFID, or Avoidant Restrictive Food Intake Disorder,
is different from the others in that it isn't associated with
thoughts and feelings about body weight and shape
in the same sort of way.
The 3 sort of main types that we talk about are
Avoidance of food for sensory reasons,
so this would be when fussy eating does start to veer into
becoming harmful.
So someone is so fussy that they are unable to eat in a
normal social situation or if they're unable to eat
enough of the types of foods that they need to for normal
brain development or for normal physical development,
that's when we would say that something has become,
when fussy eating has become a type of ARFID.
And when I say sensory reasons I mean things like the texture,
the smell, the taste, the colour, the packaging of food
might be what's making it difficult for a child or young person
to eat that particular type of food.
The other types of ARFID that have been described are
Phobic type of food avoidance, so for example
if somebody suddenly develops a fear of being sick as a result
of eating, or a fear of choking and that might be triggered
by some experience that they've had, so they may have some
sort of traumatic event, um and then they stop eating because
they become fearful of eating because of the consequences,
but those consequences are not about the impact on their
weight and their shape, that's another type of ARFID.
And then the third broad type are children who aren't really
aware of their appetite, don't really get the signals & cues to eat
so they become malnourished as a result of a lack of what we
call interoceptive awareness and knowing,
being able to read your bodily cues.
Most people think that change in weight is one of the key signs
of someone developing an eating disorder but actually
that's quite a late sign.
Because it often takes a little while for noticeable weight loss
and so the first thing a parent might notice is either
a child beginning to be self-conscious about their body,
in terms of the way they dress, avoiding mirrors; not wanting to
get changed in public - those sorts of things.
And of course, it's difficult to disentangle that from
the normal self-consciousness that adolescents develop about
their bodies as they change through puberty.
In terms of changes in eating behaviour, with Anorexia Nervosa,
what you might start to see is the kind of institution of some
rules about eating and rigidity about eating,
so only being prepared to eat certain types of foods,
at certain times, in certain ways, prepared in certain ways
with certain people and particularly avoidance of wanting,
wanting to isolate and cut off from social interaction
around eating. As it progresses you might start to notice things
like hiding food or in the case of Bulimia Nervosa you might
see you might find that large amounts of food have gone
missing but very much secretively so you might then
find that someone's been purging on a regular basis.
So if somebody's been for example eating happily at a meal
time but then always disappears to the loo afterwards
that might raise your suspicions particularly if it's associated
with negative self-talk about the self and the body.
And changes in mood. Changes in irritability, things that are
signs that things aren't OK emotionally.
Wanting to withdraw from interactions, wanting to withdraw
from your peer group. Those are the sorts of things that
you might think, that might make you think that something is not
right emotionally, and if it's coupled with changes in eating
behaviour and how somebody's behaving around their body
weight and shape, those are the sort of things that might make
you think "Is this person starting to develop an eating disorder?"
As a parent, one of the things you can most do is help people
think about their bodies in terms of what their bodies can DO
rather than what their bodies LOOK LIKE.