Many parents are familiar with children who are picky eaters. In fact, for babies, this is often a normal eating behavior. As children age, they start to develop their own personal food preferences. However, as children grow older an overly selective eating behavior could be a sign of deeper health concerns. Many people are not aware that eating disorders are the third most common chronic illness in adolescents according to the American Academy of Pediatrics (AAP). Since the 1950s, there has been a steady increase in the incidence and prevalence of anorexia nervosa, bulimia nervosa as well as other eating disorders in both children and adolescents.
Data from the National Institute of Mental Health (NIMH) estimates that out of 800 public high school students, approximately 20-22 students will be impacted by eating disorders and even more will experience subclinical (not detectable) symptoms of the disease. Adolescents who have suffered from eating disorders are more likely to experience medical co-morbidities such as depression, anxiety, substance abuse and suicide.
During a person’s adolescence is when many of these diseases first occur. Adolescence is a time in people’s life when a great deal of change is occurring. Body changes, confusion, social anxiety only accelerate feelings of self-consciousness and low self-esteem. The onset of eating disorders often appears during this period, but these diseases can develop at a later time in a person’s life.
Not all of these eating disorders directly develop due to body image issues. Among children, they may struggle to eat certain foods because they feel physically nauseous. This can create a lack of appetite for food, which will make it more difficult to eat. A fear of vomiting or choking makes a child avoid certain foods, which can gradually become more restrictive over time. According to the National Eating Disorder Association, this restrictive eating behavior is a possible sign of what was previously identified as selective eating disorder, but is now referred to as ARFID or Avoidant Restrictive Food Intake Disorder.
ARFID is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of fatness. Although many children go through phases of picky or selective eating, a person with ARFID does not consume enough calories to grow and develop properly. In children, this results in stalled weight gain and vertical growth. ARFID can also result in problems at school, due to difficulties eating with others and extended times needed to eat. As with all eating disorders, the risk factors for ARFID involve a range of biological, psychological, and sociocultural issues. These factors may interact differently with different people, which means two individuals with the same eating disorder can have very diverse perspectives, experiences, and symptoms.
Eating disturbances are considered problematic when it causes the child to become upset or worry and when he or she is not eating enough to sustain proper nutrition and facilitate proper growth. Complications around eating can take many forms including but not limited to:
- Trouble with food textures/sensory issues
- Temper tantrums during meals
- Refusing to eat
- Limiting food groups
- Choking, gagging, or vomiting after eating
- Body image concerns
Due to the concern over the growth of eating disorders among children and adolescents, the Centers for Disease Control and Prevention (CDC) has researched this modern health concern. The CDC made the following recommendations during their 2008 national initiative. Their screening of high school students for eating disorders found that almost 15% of girls and 4% of boys scored at or above the threshold of 20 on the EAT-26, which indicated the possible existence of an eating disorder. The CDC recommended regular health screenings for high school students in order to identify at-risk students who could benefit from early intervention. Early identification and treatment of disordered eating and weight control behaviors can prevent progression of the disease and reduce the overall chronic health risk. To complicate matters, pedestrians have pointed out that some obesity prevention efforts may actually encourage the development of an eating disorder. The majority of adolescents who develop these disorders were not previously obese, but some teenagers, in a mistaken attempt to lose weight, can develop an eating disorder.
For additional information about childhood and adolescent eating disorders, please contact River Centre Clinic. Their Childhood Eating Problems Program director is Anna Lippisch, MSW, LSW. She can be reached at 419-885-8800 or by email. The EAT-26 (Eating Attitudes Test) assessment provides anonymous and instant feedback for a variety of eating-related health conditions.
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Childhood eating problems, Adolescents eating disorders, ARFID