When the topic of body image and eating disorders is brought to a person’s attention, more times than not the idea of a self-conscious, thin adolescent girl comes to mind. However, reports have shown that children are exhibiting signs of lowered impressions of their own body and the presence of eating disorders are increasing at a younger age (Mehlenbeck, 2007). Very little is known about the commonness of eating disorders in pre-pubertal girls and boys. However, eating disorder specialists and programs in the United States are reporting an increase in young children who need help with related eating problems. The problem with body dissatisfaction is causing an increase in disordered eating and weight loss in young children. “Recent studies have shown that 42 %of first-, second- and third-grade girls want to be thinner; that 40 % of almost 500 fourth-graders surveyed said they diet “very often” or “sometimes”; and that 46 percent of 9-year-olds and 81 percent of 10-year-olds admit to dieting, binge eating or fear of getting fat” (DeLeel, Hughes, Miller, Hipwell, & Theodore, 2009). Also, it has been reported that as early as the age of four and five that children are expressing the need to diet. It has been said the recent increase in children developing eating disorders may result from the family environment along with the message society gives about the importance of being thin.
There are two types of eating disorders which are noted as being used to control food intake and result in extreme weight loss, Anorexia Nervosa and Bulimia. “Anorexia is a condition in which a child refuses to eat adequate calories out of an intense and irrational fear of becoming fat” (Mehlenbeck, 2007). “Bulimia is a condition in which a child binge eats and then purges the food by vomiting or using laxatives to prevent weight gain” (Mehlenbeck, 2007). Diagnosing a child with an eating disorder is difficult at first because children rarely fit the DSM-IV criteria. “The DSM-IV criteria for Anorexia Nervosa include:
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Refusal to maintain body weight at or above a minimally normal weight for age and height or failure to make expected weight gain.
Fear of gaining weight
Body image distortion or undue influence of body shape on self-evaluation.
For post-pubertal women, amenorrhea (loss of menstruation) “(American Psychiatric Association, 2000).
This criterion is hard for specialists and doctors to diagnosis school aged children for many reasons. The first reason is the frequent growth spurts in both height and weight that pre-pubertal children exhibit during this time in their life. Therefore, it is hard to measure an expected weight for a child at this age because all children are different. Children who do not gain weight around this age, but do grow in height are not always a target for an eating disorder. This is the age which children are very active and participate in sports which may be the reason why they do not gain weight (Mehlenbeck, 2007).
The second and third diagnostic criteria present a problem when dealing with young children because they have a difficult time expressing fear of weight gain, body image distortion or the influence the shape of their body has on their self-evaluation (Mehlenbeck, 2007). Also, in young children the loss of menstruation does not come into play because many girls have not reached puberty. Therefore, diagnosing an eating disorder has become complicated for experts.
In addition to the problems with the diagnostic criteria from the DSM-IV, specialists and physicians are not adequately trained to look for eating disorders in children. Problems with eating focus on picky eaters and issues of slow weight gain based on the stage of development for younger children. Physicians seldom consider that a child who is not eating may be linked to a problem with body dissatisfaction (Truby & Paxton, 2002). It is more common to associate eating problems with the notion that the child is a picky eater rather than with them having an eating disorder.
Mehlenbeck discusses a specific case in which an 11 year old boy named Tim exhibits signs of an eating disorder in order to try to lose weight to get in shape for a sports team. His yearly physicals seemed to be fine, although at his 10 year old checkup, his physician noticed that he slowly had dropped a small amount of weight, but was not concerned. However, for his 11 year old check up, it was reported that he had dropped below the 5th percentile BMI for his age and his heart rate had drastically increased. His mother reported that he was always cold, irritable and rarely ate with the family. He denied having a weight focused problem but did admit that he noticed he could not play as well as he use to and that he believed that it was based on a slight weight gain. He was admitted inpatient to re-feeding and to address his medical condition. He was nutritionally and medically monitored at all times. His family practiced techniques which they learned in family based therapy. Tim’s 500-calorie a day diet had been described as a source of comfort for him. During the long process of therapy, Tim was able to rejoin the family in time and able to return to a healthy eating plan, although he was monitored continuously (Mehlenbeck, 2007). Tim’s diet gave him comfort because it allowed him to believe that he had control over his performance on the court by monitoring his food intake. It was comforting to him that he believed he was actively improving his game by controlling what he put into his body.
Tim’s case is just one example of a young child who is exhibiting eating problems. A study done on atypical eating in young children, however, linked bizarre eating behaviors and low weight in young children to a wide range of “critical familial psychosocial problems” (Jaffe & Singer 1989). This study focused on 8 pre-pubertal patients and discovered that each child had a significant associated psychopathology, which required treatment after discharge. They all refused to eat normal amounts of food and struggled with family about eating and weight gain. However, none exhibited a distorted body image or fear of fatness. This study believed that eating disorders may in fact be more common in children than ever thought of before hand, but they may be associated with family or social conflict (Jaffe & Singer 1989).
Children raised in a dysfunctional family are at higher risk for developing an eating disorder. A family life where there is physical or sexual abuse may result in a child turning to an eating disorder to gain a sense of control. Eating disorders are a child’s remedy. They help them deal with emotions and are especially prevalent in children who were raised in a home that did not allow feelings to be expressed. Research also shows that children are at a high risk for developing an eating disorder if their parents are preoccupied with appearance and weight. If parents (or siblings) are constantly dieting and expressing dislike towards their own bodies, the child will receive the message that appearance is the most important thing to be concerned about (Jaffe & Singer, 1989).
Society and the media also sends the message that being thin is the most important and necessary thing there is. Children are exposed to more at younger ages, therefore the media’s messages are influencing children during important developmental stages. Children have been constantly bombarded with stimuli from their environment telling them they need to be thin. Unfortunately, it is having aversive affects on children and their image of themselves.
Reports have shown that 80% of girls in grades 3 – 6 have bad feelings about their bodies (Kalish, 2004). This issue of body dissatisfaction diverts the young child’s attention way from school work and from social interactions with peers. Preteen boys also worry about how their build compares with others. They are focused on sports and with the muscular men they see on television and have been conditioned to believe that muscles are more important than what is on the inside.
“Believing that outward appearance is a reflection of inner quality, children with body image concerns develop a sense of who they are and how they should behave by internalizing messages about themselves from others” (Kalish, 2004). Children lacking self-esteem and who seek acceptance and approval are particularly sensitive and susceptible to the perceptions of parents, family, peers and the media. Body image concerns may be precursors to eating disorders. Even when they do not lead to clinical disease, however, they deserve attention so the child can learn to enjoy a healthful relationship with food (Kalish, 2004).
With that being said, it is important to be observant of an atypical eating style in a child as early as possible. Symptoms such as ritualized eating, significant weight loss, and food restriction do not necessarily, but can lead to “early onset anorexia” (Jaffe & Singer,1989). Other factors including social interactions as well as family stability should be taken into account. It is important for parents and family members to be aware of signs such as constantly missing dinner or pushing food around on a plate. The consequences of early onset anorexia include “bradycardia and orthostasis, potentially leading to heart failure” (Jaffe & Singer,1989). Children also experience muscle loss, dry hair and skin and gastrointestinal difficulties. Long-term complications include stunted growth, bone density loss, difficulties in bone formation, and a delay in puberty. Signs to look for due to malnutrition in a child include mood swings, lethargy, increased self-isolation and an obsession with food and/or exercise. Once these complications are observed and taken seriously, they can be reversed once an appropriate diet and exercise regiment is put together (Jaffe & Singer,1989).
The problem however is that treating a child with an eating disorder is very different than treating an adolescent. This is because treating an adolescent who has an eating disorder requires the parent to be removed from the equation. However, a lot of eating problems in children stem from problems which may occur within the home, so family based therapy is suggested. Using the same treatment technique on a child that is used on an adolescent can be damaging because of the difference in developmental stage. An example of this is presented by Mehlenbeck of a 7 year- old girl who was isolated from her parents. Casey was admitted inpatient for an eating disorder. She was allowed contact with her parents for only one hour per evening if she was able to complete all her meals. When she was discharged to a day treatment program, Casey developed significant anxiety and was suffered from nightmares. She also became physically violent toward her mother. Her isolation from her parents created new fears of abandonment (Mehlenbeck, 2007). For this exact reason, family-based treatment has become the selected course of action to help children with eating disorders.
Dr. Shu, a pediatrician from Atlanta, tells Health and Wellness magazine that there are ways to lessen a child’s concerns about gaining weight. As a child gets older, is it typical that they will become increasingly aware of how their bodies compare to those of their friends, teens, adults that they see around them or even the figures in the media. Parents are urged to start at a young age by clarifying the concerns that a young child may be expressing about their body. Dr. Shu mentions that it is possible that the child is looking for a little reassurance that they are perfectly normal (Shu, 2007). This opportunity should be used to teach children that people have different body types and that being healthy is what is most important.
Dr. Shu further mentions that a parent should focus on their child’s strengths and the positives that their body can do. Examples to mention would be sports, dancing or artistic abilities (Shu, 2007). It is also important for a parent to encourage the child to eat healthy foods and to exercise regularly. It should be something which is discussed on a regular basis. Also, it is imperative to mention concerns a child may have about weight with the family pediatrician. The family doctor can asses the child’s height and weight and inform parents where the child stands comparatively with other children of their gender and age.
Parents need to set an example for their children. Children learn by what they observe. If they are observing a healthy environment which is not focused on a negative body image with an emphasis on dieting, then they will be likely to follow the model set in place for them. An eating disorder is a very serious problem and needs to be treated as early as possible. It is important, as mentioned earlier to have treatment which includes the family. This is because the child’s eating disorder may be based on a problem which is deep seeded with in the family dynamics and also because of the child’s age. It is the initial approach to any problem with body image or eating disorder which is crucial for a person to recover and create a positive relationship with themselves and with food.
