Guide: Children eating habits, attitudes and behaviours

Eating disorders are not only a concern for adolescents and adults, but they can also affect children as well. Doctors and psychologists have treated children as young as the age of 5 years old for eating disorders. This is concerning because a child at this age needs to make sure that they are eating properly to maintain proper growth and development. Any small amount of weight loss in relation to food refusal can lead to early symptoms of an eating disorder diagnoses. If not discovered quickly the results can result in more serious health issues later on.

According to Eating Disorders Org, Researchers say that 20-25% of children that suffer from eating disorders are boys. Parents and any influential figure that is involved in a child's life are shown to have the biggest influence on this. A positive role model in a child's life will go a long way.

Doctors are unsure of what is the root cause of an eating disorder. A combination of social, behavioral, and biological factors can all play a role in developing an emotional or psychological issue which can eventually lead to an eating disorder. The disorder does not come from the food itself. You must be careful not to confuse a child who refuses to eat or is a picky eater for a child with an eating disorder. Children who are at risk of an eating disorder will usually struggle with one or more of these problems:
 

• Fear of becoming overweight

• Distress

• Low self-esteem

• Depression

• Anxiety

• Bullying

There are 3 types of eating disorders that can affect an individual. Anorexia is the most common eating disorder that affects children. The other two disorders, bulimia and binge eating, are more prevalent in adolescents and adults. 

This disorder usually stems out of fear of gaining weight and an unrealistic perception of body image. A child who is bullied or may witness others get bullied for their weight may lead to the disorder. The child will greatly limit the food they eat and view themselves as overweight when they are clearly underweight. Anorexia can lead to brain damage, bone loss, and other serious health effects if left untreated. 

Bulimia Nervosa is characterized by bouts of binge eating followed by either forced vomiting or excessive exercise. Individuals who are already unhappy with their body image are driven by a fear of more weight gain which then leads to the expulsion of any calories that have been consumed, either by purging or over excercising. The purging and over-exercising can lead to serious health effects such as gastrointestinal problems, severe dehydration, and heart issues. 

Binge eating disorder is when someone loses control of their eating but it is not followed by compensatory behaviors like purging, excessing exercising of fasting. Many people suffer guilt-related symptoms from their behavior which progresses the disorder even more. Many sufferers may be obese or risk developing other conditions like cardiovascular disease.

These disorders are usually seen in adolescents and adults but the disorder may originate in childhood. The three diagnoses that are used for a child that may be suffering from an eating disorder are:
 

• Avoidant/Restrictive Food Intake Disorder (ARFID)- When a child shows a lack of interest in food out of fear or a negative experience ( choking, vomiting, etc)

• Eating Disorder Not Elsewhere Classified (EDNEG)- an Irregular eating habit that does not fit the criteria of Anorexia, Bulimia, and Binge Eating classification

• Anorexia Nervosa (AN)- Most commonly seen eating disorder in children. 

CEBQ or Child Eating Behaviour Questionnaire was created for parents to evaluate a child's eating habits. It is made up of a series of 8 scales and each question is rated using a 5 point scale ranging from "never" to "always". 

Reflects eating with social cues.." Does my child eat when it is time to eat?"

Eating significantly more due to an emotional issue.

Rates on how much your child enjoys food

Does your child need to carry a drink around with them at all times, especially the sugar-sweetened ones.

When a child can refuse more food after already eating

Usually is caused by a lack of enjoyment or interest in eating

Eating significantly less in response to an emotional issue.

Rejection of food a child usually enjoys or any new foods that may be introduced.

The Children's Eating Attitude Test or (ChEAT)  is one of the more widely used tests to measure symptoms and concerns of eating disorders. The test is given to the child to complete. It is made up of 26 questions that are based on perceived body image, obsessions/preoccupation with food and dieting practices. Each question is rated on a 6 point scale. It is comprehensible enough that an 8-year-old can complete this test. It takes about 30 minutes to complete.

This questionnaire is used internationally and is helpful in identifying any abnormal eating issues. The results from the questionnaire will not yield a specific result or diagnosis, but it is a particularly useful tool that can assess a possible risk for an eating disorder. As with any test, honesty is key. That is why the combination of the results of this test and of any collateral information obtained from the child, their parents, and the child's BMI will help in making a more accurate diagnosis.

There are a number of ways that not only parents but also teachers, older siblings, and other influential adults in a child's life can affect their perception of food.
 

• Don't label foods as "good" or "bad". This can lead to feelings of guilt and shame especially when bad foods are eaten

• Don't use food as a bribe or a form of punishment

• Encourage self-acceptance

• Teach them that weight gain is normal

• Understand the difference in eating habits between children and adults. Their taste for certain foods will change often and they also may eat more frequently during periods of growth.

• Teach them the importance of not placing too much value on one's physical appearance. It is what's inside that counts.

• Lead by example. Children are sponges and watch and copy everything that you do. So you yourself don't skip meals or enforce diets on children.

• Don't tease or criticize other children.

• Help your children to understand that they don't need to look like the images that they see on t.v. or in magazines. Teach them the acceptance of different body shapes and sizes, especially their own.

Parents need to be involved in all aspects of a child's daily nutrition, both at home and at school. Make sure to plan your meals and keep in mind foods that your child may enjoy. Involve them in not only picking the meals but also in planning and preparing the meal as well. This is a win-win, because not only are they interested in what they will be eating, but it is also quality time spent with your child. Introduce new foods slowly. Don't get discouraged or upset if they don't like it as long as they try it.

I have one rule in my house when it comes to eating. "You can't say you don't like it If you don't try it". My children need to try everything at least once. If you try it and don't like it, I can accept it. It is amazing to see that when they actually try it and may end up liking it. Make mealtimes a fun time for you and your child. Teach them the importance of the basic food groups and how they help them grow, this knowledge will last them a life time.

References:

MIDSS is one website where you can get a copy of the CEBQ or Child Eating Behaviour Questionnaire.
Eating Disorders in Children
chEAT Test