Eating Difficulties

What you might see or what a young person might report

• Faddy or fussy eating; only eating a limited repertoire of foods (certain colours, textures, temperatures)
• Wanting to or trying to diet by ‘eating healthily’ or following eating regimes, such as ‘clean eating’, ‘raw food’, ‘vegan’
• Taking a more active interest in food, meal preparation, e.g. checking food labels or packaging
• Taking a more active interest in fitness/ health or wellbeing
• Increase in activity/ exercise
• Talk about body dissatisfaction/ worrying about appearance
• Comparing themselves to other people
• Feeling anxious about eating in public/ in front of others
• Young people with Type 1 diabetes may become more inconsistent with insulin and diabetes is less well managed (this should be checked with a medical team as a matter of priority)
• No longer eating foods they previously enjoyed

Things to try, support and next steps

• Be aware of any changes in eating behaviour as this is often seen before any physical signs.
• This may include:

If someone is developing an eating disorder, often changes in behaviour are noticeable before changes to physical appearance. Signs include:

• Saying they have eaten earlier or will eat later, or that they have eaten more than they have
• Not being truthful about how much weight they have lost
• Strict dieting and avoiding food they think is fattening
• Counting the calories in food excessively
• Eating only low-calorie food, or otherwise limiting the type of food they will eat
• Missing meals (fasting)
• Avoiding eating with other people
• Hiding food
• Binge eating
• Cutting food into tiny pieces to make it less obvious they have eaten little or to make food easier to swallow
• Eating very slowly
• Taking appetite suppressants, such as slimming or diet pills
• Obsessive and/or rigid behaviour, particularly around food
• Irritability
• Excessive exercising – this might involve exercising when not physically well enough to do so, or feeling guilty or anxious about not exercising
• Vomiting or misusing laxatives (purging)
• Social withdrawal and isolation 
• Wearing baggy clothing to hide their body, due to self-consciousness or to make weight loss less noticeable
• It is important that young people eat regularly so insist upon breakfast, lunch and dinner plus snacks
• Encourage a balanced diet; with all food groups included (carbohydrates, protein, fats, vegetables and fruits, dairy/ dairy alternatives ). It’s ok to have snacks and treats
• Ensure young people drink plenty throughout the day; aim for 6-8 glasses per day (water, milk). Avoid sugary drinks.
• Be active with your young person so that you can monitor and ensure they are exercising in a way that is appropriate
• If you are concerned about your child’s eating:

See your GP (ask for physical health observations to be done- height, weight, blood pressure, pulse)

Inform your child’s school to share concerns and ask if they have noticed any other concerns

• Monitor and restrict the use of apps/ gadgets that track exercise and food e.g., My Fitness Pal and Fitbit watches
• Encourage team sports and activities rather than solitary sporting or fitness activities. Ensure food and fluids are had before and after exercise.
• Monitor use of social media and ensure only positive accounts are being followed/ accessed
• Discourage talking about body concerns, weight or food/ eating habits with others

Useful resources:

• For fussy/ faddy eating : Food Refusal and Avoidant Eating in Children; A Practical Guide for Parents and Professionals
• The Self-Esteem Workbook by Lisa Schab
• Banish Your Self-Esteem Thief by Kate Collins-Donnelly
• Banish Your Body-Image Thief by Kate Collins- Donnelly
• Beat (eating disorder charity): https://www.beateatingdisorders.org.uk/

What you might see or what a young person might report

• A committed and persistent effort to lose weight or control weight or shape through:

Dieting/ restricting food intake

Exercising/ increased activity

Purging (self-induced vomiting)

Taking laxatives

Or

Eating excessive amounts/ bingeing/ constantly seeking food; gaining weight

Behavioural signs can include:

• Saying they have eaten earlier or will eat later, or that they have eaten more than they have
• Not being truthful about how much weight they have lost
• Strict dieting and avoiding food they think is fattening
• Counting the calories in food excessively
• Eating only low-calorie food, or otherwise limiting the type of food they will eat
• Missing meals (fasting)
• Avoiding eating with other people
• Hiding food
• Binge eating
• Cutting food into tiny pieces to make it less obvious they have eaten little or to make food easier to swallow
• Eating very slowly
• Taking appetite suppressants, such as slimming or diet pills
• Obsessive and/or rigid behaviour, particularly around food
• Irritability
• Excessive exercising – this might involve exercising when not physically well enough to do so, or feeling guilty or anxious about not exercising
• Vomiting or misusing laxatives (purging)
• Social withdrawal and isolation 
• Wearing baggy clothing to hide their body, due to self-consciousness or to make weight loss less noticeable
• Experiencing upset or distress/ feeling of guilt or shame after eating
• Dissatisfaction about body image
• More emotionally labile/ more sensitive (upset, irritable, withdrawn) especially when boundaries are put in around food or exercise
• More argumentative (especially around food or mealtimes)
• More controlling or rigid around food/ mealtimes and other areas of life
• Preoccupied/ overly concerned/ interested by food (e.g., counting calories)
• May show some signs of physical compromise e.g., gradual weight loss, tired/ lethargic, difficulties concentrating, not seeming usual self, feeling cold
• Other areas of life might be a struggle e.g., academic work, friendships, engaging in family life

Things to try, support and next steps

• Ensure that the young person eats regularly. Eat together as much as possible. Make sure that 3 meals plus snacks are provided and eaten.
• Make sure that all food groups (carbohydrates, protein, vegetables and fruits, dairy/ dairy alternatives ) are in the general diet, plus it’s ok to have snacks
• Ensure young people drink plenty; aim for 6-8 glasses per day (water, milk, avoid sugary drinks)
• Calm support during mealtimes.
• Support your young person to access self-help resources including:

YP section- eating difficulties, anxiety, depression (see downloads)

Podcasts and Videos Section on www.hampshirecamhs.nhs.uk

• Watch our parent/ carer workshop on:

How to support a young person with an eating difficulty here: https://youtu.be/-ApfAzKOy60

How to support a young person with anxiety: https://youtu.be/LMFQHABnH1M

How to support a young person with depression/ in crisis/ who engages in self-harm: https://youtu.be/qBAZQVjSmQU

• Share concerns with your child’s school/ college
• See your child’s GP; ask for physical observations to be taken (including; height, weight, temperature, blood pressure, pulse and request a blood test)
• Inform and access pastoral support from school
• Monitor and restrict use of apps or gadgets that track exercise and food e.g., My Fitness Pal and Fitbit watches
• Monitor use of social media and ensure only positive accounts are being followed/ accessed

Other Useful resources:

• For fussy/ faddy eating : Food Refusal and Avoidant Eating in Children; A Practical Guide for Parents and Professionals
• What’s Eating you? A Workbook for Teens with Eating Disorders by Tammy Nelson
• The Self-Esteem Workbook by Lisa Schab
• Banish Your Self-Esteem Thief by Kate Collins-Donnelly
• Banish Your Body-Image Thief by Kate Collins- Donnelly
• Beat (eating disorder charity): https://www.beateatingdisorders.org.uk/

What you might see, or what a young person might report

Emergency symptoms – seek immediate medical advice

• Sudden or rapid weight loss
• Fainting/ collapse
• Drowsiness
• Refusing food or drink for more than 24 hours
• Chest pains
• Concerns about daily vomiting
• Significant restriction of food (and fluid) leading to rapid weight loss. This is a concern for both young people that lose weight and become underweight as well as young people who perhaps are overweight then lose weight and appear a healthy weight. It is the speed of weight loss not necessarily just their weight that is a concern.
• Young person may avoid eating; excuses such as ‘have already eaten’, ‘not hungry’, ‘don’t feel well’
• Distress prior to, during or after meals. You might notice your young person may want to prepare their own food or eat alone
• Preoccupation with food/ eating/ weight or shape or having rituals around eating/ preparing food such as weighing food, eating with certain crockery/ cutlery
• Unusual eating behaviour such as unusual combinations of food or cutting up food into very small pieces/ eating very slowly
• Hiding or throwing food away
• Weight control behaviour including; exercise/ increased activity, laxative/ diuretic misuse, self-induced vomiting
• Young people with Type 1 diabetes may become more inconsistent with insulin and diabetes less well managed
• Reluctance, avoidance or secrecy of the young person to talk about eating; lack of recognition of concern that others may have or minimising the extent of difficulties
• More withdrawn/ lethargic or tired
• Feeling physical unwell; dizzy, light-headed, chest pains, fainting, stomach pains, constipation, coldness
• Symptoms of vomiting including bad breath and swollen or puffy face; poor dental health
• More emotionally labile/ more sensitive (upset, irritable, withdrawn) especially when boundaries are put in around food or exercise
• More argumentative (especially around food or mealtimes), may become aggressive and violent#
• May hide body under baggy clothing
• Either becomes preoccupied by checking themselves in the mirror and weighing or avoids mirrors altogether
• Frequent trips to the bathroom especially after meals
• For girls: periods stop (they make stop asking for feminine hygiene products)

Things to try, support and next steps

• Share concerns with your child’s school/ college
• See your child’s GP; ask for physical observations to be taken (including; height, weight, temperature, blood pressure, pulse and request a blood test)
• Important that all young people eat regularly so insisting upon breakfast, lunch and dinner plus snacks. Support and supervise meals and snacks. If a young person has severely restricted their food and fluid, you must seek advice from a medical professional about restarting eating and drinking as this needs to be done with careful monitoring of physical health.
• Ensure diet is balanced with all food groups (carbohydrates, protein, vegetables and fruits, dairy/ dairy alternatives ) plus it’s ok to have snacks
• Ensure young people are well hydrated; aim for 6-8 glasses per day (water, milk, avoid sugary drinks)
• Support your young person to access self-help resources including:

YP section- eating difficulties, anxiety, depression (see downloads)

Podcasts and Videos Section on www.hampshirecamhs.nhs.uk

• Inform and access pastoral support from school
• Monitor and restrict use of apps/ gadgets that track exercise and food e.g., My Fitness Pal or Fitbit watches
• Monitor use of social media and ensure only positive accounts are being followed/ accessed

Other Useful resources:

• For fussy/ faddy eating : Food Refusal and Avoidant Eating in Children; A Practical Guide for Parents and Professionals
• Skills based Learning for caring for a Loved One with an Eating Disorder by Janet Treasure, Grainne Smith and Anna Crane
• Anorexia and Other Eating Disorders; How to help Your Child Eat Well and Be Well by Eva Musby
• When your teen has an eating disorder by Lauren Muheim
• The Self-Esteem Workbook by Lisa Schab
• Banish Your Self-Esteem Thief by Kate Collins-Donnelly
• Banish Your Body-Image Thief by Kate Collins- Donnelly
• Beat (eating disorder charity): https://www.beateatingdisorders.org.uk/

​​​​