Early Onset Eating Disorders

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Eating disorders usually begin during adolescence, often at the start of a young person’s teenage years. However, in some cases, eating disorders can begin earlier in children as young as 8, 9 or 10. Known as early-onset eating disorders, young children’s eating problems are often similar to those experienced by older adolescents, underpinned by concerns about shape and weight and attempts to cope with difficult emotions.

Many parents don’t expect younger children to develop eating disorders and can often miss the warning signs. They may explain away disordered eating behaviours as something else, rather than seeking medical support. For children with eating disorders, getting professional help is the most important thing. While early-onset eating disorders can feel scary, with effective treatment young people can recover and reclaim a childhood of fulfilling experiences and positive growth.

This blog offers some information about how eating disorders affect young children and their health and well-being. It also explores how parents’ relationships with food may influence their children’s eating behaviours and how children feel about their bodies and themselves.

What Are Early-Onset Eating Disorders?

Early-onset eating disorders are eating disorders that begin before the age of 14. 

It’s normal for children to experience some changes in the way that they eat. They may not want to eat certain foods or find they have a larger or smaller appetite than usual. Eating problems develop when these thoughts, feelings, and behaviours start to affect a child’s well-being and impact their daily life.

Eating problems in young children may involve using food to cope with their emotions or avoiding food when they’re feeling bad. They may start only eating a very narrow range of foods and refuse food even when they’re hungry. Young children can also feel worried about their body shape and weight: they may be afraid of gaining weight or perceive their body differently from other people.

Like older adolescents, younger children can have different types of eating disorders. The most common are:

  • Anorexia nervosa, when children place a lot of importance on their shape and weight and restrict the food that they eat
  • Avoidant/restrictive food intake disorder (ARFID), a new diagnosis that encompasses different eating problems that aren’t related to shape or weight. These may include:
    • Selective eating, when children refuse to eat or only eat a very narrow range of foods
    • Food avoidance emotional disorder, when difficult emotions like sadness or anxiety cause children to avoid food

Younger children may also experience bulimia nervosa, but this is less usual than among adolescents and young adults.

Early-onset eating disorders are serious conditions which, if untreated, can have potentially life-threatening consequences. An Australian study found that children were on average unwell for 8 months before diagnosis and 64% required hospital admission.

If a young person shows signs of disordered eating, it’s important to reach out for medical support immediately. Professional treatment programs can support children of all ages to safely recover from eating disorders, and the earlier they receive treatment, the better. Recognising the problem early can prevent short and long-term physical and mental health problems that come alongside eating disorders and make the journey to recovery shorter and easier.

How Common are Eating Disorders in Younger Children?

Diagnoses of eating disorders in children aged 13 or younger are relatively rare. Research has found that:

  • In Canada, 2.6 in every 100,000 children aged 5-12 were diagnosed with a restrictive eating disorder by a paediatrician (2011)
  • In Australia, 1.4 in every 100,000 children aged 5-13 received a diagnosis (2009)
  • In the UK,  the overall incident rate was 1.1 in every 100,000 children aged 5-12 (2011)

However, while early-onset eating disorders are still uncommon, some evidence suggests that they are rapidly increasing. An Australian study published in 2022 found that between 2016 and 2018, the estimated prevalence was 2.9 in 100,000 – almost double the 2009 figure.

The study also found that:

  • 45% of the children with a diagnosis were boys
  • 76% had a fear of gaining weight
  • 73% had a preoccupation with body weight
  • 63% had a misconception about their body size
  • 78% met the DSM-5 criteria for anorexia nervosa

How Do Early-Onset Eating Disorders Affect Other Mental Health Conditions?

Children with early-onset eating disorders may be more likely to develop other mental health conditions such as depression. Eating too little food affects our ability to produce balanced hormones that make us feel good and keep our emotions stable. Children may feel exhausted, frustrated, lack motivation, and find it hard to maintain friendships and relationships with other people.

One study found that ⅓ of children with early onset anorexia also had a depressive disorder. In most of these cases, symptoms of depression started after the beginning of their eating disorder. Mental health conditions like depression can also sustain eating disorders when young people use food to cope with their difficult emotions.

How Can Diet Culture and Rules at Home Affect Younger Children’s Relationship with Food?

Children are deeply affected by the world around them. They learn from how other people act around them, mimicking words, and behaviours, and developing similar attitudes. The way that other people treat themselves and others also affects the way that children perceive and value themselves. Children begin to notice, copy, and interpret behaviours from a very young age, often without expressing what’s happening in words.

While parents are never responsible for a young person’s eating disorder, the way that parents approach food can impact how children feel about eating and the importance of shape and weight. When parents follow strict rules about food – or create rules for the family – it may cause children to experience similar anxiety about eating, expressed as food avoidance or selective eating. Talk of diet culture, weight, and body shape, can encourage children to think that their shape and weight are an important part of their value, something that’s a key part of the pathology of several eating disorders.

While studies connecting food rules at home to early-onset eating disorders are limited, some research has explored the link between eating disorders in mothers and their children. One study found that 12.9% of mothers of children with early-onset anorexia, and 33.3% of mothers of children with food avoidance emotional disorder, had a previous diagnosis of an eating disorder. This compares to an average prevalence rate of 5%.

While adults with a history of eating disorders can still be great parents, they may sometimes require extra support to create a home environment that encourages healthy relationships with food, shape, and weight. Mental health and eating disorder specialists can help parents understand behaviours that may affect the way their child views food, themselves, and their bodies and learn how to identify, manage, and overcome behaviours that may be harmful.

For children in treatment for eating disorders, family therapy, and parent interventions can play an important part in the recovery programs. Eating disorders are never the fault of parents, but certain behaviours may help to sustain eating problems and make recovery more difficult.

Family intervention programs can help to create a food culture and eating habits that support a child’s recovery and lay the foundations for a lasting, positive relationship with food. They also aim to improve emotional communication and negotiation within families, promoting environments that allow flexibility and autonomy for each individual and their choices.

Treating Early-Onset Eating Disorders

Early-onset eating disorders are serious conditions that can feel scary for both young people and their families. The good news is that eating disorders are treatable and, with the right support, children can recover and reclaim a future full of possibilities. 

There are several evidence-based treatment methods proven to help young people overcome disordered eating and address the underlying causes of their behaviours. Some of these treatment approaches include:

  • Cognitive-behavioural therapy
  • Interpersonal therapy
  • Alternative therapies like art and music therapy
  • Nutritional programmes
  • Family therapy

Children with eating disorders may require varying levels of care depending on the severity of their condition. Some children may need intensive care or hospitalisation during the first stages of their treatment, while others may benefit from residential or outpatient care. Psychologists, medics, and other health professionals can assess and determine the best treatment plan for each young person.

The Wave Clinic: Making a Difference in the Lives of Young People

The Wave Clinic is a specialist mental health treatment centre in Malaysia, supporting young people from around the world to build fulfilling and optimistic futures. Our whole-person approach combines exceptional medical and clinical care with education, social responsibility, and a gap year experience, helping young people reconnect with their dreams and develop the skills they need to follow them. We focus on full recovery and positive growth, working with children, teenagers, and adolescents to regain their confidence, self-esteem, and self-love.

The Wave is a Global Centre of Excellence for the treatment of eating disorders, bringing together experts in young people’s mental health from all over the globe. We’re here to make sure every young person is safe and supported by a team of professionals in every moment of their stay.

If you would like to find out more about our programs or start the admissions process, contact us today. We’re here for you.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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