Eating disorders usually develop during adolescence. But some young people develop eating disorders even earlier, before the age of 14. These are known as early-onset, or prepubescent, eating disorders.
Early-onset eating disorders are rare, but they are very serious. Weight loss in early-onset anorexia nervosa is often more severe and quicker than in adolescent-onset anorexia. Early-onset eating disorders are also linked to co-occurring disorders, such as depressive disorders, even among young children.
Like any person with an eating problem, children under 12 with early-onset eating disorders should receive professional support as soon as possible. Early interventions are associated with better outcomes, and treatment approaches have been adapted by researchers and professionals to effectively support young children.
Understanding Eating Disorders in Under-12s
While eating disorders in young children are still relatively rare, some evidence suggests they are rapidly increasing. An Australian study from 2022 found that between 2016 and 2018, the estimated prevalence was 2.9 in 100,000, almost twice as much as in 2009.
Children under 12 can experience all types of eating disorders. But eating disorders involving restrictive eating, like anorexia nervosa or ARFID, seem to be most common. Eating disorders in young children are sometimes connected to underlying emotional patterns such as emotional dysregulation.
Some of the most common eating disorders in prepubescent children are:
- Anorexia nervosa, when a child severely restricts their energy intake and is preoccupied with their body shape or weight
- Avoidant/restrictive food intake disorder, when a child avoids certain food groups or eats very little food in general because of anxiety, sensory sensitivity, or other reasons
- Eating disorder not otherwise specified (EDNOS), such as loss of control eating
Eating disorders in children under 12 often look a bit different to adolescent eating disorders. For example, early-onset anorexia is more likely to be connected to teasing, harassment, and critical comments than adolescent anorexia. It’s also associated with more rapid weight loss and a greater refusal of food.
Under 12s with anorexia may be less likely to verbally express concerns about shape and weight in the early stages of the disorder. Like adolescents with anorexia, they often experience rigid thinking. But perfectionism and low self-esteem are less common.
While binge eating is common in children aged 6- 12, few children meet the diagnostic criteria for binge eating disorder. Instead, children with loss-of-control eating or binge eating episodes may be diagnosed with an eating disorder not otherwise specified. As with adolescent binge eating, binge eating in 6 to 12-year-olds often comes with emotional distress and disordered eating behaviours.
What Causes Eating Disorders in Under-12s?
Many different reasons eating problems can develop in young children, and not all have to do with body shape and weight.
Some eating disorders originate in a child’s very early years, shortly after their birth, when choices are made between breast-feeding and bottle-feeding. Early feeding difficulties can appear, creating an anxiety response in both mother and baby. This can affect the way a baby is weaned and how their eating behaviours develop.
Other children encounter problems with food early on in school. It might be related to having to eat foods they don’t like, such as being forced to take fruit or vegetables as a school snack. Or they may have had an incident of choking or vomiting after eating.
These experiences can affect their brains’ response to future attempts to introduce a new food or to reintroduce the same food. They may experience intense anxiety and distress about trying a new food or about eating in general. This can make it feel hard or even impossible to eat certain foods.
These early experiences with food essentially create a trauma response to certain kinds of eating. Like other traumatic events, the long-term impact of the trauma depends on the care and support a child receives following the incident. Sometimes, the way eating problems are handled – inside or outside the home environment – can cause trauma-associated anxiety to persist in the long term.
Bullying is another common experience that can lead to the development of eating disorders at a young age. Bullying, teasing, and peer criticism, which may or may not be related to food and eating or body weight and size, can leave a child feeling unaccepted on the inside or outside. They may start using disordered eating behaviours to try and cope with these feelings and distress. Research suggests that interpersonal difficulties play an essential role in the development of anorexia and other eating disorders.
Family conflicts and trauma, such as parental separation and divorce, can also make a child feel like they have to work hard to be accepted. With so many aspects of life seeming outside their control, they may feel more valuable if they can control their eating behaviours or body shape and size.
Young children may also be affected by their families’ or society’s issues around food and body size. Families may have strong ideas about health and fitness and what that means. This means that young children growing up may be exposed to ideas that are difficult to manage.
What Does Eating Disorder Treatment for Under 12s Involve?
Eating disorder treatment for children under 12 depends on the type of disorder and each child’s unique experience with the illness. Some children with more severe eating disorders may require inpatient care, while others can recover at home with outpatient support. Families typically play a crucial role in children’s recovery, collaborating with therapists to provide adequate support and compassionate care.
Of course, treatments need to be adapted to be suitable for young children. Therapists may use techniques such as drawing or role-playing to help younger children express their thoughts and feelings and learn in creative ways.
Family involvement in treatment is also fundamental for children under 12. This includes teaching parents how to model positive food behaviours at home, and parenting styles and techniques that encourage positive eating habits. It might also involve identifying and addressing unhelpful family dynamics that help to maintain eating disorders and learning how families can best support a child’s recovery.
Treatment for Early-Onset Anorexia Nervosa
Treatment for early-onset anorexia involves medical treatment to restore physical health, alongside therapeutic care that promotes long-term mental and physical recovery from the disorder. Children need to regain weight and nutritional balance as soon as possible to allow for healthy emotional and physical development, especially as they approach puberty.
However, weight restoration alone is not a measure of recovery from eating disorders. Effective treatment addresses the underlying thoughts, emotions, and experiences that cause disordered eating behaviours. This might be interpersonal difficulties, experiences of bullying, trauma, and ways of thinking.
Family involvement is fundamental to treatment for under-12s. Standard treatment approaches, such as family-based treatment, support parents in managing their child’s eating and creating a positive food environment at home. Treatment begins by giving parents complete control over their child’s eating habits, before gradually giving back independence that’s appropriate for their age.
Therapists may also work with families to respond to their child’s illness in a way that supports their recovery, by avoiding criticism, affirming positive change, and approaching their child with warmth and compassion.
Treatment for ARFID in Young Children
The kind of treatment a young child with ARFID will receive depends on the cause of their avoidance or restriction of food. When anxiety around food underpins their eating behaviours, treatments like cognitive-behavioural therapy can support children to address the root of their anxiety and slowly become more comfortable with eating more foods.
Therapists may support children in gradually encountering a new food in a safe environment, first by looking at it, and later by touching it. With time, they can begin to reintroduce it into their everyday life. Parents can also play an essential role in overcoming food-related anxiety.
The Wave Clinic: Specialist Recovery Programs for Young People
The Wave Clinic offers specialist mental health support for children, young people, and families living with eating disorders and other mental health concerns. We’re a Global Centre of Excellence for the treatment of eating disorders, offering a diverse selection of evidence-based modules through residential and outpatient programs.
Our programs are family-centred, including intensive weeks of family therapy to support a young person’s recovery. Our treatment spaces are open to any child or young person experiencing an eating problem, regardless of the body they live in or their symptoms.
If you’re interested in learning more about our programs, please contact us today.
