In the past few decades researchers have focused on eating disorders, the causes of these disorders and how the treatment of eating disorders. However, it has mainly been in the last decade that researchers have started looking at eating disorders in children, the reasons why these disorders are developing at such a young age, and the best recovery program for these young people. To understand this growing problem it is necessary to ask a few important questions:
- Is there a relationship between family context and parental input and eating disorders?
- What effect do mothers who suffer or have suffered from an eating disorder have on their children and specifically their daughters' eating patterns?
- What is the best way to treat children with eating disorders?
Types of Childhood Eating Disorders
In an article focusing on an overall description of eating disorders in children, by Bryant-Waugh and Lask (1995), they claim that in childhood there appears to be some variants on the two most common eating disorders found in adults, anorexia nervosa and bulimia nervosa. These disorders include selective eating, food avoidance emotional disorder, and pervasive refusal syndrome. Because so many of the children do not fit all of the requirements for anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified, they created a general definition which includes all eating disorders, "a disorder of childhood in which there is an excessive preoccupation with weight or shape, and/or food intake, and accompanied by grossly inadequate, irregular or chaotic food intake" (Byant-Waugh and Lask, 1995). Furthermore they created a more practical diagnostic criteria for childhood onset anorexia nervosa as: (a) determined food avoidance, (b) a failure to maintain the steady weight gain expected for age, or actual weight loss, and (c) overconcern with weight and shape. Other common features include self-induced vomiting, laxative abuse, excessive exercising, distorted body image, and morbid preoccupation with energy intake. Physical findings include dehydration, electrolyte imbalance, hypothermia, poor peripheral circulation and even circulatory failure, cardiac arrythmias, hepatic steatosis, and ovarian and uterine regression (Bryant-Waugh and Lask, 1995).
Causes and Predictors of Eating Disorders in Children
Eating disorders in children, like in adults, are generally viewed as a multi-determined syndrome with a variety of interacting factors, biological, psychological, familial and socio-cultural. It is important to recognize that each factor plays a role in predisposing, precipitating, or perpetuating the problem.
In a study by Marchi and Cohen (1990) maladaptive eating patterns were traced longitudinally in a large, random sample of children. They were interested in finding whether or not certain eating and digestive problems in early childhood were predictive of symptoms of bulimia nervosa and anorexia nervosa in adolescence. Six eating behaviors were assessed by maternal interview at ages 1 through 10, ages 9 through 18, and 2.5 years later when they were 12 through 20 years old. The behaviors measured included (1) meals unpleasant; (2) struggle over eating; (3) amount eaten; (4) picky eater; (5) speed of eating (6) interest in food. Also data on pica (eating dirt, laundry starch, paint, or other nonfood material), data on digestive problems, and food avoidance were measured.
The findings revealed that children showing problems in early childhood are definitely at an increased risk of showing parallel problems in later childhood and adolescence. An interesting finding was that pica in early childhood was related to elevated, extreme, and diagnosable problems of bulimia nervosa. Also, picky eating in early childhood was a predictive factor for bulimic symptoms in the 12-20 year olds. Digestive problems in early childhood were predictive of elevated symptoms of anorexia nervosa. Furthermore, diagnosable levels of anorexia and bulimia nervosa were presaged by elevated symptoms of these disorders 2 years earlier, suggesting an insidious onset and an opportunity for secondary prevention. This research would be even more helpful in predicting adolescent onset of eating disorders if they had traced the origins and development of these abnormal eating patterns in children and then further examined alternative contributors to these behaviors.
Family Context of Eating Disorders
There has been considerable speculation regarding familial contributors to the pathogenesis of anorexia nervosa. Sometimes family dysfunction has proved a popular area for consideration for eating disorders in children. Often times parents fail to encourage self-expression, and the family is based on a rigid homeostatic system, governed by strict rules that are challenged by the child's emerging adolescence.
A study by Edmunds and Hill (1999) looked at the potential for undernutrition and links with eating disorders to the issue of dieting in children. Much debate centers around the dangers and benefits of dieting in children and adolescents. In one aspect dieting at an early age is central to eating disorders and has a strong association with extreme weight control and unhealthy behaviors. On the other hand, childhood dieting has the character of a healthy method of weight control for children who are overweight or obese. Especially important for children is the family context of eating and particularly the influence of parents. A question arises concerning whether highly restrained children receive and perceive parental control over their child's food intake. Edmunds and Hill (1999) looked at four hundred and two children with a mean age of 12 years old. The children completed a questionnaire composed of questions from the Dutch Eating Behavior Questionnaire and questions concerning parental control of eating by Johnson and Birch. They also measured the children's body weight and height and completed a pictorial scale assessing body shape preferences and the Self-Perception Profile for Children.
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