In trying to understand why a child or young person may be binge eating or vomiting, ask yourself the following:
- Do you know if they have recently experienced bereavement or divorce?
- Do you know if they have experienced any trauma in the past?
- Do you know if they have been bullied at school for being 'fat' or for other things?
- Do they come from a family where there is an unusual emphasis placed on eating and drinking?
- Are they known for trying harder than others to please adults?
- Do they come from a home where there is poor role modelling in relation to food choices?
- From the information available to you, have patterns or changes in patterns of eating and drinking become well-established?
- Are the changed behaviours in relation to eating and drinking happening in certain situations and not others?
- Do you know if they are sometimes eating and drinking normally? If so, with whom and where?
- What, if any, appear to be the adverse effects of their eating behaviour on the people around them?
- What, if any, appear to be the benefits (to them) of their behaviour in terms of the effect on others?
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Attempting to respond helpfully to a child or young person whose eating and drinking behaviours are causing concern can evoke very strong feelings in the helper. These can range from a feeling of helplessness to a feeling of intense frustration if, for example, attempts to persuade a child to eat or to stop inducing vomiting seem to be failing.
Successful attempts in situations where others appear to be failing can also evoke very strong feelings in the helper arising from the sense of having become an important or even indispensable source of help. These feelings can be very gratifying but can also be a worry to a helper or contribute to them becoming over-involved. There is such a thing as being too well 'tuned in' to what a child or young person is experiencing, in relation to their attitude to eating. When this happens there is a danger that the worker loses their ability to stand back and make good decisions which are in the best interests of the child.
For further advice, see section on being aware of yourself and your own response.
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If a young person is binge eating and vomiting and this has become a habit or pattern of behaviour, they may have developed a condition known by psychiatrists as Bulimia Nervosa or Bulimia. If you have concerns that this description matches the behaviour of a young person known to you then you should seek advice from your local mental health specialist team.
If the behaviour is not part of an established pattern or if the young person is waiting to be assessed by a specialist you can be helpful by:
- Calmly and discretely arranging to speak to the child/young person on their own. For more information, see section on counselling techniques.
- In a caring and non-judgemental way, sharing with them what you have observed about their behaviour.
- Explaining that you have concerns that what you have observed to be binge eating and vomiting may indicate that they are unhappy or worried.
- Providing an opportunity for the young person to talk privately and confidentially to you or appropriate others about their concerns and worries.
- Respectfully and sensitively providing information about the potential negative effects of binge eating and vomiting such as damage to teeth.
- Advising them not to brush their teeth after each episode of self-induced vomiting, but to rinse with water or milk (to avoid brushing acid into their teeth). Chewing gum also helps to protect teeth enamel.
- Discussing areas of their life (other than food) in which the young person feels in control and successful.
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- If a young person is binge eating and vomiting and this has become a habit or pattern of behaviour, they may have developed a condition known by psychiatrists as Bulimia Nervosa or Bulimia. If you have concerns that this description matches the behaviour of a young person known to you then you should seek advice from your local mental health specialist team.
- If you are given an indication that the child/young person’s change of eating habits has been in response to a serious trauma in their lives, such as sexual abuse, seek advice from your local mental health specialists and/or social work department.
You should get in touch with your local health centre or hospital to obtain a contact number for the appropriate children and young people's mental health specialists.
Remember - you can contact your local mental health specialists for a number of reasons, for example:
- For advice on how to make a referral about a named child.
- For advice about whether or not to make a referral (it is normal practice to seek this advice without naming the child in the first instance).
- For advice about what to do (once again there should be no necessity to name the child).
By not naming the child you are protecting their right to confidentiality. This method of seeking advice also has the advantage that you do not need to get anyone’s consent in advance of your contact phone call.