In trying to understand why a child or young person may not be eating enough, 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 make the helper feel very important or even indispensable. Such feelings can make a worker feel good about themselves but may result in 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. An example would be a worker agreeing to keep confidences about a young person’s health or eating habits when that young person’s health is showing signs of serious deterioration.
For further advice, see section on being aware of yourself and your own response.
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- Do whatever you can do to make mealtimes and eating enjoyable and fun.
- Remove any pressure that has built up around mealtimes.
- Experiment with different foods - cooked, prepared and presented in different ways.
- Reward the child for finishing their meal. For more information, see section on behavioural techniques.
The key task here is to try to discover whether:
- The child/young person has temporarily lost their appetite due to a physical illness.
- The child/young person has temporarily lost their appetite because they are unhappy or experiencing other strong emotions.
- The child/young person is 'dieting' or attempting to eat more healthily as part of a passing phase. This is well within the range of normal behaviour for adolescents (particularly girls). These children/young people will often be inconsistent in their dieting attempts. An example would be missing lunch and then eating a chocolate bar.
- The child/young person has developed a pattern of unhealthily restrictive eating together with an obsessive attitude towards their food intake and weight loss.
You can find this out by doing the following:
- Calmly and discretely arrange 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, share with them what you have observed about their eating and drinking behaviour, and ask them for their explanation of what you have observed.
- If you have a responsibility for providing them with food find out if they would eat more if alternative food was provided.
- Explain that you have concerns that what you have observed to be restrictive eating may indicate that they are unhappy or worried.
- Provide an opportunity for the child/young person to talk privately and confidentially to you about their concerns and worries.
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- Don't react angrily to a child/young person refusing to eat.
- Don't punish a child/young person for not eating.
- Don't act in such a way which suggests that you are highly anxious or panicking about a refusal to eat (in other words, remain calm).
- Don't try to force a child/young person to eat.
- Don't get into conversations about how fat or thin people are or about whether this is a good or bad thing.
- Don't get into conversations about your own difficulties with eating or drinking.
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- If you have concerns that a pattern of restrictive eating has become established which goes beyond "normal" dieting or healthy dieting, and the young person is developing an obsessive attitude towards food and weight loss, whilst appearing to become less healthy as a result, seek immediate advice from your local mental heath specialists.
- 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.