When to Seek Help for my Child’s Eating Habits

We all want our children to be healthy and happy, but sometimes navigating our children’s food preferences and the time and energy it takes to plan and cook meals can be overwhelming (let alone getting them to eat them without a struggle).

It can also be challenging to determine if a child is just “picky” and going through a food preference phase, or if their eating habits are problematic enough to need assistance.

It’s important to develop an understanding of what is considered a healthy relationship with food and when a child’s eating habits are unhealthy and could benefit from treatment.

Let’s take a look at typical eating habits in children and teenagers and what is considered a warning sign that you may need to seek help from a professional.

 

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What’s Typical and What’s Not?

The Center for Disease Control and Prevention (CDC) statistics clearly show that many parents struggle with educating and balancing the nutritional needs of their children.

Studies show that most children struggle to meet the daily recommended fruit and vegetable amounts, and that “empty calories from added sugars and solid fats contribute to 40 percent” of their daily calories ^[1].

Imbalance in healthy nutrition could be to blame for a large amount of the physical, emotional, and social struggles that children are experiencing today — unhealthy diet choices can lead to many problematic symptoms and behaviors, including:

Decreased energy/concentration or hyperactivity behaviors, decreased cognitive development and school performance, problems with sleep, struggles with emotional regulation, an increase of depression symptoms or other mental health concerns^[2], and, of course, physical health issues (constipation, asthma, eczema, obesity, cancer etc.).

In addition to the quality of the food children are eating, the way they are eating is also something to be assessing throughout a child’s life.

 

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Normal Eating Habits in Children 0-18

Below is a summarized list of typical and appropriate food habits based on the age of your child^[3]:

Newborns (0-2 months+):

Newborns have a lot of variation in the frequency of their hunger and how much they need. As they grow, they may need more frequent feedings and may be hungrier, and then their patterns of eating may level out for a time.

Most professionals suggest using “cue feeding” techniques ^[4] to gauge what your baby needs during this time, as infants often determine what they need and when.

Infants (2 months-1 year)

Babies will begin to eat solid foods around six months old, generally beginning to show interest in solid foods and possibly disinterested in breast feeding or formulas (though not always).

There will be a lot of variance of readiness and interest in solid foods at this time. As long as you follow your child’s lead, they will let you know when they are ready for the full transition to eating solids.

Toddler/Early Childhood (1 year-5 years)

This is when a child begins to express preferences, and this can be a difficult time to manage for parents, as children often fight their parents about anything and everything food-related. They may begin to detest normally preferred foods (or say they don’t like it anymore), and flat out refuse to eat anything.

Their appetite is changing from that of an infant, where they require consistent food to grow their bodies, to a toddler who begins to grow at a slower pace. They may have days where their appetite may actually be less than other days, and they may not want as much food.

This time is when children begin to listen to their bodies and articulate how they’re feeling, so it’s important to be aware and respectful of this as a parent (more on this in the How Can I Help? Section later).

School-Age (6-12 years)

Children at this age begin to establish more solidified preferences and independence around food and eating. Children may have likes and dislikes at this stage and may have established patterns of when and how much they eat. Depending on growth, children may eat more at times and less at others.

Children at this age begin to be more aware of the conversations at home and school related to healthy food and nutrition and can absorb messages about the importance (or lack of importance) of healthy foods.

They may also begin to hear messages about how food is related to physical appearance, but it is rare for children this age to begin to connect food and eating to their body and body image, though this is the period where that connection begins to develop.

If they hear a lot about these connections, however, particularly if a parent is concerned about the child’s weight, they may develop these insecurities prematurely.

Adolescence (12-18 years)

As teens become more independent with age and growth, they begin to develop an idea of how they want to feed themself and care for their body. At the same time, this period of a teen’s life is filled with what psychologists call “imaginary audience ^[5]”, or the heightened awareness of others’ perceptions about them and how they look and act.

They may believe that others are constantly judging them and can develop a sense of self-consciousness that is often interconnected with eating and food. If a teen believes their body image does not fit in with the social norm, they may fixate on trying to minimize their weaknesses and highlight their strengths.

This could mean changing the way they eat to improve upon themselves physically, or to gain positive attention from their peers. This is typical but should be monitored to ensure that children are not making drastic changes that could affect their health in negative ways.

**Note: While these are considered typical patterns of behavior in children, using the tips in the “How Can I Help My Child?” section below can help to improve their eating habits!

 

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Eating Habits That May Require Professional Assistance in Children Ages 6-18

Most parents do not have difficulty determining whether or not their newborn, infant, or toddler is having eating struggles; it is pretty easy to tell if they are having difficulty at those ages. If a child is not gaining weight or growing, or if they are gaining too much weight, these are signs of eating struggles.

Children should be monitored frequently by their doctor who will make sure they are on the right track for their age related to food and nutrition and will make adjustments or get the family support when necessary.

Struggles with knowing exactly what is typical and not relating to food habits often arise in school-age children and progress as they age. Let’s discuss what may be considered atypical beginning in these stages to suggest when a parent should seek professional assistance to address these difficulties.

 

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Red-Flags for Problematic Eating Habits

As children grow, parents are on guard for clues that their child may be experiencing medical problems. They should have that same vigilance related to food and eating habits, since they are so interconnected. Catching problematic eating habits early is the best way to get your child the help they need so it does not become a more significant problem later on.

It’s important to note that food-related issues can be subtle and may not include some of the common red flags that accompany eating disorders, including fixation on weight or body image, or other things that may be more of an obvious concern.

Often, children can experience problematic eating habits and not directly meet criteria for an eating disorder, while other children may meet the medical criteria for diagnosis (see below for info on eating disorder criteria).

Here are some clues that a child may be beginning to experience problems related to their eating and relationship with food^[6]

• Tantrums around meal time, refusing to eat frequently, or reducing the amount of food eaten
• Hiding/hoarding food or refusing to eat in front of others
• Aversion to tastes and textures in food that remain consistent
• Anxiety around bowel movements, fear of nausea or stomach problems
• More bowel movements than normal, or constipation
• Worrying about body image, making self-deprecating comments about their body
• Weight loss, and lack of healthy growth for age and body type
• Thinning of hair, or fine hair growth on body not consistent with typical body hair
• Delay of puberty

 

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Types of Atypical Eating Struggles in Children 6-18

The clues listed above are definitely red-flags to watch for when assessing the health of your child. If you begin to notice these clues persistent in your child’s behavior (not temporary, but more longstanding), they may meet criteria for an eating disorder.

Following is a list of problematic eating habits considered severe enough to meet the criteria for a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5^[7], and what symptoms are present in children who experience them^[8]

Avoidant/Restrictive Food Intake Disorder (ARFID)

Failure to eat enough quality, nutritional food to provide the body with the energy needed to function. This is associated with one or more of the following:

• Significant weight loss, never meeting weight criteria for age, or decreasing growth
• Significant nutritional deficiency
• Dependence on feeding tubes or oral nutritional supplements
• Difficulties with psychosocial functioning ** not better explained by lack of available food or culturally sanctioned practices.

Rumination Disorder

• Repeated regurgitation of food for a period of at least one month — food may be rechewed, re-swallowed, or spit out.
• This is not related to a medical condition, such as a gastrointestinal problem, but is a separate behavioral issue.
• If it’s occurring alongside other mental health diagnoses, it will only be diagnosed as its own disorder if it meets the criteria to be independently treated.

Pica

• Persistent eating of non-nutrient substances for a period of at least one month. Non-nutrient substances could include paper, hair, dirt, soap, sand, chalk, etc. This behavior is considered developmentally inappropriate due to age, i.e., some young children put inedible things in their mouths and would not meet criteria for this; this is regarding purposeful eating of something that is not food.
• Not culturally supported or socially normal for their surroundings.
• This can be related to other mental health diagnoses and disorders (i.e. autism spectrum disorder) but can only be diagnosed itself if it warrants specific and independent clinical attention.

Binge Eating Disorder

• Recurrent episodes of binge eating, which is described as the following:
  • Eating a significantly large amount of food (considered larger than most people would eat during a similar period of time during similar circumstances)
  • Feeling a lack of control over eating during the episode
• Eating more rapidly than normal, eating until uncomfortably full, eating large amounts of food when not hungry, eating alone because of embarrassment due to how a child is eating, feeling depressed and guilty afterwards.
• Occurs at least once a week for three months and causes the person significant distress.

Bulimia Nervosa

• Recurrent episodes of binge eating combined with inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, using laxatives or other ways of eliminating foods from the body before it has been absorbed and digested(diuretics, medicines, etc.), fasting, excessive exercise, etc.
• The above-mentioned behaviors occur at least once a week for three months and the child describes doing it due to a change body shape and weight.

Anorexia Nervosa

• Persistent pattern of restricting food that leads to significantly low body weight, based on what is expected for age, sex, and health of the child.
• Intense fear of gaining weight or becoming fat, or the child believing that they are already fat, which decreases their ability to gain needed weight to remain healthy.
• Struggles with accepting and identifying the seriousness and dangerousness of low weight or drastic measures being taken to lose weight.

Other Specified Feeding or Eating Disorder (OSFED)

Any person who is experiencing feeding or eating difficulties but doesn’t meet criteria for any of the other disorders. Here are some examples:

• Atypical Anorexia Nervosa
  • If all the criteria are met except significant weight loss, they would be diagnosed this way.
  • If the duration of time has not been enough for abovementioned diagnoses.
• Purging Disorder
  • If not accompanied by binge eating, strict purging or throwing up to lose weight would be considered OSFED.
• Night Eating Syndrome
  • Eating excessive food after evening meal and late at night.

Unspecified Feeding or Eating Disorder (UFED)

Any feeding or eating behaviors that cause a person to experience significant distress but do not meet any of the criteria for specific feeding or eating disorders.

**Note: If you notice these symptoms with your child or teen, it is recommended that you seek assistance from a mental health professional to help improve your child’s ability to cope with their struggles with eating habits.

 

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What Causes Unhealthy Eating Habits and Eating Disorders?

Unfortunately, it is largely unclear what causes eating disorders or unhealthy eating habits in children. However, it is commonly suggested from extensive research that eating disorders are relatively heritable, possibly from a biological/genetic source, but more often directly connected with having a family member with an eating disorder.

Studies show that children who have a parent or other close family member who struggles with significant poor eating habits are 7-12 times more likely to develop one as well.

This suggests that a large portion of the development of food-related mental and physical health problems directly relate to the “nurture” part of development, as opposed to the “nature” part that is associated strictly with genes and heredity.

Eating is obviously a necessary behavior to sustain life for any living being; but for humans, eating is also heavily rooted in our socialization, culture, tradition, and even our emotions. The way we eat and what we eat can reveal a lot about us and can lead to generalizations by others about who we are.

While children are born with a strong connection to sustenance for survival, it isn’t long before a child begins to absorb the social and emotional food messages surrounding them, and formulates connections about what food and eating means to them.

If a child is exposed to a variety of types of foods and is taught to understand the importance of balancing healthy and unhealthy food choices, they are likely to maintain a healthy relationship with food and eating throughout their life.

On the other hand, lack of this type of education, in addition to many other socioemotional factors, can cause children to develop a chaotic understanding of the purpose of food and eating and can lead to some serious physical and emotional struggles that require professional assistance.

Children with chronic illness and other mental health concerns are also at an increased risk of developing problems regulating their eating habits.

Depression, anxiety, and other mental health struggles can be expressed through difficulties regulating eating and subsequently increase the chances of a child developing more severe eating-related struggles, as well^[9].

 

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Can Other Things Cause Problematic Eating Habits?

While having someone in their family that is experiencing problematic patterns of eating is a large contributor to a child developing a difficulty with eating, there are definitely other ways that children begin to use unhealthy eating to cope with other difficulties.

Here’s a list of some common coinciding events that can contribute to negative eating habits and may exacerbate some food-related struggles in children and teens:

Family Dysfunction

In addition to problematic messages about food, body image, and what to eat and when, children who live in high-conflict, violent, or stressful homes can experience emotional dysregulation that can cause them to retreat emotionally and begin to use food as a source of coping.

The term “comfort food” is used to connect the fact that we often have emotional messages about certain foods, whether they are nostalgic because of tradition or family preference, or because we really enjoy the taste and sensation that we get from eating them.

As a result, when feeling distressed or uncomfortable, people will often turn to food to help them cope. It’s also possible that the opposite is true for some children. Some children, when stressed or feeling uncomfortable, will avoid food and eating to try to cope with how they’re feeling.

Either way, if these patterns continue without being addressed, they risk using them throughout their lives to handle stress and that can harm their bodies and their mental states.

Peer Problems

Kids and teens begin to compare and contrast the way they look based on their peers and what they see in the media when they begin school. As a result, kids begin to establish connections with others based on similarities and whether or not they fall into the stereotypical body images that are seen as ideal.

Sometimes, kids are bullied or teased because they may not fit into an unrealistic representation of a healthy child. Bullying about the way a person’s body looks begins very early in social settings and can have catastrophic effects on self-image.

In addition to the way someone looks, the food they eat may be scrutinized by others if a child is eating something culturally significant that is seen as odd to others who don’t share the same history, or for many other reasons.

All in all, peer bullying is an influencing factor and can cause kids to find ways to improve their self-image by sometimes drastically altering their eating to “fit in” with the crowd.

Medical Concerns

Medical concerns should be addressed if you notice a child beginning to have different patterns of eating that seem unhealthy or problematic.

Sometimes there are genetic or biological reasons for body changes or appetite changes, but it is always good to seek confirmation of medical health first, before addressing the mental health connections that often follow problematic eating habits.

 

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How Can I Help My Child?

Keeping a watchful eye on your child’s eating habits and noticing when something begins to seem troubling or problematic is the first step in ensuring that your child gets the support needed to stay healthy.

Once you notice eating habits outside of the norm of typical pickiness or fluctuations in appetite that may stem from growth or establishing independence, the most important thing is to get help from a professional in the medical, nutritional, or mental health community.

These professionals can assess where problems are stemming from and help kids learn tools to redirect their relationship with food and eating back onto a healthy track.

In addition to seeking out professional help, the following concrete parenting strategies help kids develop solid, healthy eating habits at home:

Monitor Everything

When you first became a parent, I bet you spent all of your time watching them to make sure they were safe and healthy. While you don’t need to be this meticulous in your observations of their every moment as they age, it is important to keep an eye on eating patterns and preferences to notice if and when something seems problematic.

This is exceptionally important as kids age, as subtle changes in eating habits and activity levels can tell you a lot about emotional state that a child may not tell you directly. For example, a child who is sedentary and over snacking may be experiencing symptoms of a mental health concern that is not noticable in other areas.

By contrast, active, athletic children may be praised for their energy and athletic ability but could be struggling with self-concept issues that cause them to use exercise in an unhealthy way.

Avoid Food-Focused Rigidity and Reward/Punishment

Recognizing that each child will have different appetite needs day to day is important to help maintain individuality and their overall relationship with food. Avoid forcing children to finish all of their food or “clear the plate”, as this can force children to eat when they are full, thus developing unhealthy thoughts and feelings related to food and nourishment.

It’s also important to avoid using food as a reward or punishment; rewarding children with sweets or other desired (and often unhealthy) foods to improve behavior sets them up for a lifetime of seeing unhealthy food as something to be desired and earned and mixes up the messages of healthy/unhealthy food balance.

Similarly, punishing someone by taking away a food preference can also complicate their ability to conceptualize food and eating appropriately.

Practice What You Preach

A child’s greatest example of how they understand food is developed by watching the adults around them and internalizing the messages they perceive. You are your child’s role model for most things, but few are as important as helping them have a healthy perception of food and eating.

If you instill in your child the importance of eating fruits and vegetables, but rarely touch them on your own plate during a meal, a child will begin to push back and develop rigidity around the things that are good for them.

In addition to this, the messages you convey about your own relationship with food and body image will come through as children age, as well.

If you constantly complain about how you are uncomfortable with the way your body looks, if you fixate on your weight and how you don’t like the way you look, children begin to absorb those messages and question whether or not they have a body that is considered ideal.

Having a solid separation between food and body image is so important for parents to emulate so that children do not begin to demonize food as the thing that keeps them from attaining an often-unrealistic body image that is touted by society.

Involve Kids in the Meal Prep Process

Getting children interested and active in the food selection, planning, and preparation is a great way to instill a healthy mindset about food.

Kids love to have the ability to make decisions about what happens around the home, so giving them the opportunity to pick foods and praising them for their healthy choices is a great way to encourage their healthy eating habits, in addition to encouraging independent thoughts and feelings.

Allowing them more responsibility for helping out with meals as they age is also a great way to foster a sense of independence, and to help kids recognize the benefits of knowing how to cook and feed themselves.

It’s been said that children who help out with meals in the home are much more confident and able to eat better and have better relationships with food once they’re out of the home, so helping them develop those skills early can help them prioritize healthy food later.

Variety is Key, as is Flexibility — The 85/15 Rule

Children begin to develop rigid preferences early on if parents do not prioritize exposure to a vast variety of foods, particularly healthy, nutrient-rich foods.

Children will often balk at these foods, but, kids will often be able to overcome their initial hesitation and become more daring with their eating habits if healthy foods are continually presented and parents have a positive relationship with them and encourage them.

In addition to this, having a healthy balance between what is considered “healthy” and “unhealthy” for all family members is important.

I love the 85/15 rule because it helps put things into perspective; the theory is that you can sustain a healthy and balanced life by prioritizing eating healthy, nutrient-rich foods 85 percent of the time, and then allow yourself and your family the flexibility of eating less health-conscious foods 15 percent of the time.

This fosters a solid mental state around food and eating and can help you not feel the need to restrict things that are enjoyable.

Allow for Individuality

While we want to prioritize health and wellness in our children, it is important to not allow meal time to become a battle zone. The more stress and forced feeding that happens during meal time, the more children will recoil and refuse to be flexible with their food choices.

Some children are really rigid with what they want to eat, and that will require some patience and prompting. It is important to recognize that forcing children to eat something they do not like only encourages them to develop an unhealthy relationship with food.

Listen to the cues your child is giving and provide options that they enjoy while working to encourage appropriate and consciously healthy options as well. There are many ways to do this.

For example, if a child loves pasta, there are a lot of vegetable-based pasta options that are much more nutrient-dense and provide protein-rich vegetables in a form that looks and tastes like a nutrient-lacking ordinary pasta.

Sneak in healthy foods to begin to get kids to eat the things that are good for them, while slowly exposing them to healthy options to get them to eat healthy foods on their own.

Keep Food Messages Healthy

Food and eating are so interconnected into our social world and relationships that this is hard to navigate. While food in and of itself is something we ingest to give us the energy to get through our day, there are many emotional connections tied to food due to the way that eating stimulates the emotional parts of our brain.

Eating together, or “breaking bread”, has long been a way to meet, connect, and build relationships with others. It’s important to acknowledge this, while also helping children understand that food is something that helps nourish our bodies and keeps us healthy.

While there can be added benefit in the emotional connections we experience with the foods we enjoy, it is important to help children understand that they can change their emotional state in many other ways other than eating, and should use these other coping skills more often than not before resorting to food.

Send Kids Clear Messages About Who They Are

Often when children are struggling with weight issues, the focus begins to center around what they’re eating and how they’re eating, and feels like this is the only component of your child that matters to you. This messaging definitely does not help a child begin to separate their body image from nourishing themselves with food.

While working with a child to improve their health and eating, it’s also important to take time to specifically notice and describe their other attributes that make them who they are.

Praising them and describing all of their positive qualities and what you love about them will help them separate from the difficulties they are experiencing with their eating habits.

Talk it Out

Like most things, having open communication in your family about food, health, and body image is so important to sustaining healthy development. Children hear and see things — not just in your home, but at school, other social settings, and through media and social networking — that send mixed messages about food and eating.

It’s important to have a dialogue with your children about these messages to educate them on their bodies, how they change, and what it means to be healthy.

Encourage Movement and Activity Away from Screens

While discussing food and eating, planning meals, and prioritizing healthy options are all critical ways to help improve a child’s understanding of how to treat their body, it is also important to consider how lack of activity can affect their relationship with food and wellness.

Sedentary children who spend a lot of time utilizing screens are much more likely to develop snacking habits that can negatively impact their health and weight. It’s important to have just as much balance in activity levels as you do in food choices.

The best way to help kids develop healthy habits around body wellness in addition to food and eating habits is to ensure they have time each day to run around and be a part of an athletic or energy-expelling activity.

 

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What Can I Expect in the Future?

Eating habits vary in how they manifest — depending on when and how they are addressed, poor eating habits can be relatively short or could be life-long, depending on severity. It is important to remember that fluctuations of appetite and eating patterns are a normal part of development and that some things will subside on their own.

That being said, children and teens who are exhibiting red flags and concerns should be assessed so they can get help as soon as you begin to notice unwanted patterns developing. Early intervention is key in eating-related difficulties and can significantly improve the ability to change the way they think and feel about eating and body image.

If struggling kids do not get this help, they may be able to make sense of their eating and self-image concerns on their own, but it may be a long process of trials and tribulations that could lead to unhealthy outcomes first.

 

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What to Expect When Seeking Help

Eating and food-related problems are obviously concerning and need to be addressed with both a medical and mental health team to tackle both sides of these complicated problems. Getting support from a medical professional will help determine if there is anything that can be done to help the more biologically-induced problems.

Medical professionals can possibly prescribe a treatment plan without needing the assistance of a mental health professional. If your child is experiencing mental health symptoms as a result of, or in combination with, medical food-related problems, it is important to connect with a mental health professional who can help them understand what they are thinking and feeling related to food and eating and how to manage and overcome these issues.

There are many different approaches used to help children and teens who experience eating habit difficulties, but the most common approach is utilizing cognitive behavioral therapy (CBT) techniques.

CBT is a well-researched approach that helps children understand the thoughts they are having, how these thoughts contribute to how they feel, and how their feelings contribute to their eating behaviors.

This is usually done one-on-one with children to help them fully connect how their thoughts and feelings are contributing to their difficulties in managing their eating habits.

Dialectical Behavior Therapy (DBT) is another evidence-based treatment that can help children and teens recognize the patterns of unhealthy eating and teach them how to tolerate discomfort and address it through healthier coping skills than they are currently exhibiting with their poor eating habits.

In addition to this, professionals often use family therapy to help family members understand their role in reinforcing negative patterns and learn how to help them improve the way they think and address food in the home.

Sometimes children struggling with various mental health concerns that are portrayed through poor eating habits may require a psychiatrist’s support.

A child may be prescribed medication in addition to the above-mentioned therapeutic treatments to improve their ability to use coping skills presented in treatment, rather than giving in to unhealthy eating-related impulses.

Raising a child who is experiencing significant difficulties related to eating habits can be overwhelming, but knowing what is considered atypical empowers you to act quickly to help your child overcome struggles.

Mental health and medical professionals are dedicated to helping children and their families develop the best ways to understand food and health and how to incorporate strategies to help everyone feel like they have a healthy balance at home.

The development of early healthy patterns will help your child develop sustainable, life-long healthy ideas about food and the importance of prioritizing balanced nutrition in their lives.

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 References

1. Childhood Nutrition Facts | Healthy Schools | CDC. (n.d.). Retrieved March 1, 2019, from https://www.cdc.gov/healthyschools/nutrition/facts.htm
2. Thomas, L. (2018, August 23). How Fast Food Affects Children’s Health. Retrieved March 1, 2019, from https://www.news-medical.net/health/How-Fast-Food-Affects-Childrens-Health.aspx
3. Feed in the right way for your child’s stage of development. (n.d.). Retrieved March 1, 2019, from https://www.ellynsatterinstitute.org/how-to-feed/child-feeding-ages-and-stages/
4. Cue feeding ~ Breastfeeding on demand. (n.d.). Retrieved May 15, 2019, from https://www.breastfeeding-problems.com/cue-feeding.html
5. Jean Piaget’s Theory Of Cognitive Development. (n.d.). Retrieved March 1, 2019, from https://www.mentalhelp.net/articles/jean-piaget-s-theory-of-cognitive-development/
6. Eating Disorders in Children 12 and Under: Learn the Warning Signs. (n.d.). Retrieved March 1, 2019, from https://www.psycom.net/eating-disorders-in-children
7. American Psychiatric Association. (2013). Feeding and Eating Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
8. Breanna. (n.d.). Classifying eating disorders – DSM-5. Retrieved March 1, 2019, from https://www.eatingdisorders.org.au/eating-disorders/what-is-an-eating-disorder/classifying-eating-disorders/dsm-5#anorexia
9. Eating Disorders in Children 12 and Under: Learn the Warning Signs. (n.d.). Retrieved March 1, 2019, from https://www.psycom.net/eating-disorders-in-children