It is an interesting reflection on our society that workers in out-of-school clubs should have to think about being aware of eating disorders in children. Childhood is changing. Children are maturing physically much earlier. They are also increasingly sophisticated in matters of dress and entertainment.
It is not uncommon for six-year-olds to celebrate their birthdays with a disco or 'make-over' party. Year 4 and 5 children may be acutely fashion- and weight-conscious, often filled with a desire to be a Britney Spears or David Beckham lookalike. In a sense, these children are not being allowed to enjoy their own body shape.
And, sadly, we seem to live in a society where appearance is all.
Youngsters in Year 6 or 7 are beginning to think about 'being fanciable'.
They are increasingly preoccupied with image and appearance. We are seeing excessive worries about weight, where such a worry is not age-appropriate as in an eight-year-old.
What is an eating disorder?
Put simply, an eating disorder is when someone doesn't want to eat, even though there may be no physical cause, such as an illness, as to why they can't eat. The 'not wanting to eat' may be mixed with an urge to binge eat followed by vomiting. Eating disorders tend to be associated with girls, but this is becoming an increasing problem in young teenage boys.
What is an eating disorder a solution to?
1. The need to feel in control
'She (her mother) can't make me eat... that's what I like, she can't make me eat' - 12-year-old Polly was on the brink of anorexia. Eating disorders are primarily about power and control. Polly's mother ran a tight ship, and her authoritarian style of parenting left very little room for flexibility.
As children grow up, they need choices. Even small choices - fish fingers or eggs for lunch? - can make a child feel they have some power in their lives. And choices help us to develop both a sense of identity (I am me and I like eggs) and a sense of privacy.
Young children may feel secure believing 'mummy and daddy know everything about me'. The older child needs more sense of a private life. Polly felt the one thing she could control was what went into her body. And she was right, of course, her mother couldn't make her eat. Her eating disorder was a bid for independence and control in her own life.
2. A request for control
By ten years old or so, youngsters are appropriately beginning to want to explore the world outside home. They are beginning to push boundaries and their sense of exploration is both exciting and frightening. At times, they are likely to feel on the brink of being out of control, if not actually out of control. Sometimes an eating disorder can be a cry for help. The exact opposite of Polly, it can be a way of saying, 'Please put some boundaries around me and make me feel safe.'
3. Anxieties about being desirable
'Does puberty hurt?' (nine-year-old girl). 'How long is adolescence? I can't hack too much of it...' (12-year-old boy).
The glamour of sexual attractiveness is much hyped in the media. Little is said about the anxieties of being sexually attractive.
We live in a time when sex is everywhere and there is no innocence anywhere. Children learn very early that sexual intimacy is a part of relationships. Most manage to hold a balance between their excitement, and their anxiety about sex. For others, coping with their own sexual feelings and the thoughts of sexual demands from others is terrifying.
At 11, Max was considered 'well fit' by the girls in his class. Fifteen months later, he had developed an eating disorder. Thin and pale, he had stopped growing and his sexual development was arrested to the point that he now looked like a child of nine or ten years old. Asked one day what would be different if he still had his 'number one fit boy' looks, he replied, 'I might want to snog everyone.' Max was so anxious about his ability to control his sexual desires he was managing to avoid adolescence by physically remaining a child.
4. Excessive academic pressure
Our self-esteem, how much we consider ourselves to be likable and lovable, is inextricably bound up with how we feel other people see us. While a youngster doesn't have to be competitive and a perfectionist to develop an eating disorder - it helps!
It is a hard task for parents to find just the right balance between motivating a child to succeed and accidentally conveying to the child that they are only lovable if they succeed. This is a particular issue in homes where education is highly valued and success and achievement are considered the norm. Eleven-year-old Eva failed the entrance exam to her chosen school causing a hiatus of distress in her family. Eva felt bad about it. She felt she had not only failed the exam, she had failed everyone. She began to hate herself - initially for the distress she had caused to her family and gradually, 'For everything about me'. Eating disorders can arise out of a sense of self-loathing. The most worrying aspect for youngsters at this stage is that self-loathing can very quickly turn into loathing other people. In Eva's mind, failing the exam was equivalent to failing to be loved.
5. Risks of promoting 'healthy foods'
Many youngsters of this age are appropriately self-conscious and health-conscious. It is not uncommon for 11- or 12-year-olds, particularly girls, to decide to become vegetarian for ethical, political or health reasons. And we live in a world of 'good and bad' foods.
Florence's mother had had a major row with the playworkers at her after-school club. At home she kept Florence on a health-conscious diet - crisps and sweets were replaced with nuts and yoghurt-coated raisins. As a child, Florence had been co-operative, but she was now demanding more usual snacks to take to club as she 'felt different'.
Her mother responded by trying to get club to ban unhealthy foods. The play leaders were taking the line that labelling foods as 'good or bad' may cause youngsters to feel guilty about what they are eating. It is better to encourage an overall healthy diet, with hopefully only small amounts of junk food included. Overly promoting healthy foods can make children rebellious about what they eat.
Florence felt she would only be attractive and loved if she remained thin, and, in her mind, therefore, healthy. She began to binge eat forbidden foods and then desperately try to regain control by making herself vomit.
Of course, both parents and play leaders want to encourage good health in children, but we need to be alert to the risks of being overprotective and anxious about what children eat.
Symptoms of eating disorders
* Sudden and inexplicable loss of weight
* Refusal to eat or disappearing at meal times
* Greed and overeating
* Food faddiness
* Excessive preoccupation or discussion about body weight
Managing eating disorders
* If you have concerns that a youngster at club is showing indications of an eating disorder, you must talk to the parents. Eating disorders can be a barometer of the emotional life of a family. They are certainly a barometer of the family's attitude to food. From birth onwards, feeding is a highly emotive issue between parents and children. Nothing worries parents more than a child who cannot or will not eat. Food faddiness can be a child's way of being angry or getting their own back on parents. From a child's point of view, it is always going to make an impact.
* Boost confidence and self-esteem - youngsters like Florence, Eva and Max need to be reminded that most people feel dissatisfied with the way they look. It is best not to argue when they declare themselves unattractive.
Rather, it may be important to give spontaneous, genuine and positive feedback about their appearance at other times, and compliment them on their good qualities of personality.
* Acknowledge that some youngsters may want to eat different foods from the rest of the family or club - vegetarians should be allowed to be vegetarian - and to break their vegetarian diet on a whim! Allow youngsters as much choice as is feasible.
Andrea Clifford-Poston is an educational therapist and author of The Secrets of Successful Parenting - Understand What Your Child's Behaviour is Really Telling You (How-to-Books, 9.99).
