1. Eating difficulties in younger children and when to worry Dr Pooky Knightsmith www.inourhands.com | @PookyH

2. Eating Disorders Food, weight or shape are used as a way of coping with difficult circumstances or emotions Eating Difficulties Younger children display a wide range of eating problems – not all are cause for concern. Some are behavioural issues.

3. Age Distribution Mostly over 11 Anorexia nervosa Bulimia nervosa Binge eating disorder Mostly under 11 Food refusal Restrictive eating Selective eating Food phobia Food avoidance emotional disorder

4. Are they hungry? Are they growing? Do they seem Happy and healthy? Is it a problem?

5. Selective Eating Extreme faddiness May last months Behaviour otherwise normal Can cause social difficulties Weight varies

6. She would only eat biscuits or crisps and NOTHING else. It had been going on as long as we could remember.

7. Encourage family mealtimes Play down fussiness Make no assumptions Praise small steps Suggest supplements if needed Monitor if needed Dental support may be needed Look at practical issues – e.g. parties Selective Eating – How to Help

8. Poor appetite Eats less than peers Often slim & short but healthy Family may have similar food intake Normal range of foods Restrictive Eating

9. He just didn’t seem that interested in food. He ate a wide range, just in very small amounts. Apparently his Dad was the same and had the same short, lean stature.

10. Monitor if concerned Reassure family / school Ensure teasing is not a problem Watch out for low self-esteem / body confidence Restrictive Eating – How to Help

11. Food Refusal POWER! Eats favourite foods Physical health okay Underlying worry Certain places / people

12. She wouldn’t eat or drink anything at school and made a huge fuss if we forced the issue but ate normally at home.

13. Support, not anger Need to work out WHAT are they trying to tell us Draw and talk Play therapy Food Refusal – How to Help

14. Highly resistant to eating & drinking Food Phobia Tend to be frightened of: Choking Gagging Vomiting May say eating hurts Mealtimes become a battleground

15. Ever since she’d choked on a piece of chicken, she was refusing any solid food in case it happened again.

16. Need treatment for PHOBIA not eating disorder Small steps – okay to return to purée Teach calming techniques Food Phobia – How to Help

17. No fear of weight gain Food Avoidance Emotional Disorder General behaviour disturbance: Sleep problems Poor concentration Tearfulness Hopelessness Associated with depression and anxiety May isolate themselves / avoid school

18. After his Grandpa died he just completely lost his appetite. He understood he was too thin and was worrying people but couldn’t manage to eat.

19. Often follows trauma or bereavement Needs support processing Support for depression / anxiety Family may need support GP may prescribe nutri-drinks Food Avoidance Emotional Disorder – How to Help

20. May refuse to walk, talk, eat, drink or take care of themselves Angry / determined / scared History of family issues May indicate abuse No physical cause Pervasive Refusal Syndrome

21. She wouldn’t walk, talk or eat and was eventually hospitalised and tube fed. It later transpired she had been being abused by her father.

22. Rapid risk assessment Do not assume abuse Multi agency approach Recovery is slow Pressure may further regression Family involvement in therapy can prove helpful in sustaining recovery Pervasive Refusal Syndrome How to Help

23. Need more support? Dr Pooky Knightsmith specialises in mental health and emotional well-being in the school setting. She can provide training sessions or workshops for school staff, parents or students on a variety of topics, including self-harm, anxiety, body image and eating disorders. For further information and free resources visit www.inourhands.com For details of CWMT funded sessions for staff, parents or students visit www.inourhands.com/CWMT Email: pooky@inourhands.com Twitter: @PookyH LinkedIn: linkedin.com/in/pooky