Fussy Eating or Eating Disorder?

fussy eating or eating disorderThe family dinner table can easily become a battle field, particularly if you have a child who is a fussy eater.

But what if it not simply fussy eating – but rather something more sinister, that you are actually dealing with? Could it be that your child has an eating disorder?

There are three main eating disorders which affect children:

  1. Anorexia Nervosa – Young people with anorexia nervosa purposefully eat less food than they need to maintain their weight. They have an intense fear of gaining weight, or “becoming fat”, and often see themselves as heavier than they are. Young people judge themselves excessively, and harshly, based on their weight. Anorexia has many short and long term health consequences, and is the most likely to be fatal of all mental disorders.
  2. Bulimia Nervosa – Young people with bulimia engage in binge eating, where they eat very large amounts of food while feeling out of control. In a bid to prevent weight gain, they engage in “compensatory behaviours” to make up for the extra calories. Behaviours can include self-induced vomiting, excessive exercise, fasting and misuse of laxatives, among others. Again, self-worth is based largely on weight and shape. Bulimia is also disastrous for health, and can be potentially life-threatening.
  3. Avoidant/Restrictive Food Intake Disorder (ARFID) – More severe than fussy eating, children with ARFID avoid food/s to the extent that they experience significant nutritional difficulties, failure to grow or gain weight, and sometimes rely on nasogastric tube feeding. This disorder is not associated with body image, and usually occurs in infancy and early childhood.

Signs of Eating Disorders in Children

It can be very hard for parents or loved ones to notice the symptoms of an eating disorder. This is because feelings of shame and self-loathing may cause your child to hide their struggles. However, as a parent you can keep an eye out for any of the following signs:


  • Unexplained, significant and/or sustained weight loss, or failure to gain weight as expected;
  • Brittle hair and nails;
  • Puffy cheeks, red eyes;
  • Constipation.


  • Frequent commenting on weight of self and others;
  • Skipping meals or making excuses for not eating;
  • Secretive exercising;
  • Long showers, increased use of the bathroom, using the bathroom right after meals;
  • “Clean eating”, and any diet that involves cutting out food groups, including vegetarianism, paleo, etc;
  • Increased interest in food preparation;
  • Cutting food into small pieces, eating slowly, hiding or throwing away food;
  • Searching “pro-eating disorder” websites, Pinterest and Instagram.


  • Emotional changes such as moodiness, sadness, anger, crying, or seeming snappy;
  • Sudden or increased interest in exercise and health;
  • Withdrawal from friends and family;
  • Personality traits such as being driven, high achieving, independent, and detail oriented can make young people more vulnerable to developing an eating disorder.

It is important to remember that eating disorders can occur in both boys and girls, and can often cause other problems such as depression, anxiety and low self-worth.

fussy eating or eating disorderWhat Should I Do?

If you do have any concerns, it is important to act. Eating disorders are notoriously difficult to treat, with adults who are treated often staying ill for 5-10 years. Many people will never seek help for their eating disorder, and may struggle with fear of food and low self-worth throughout their life.

Children and young people are particularly at risk of long term physical complications due to the growth that occurs during childhood and adolescence. Illness can affect bone density and size, fertility and hormonal changes throughout life, as well as significantly impacting major organs.

The most important reason to act early is that research shows that we are most effective at treating eating disorders early, and much less effective once the eating disorder has been around for 3 years or more. Eating disorders are appearing in younger and younger children, and children who present for treatment have often been suffering with their disorder for 6-12 months before those around them notice the signs.

Treating Fussy Eating or Eating Disorder

Due to the physical risks involved with eating disorders, it is important to link in with your GP. Your child will need regular medical monitoring while they regain weight, and recover from their eating disorder. They may also need a medical admission to hospital to support this.

The only evidence-based treatment for children with anorexia is family based treatment (FBT). Cognitive behaviour therapy and FBT are both promising approaches for children with bulimia. Families, particularly parents, are absolutely vital in the recovery from an eating disorder. In FBT, your therapist will give you the skills and the support to help your child eat and regain their life and vitality. Recovery from an eating disorder is often a difficult and tiring journey for the whole family, but with professional help recovery is possible!

A great resource for parents is the book “Help Your Teenager Beat an Eating Disorder” by James Lock and Daniel Le Grange. This can be found easiest online, or can be borrowed from me in our first session.

Tiegan Holtham psychologistAuthor: Tiegan Holtham, B BSc (Hons), M Psych (Clinical), MAPS.

Tiegan Holtham is a Clinical Psychology Registrar based in Loganholme, providing therapy from within a strength-based framework. Her area of special interest is providing support for children, adolescents and adults with eating disorders. She is a full member of the Australian New Zealand Academy for Eating Disorders (ANZAED) and the National Eating Disorder Collaboration (NEDC), is published in this area and has spoken at international conferences about new and novel approaches to eating disorder treatment.


  • Hurst, K., Read, S. & Holtham, T. (2015). Adolescent bulimia nervosa (BN): a new therapeutic frontier. Journal of Family Therapy (in press).
  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders: DSM-4 (4th ed.); 143-7. Washington, DC. American Psychiatric Publishing.
  • Bryant-Waugh, R. (2013). Feeding and eating disorders in children. Current opinion in psychiatry, 26(6), 537-542.