Childhood Eating Disorders: What the Nanny Should Know

In July we began the teaching children to respect themselves and others. Anna P., a nanny from Bethesda, MD cares for a teen-aged girl that hurts herself. She explains, "I work for a blended family and one of the teen daughters is anorexic. Nothing is more important than helping children develop self-worth and self-respect. Do you have any articles about eating disorders?"

Kids are notoriously fussy and unpredictable when it comes to eating. Some children will only eat a peanut butter and jelly if the peanut butter is a certain brand, the jelly is spread a certain way, and the bread is cut just so.

Others will eat only a certain food for each meal, such as macaroni and cheese. Most often, these kids are healthy, energetic and growing well, and merely going through a phase. These types of cycles, while frustrating to the nanny, are not a threat to the health of the child and should not be of undue concern to the nanny.

Our focus will be on those behaviors that signal the possibility of eating disorders that negatively impact the health of the child and can plague the child into adulthood.

Eating disorders can be treated by trained medical practitioners. Treatment is easier and more likely to succeed if a diagnosis is made early and the approaches to treatment are coordinated.

The nanny can be the first to spot problems and the first to issue an alert to the parents.

There are a multitude of factors that influence the eating habits of youngsters. Among the pressures exerted on youth are those of the media, the family, and by peers. The emphasis by media on celebrities and sports figures can cause a child to have unrealistic expectations and poor self-esteem. Thoughtless remarks by parents about their own bodies or about the appearance of others can influence the body image of children. Cruel teasing by peers and the desire of kids to “belong” can also lead to bad eating habits.

As we are all well aware, boys and girls are different, and those differences sometimes extend to eating disorders and the reasons for those aberrant habits. While individual differences exist, girls tend to eat less in public and binge at home in private. Boys are less likely to be concerned about overeating in public and sometimes delight in bulking up to look like a wrestler or favorite athlete.

Both sexes tend to be more inactive than previous generations; spending more time on the computer, in front of the television, and on the cell phone. For some kids, eating differently than desired by the nanny or parent is a form of rebellion. Others like to defy societal pressures and be part of an” in group” by eating unhealthy and fattening food.

Girls tend to more sensitive to remarks about weight than boys. They are more likely to discuss it among friends Girls become embarrassed about their weight and body shape more intensely and more quickly than boys do.

Behaviors that indicate eating disorders might include regular bathroom trips after each meal (to purge} and suddenly wearing baggy clothes {to hide weight loss}. Another flagged behavior might be eating little or nothing outside the home while bingeing at home in private. Constant complaints by young girls about the kind and the amount of food served at home are another warning sign that nannies should watch. Adoration of a too-thin celebrity can also be troublesome.

Conversely, some girls may overeat because of fear. Overwhelming shyness, sexual abuse, or profound unhappiness may propel a young girl to overeat to render herself unattractive and avoid uncomfortable social interaction. The girl will find solace in the preparation and eating of food substituting mastery of the “accepted” female activity rather than facing the more stressful process of exercising and addressing underlying behavioral problems. The challenge to the nanny is to recognize that there is a problem and urge the parents to seek professional help.

Ninety percent of anorexics are female. Anorexics tend to be very thin and look unhealthy because of dry skin and dull hair. Bulimics, by contrast, seem to eat normally and maintain somewhat normal weight. The binge and purge cycle of bulimia causes dehydration, dental problems, and a series of internal chemical imbalances.

Childhood eating disorders usually start when a child starts attending school. For the school-age girl, the student’s perception of her social status plays an important role in determining eating habits and weight.

Girls with lower perceived social status at school have long term weight gain and seem to increase the risk for eating disorders. Especially dreaded is the prospect of getting weighed in public, as in the school nurse’s office or in gym class.

School age boys tend to eat more at school because friends and society are more accepting of a “manly meal” and of a diet that includes overeating among males than among females. Additionally, boys may feel that extra bulk provides them protection from bullies or others that they believe threaten their safety. Overeating is also a way that some boys feel erases the stigma of the student’s family being less affluent than other families.

The nanny should be sensitive to changes in behavior and to unexplained weight gain or weight loss so that eating disorders can be recognized and treated as soon as they appear. The eating habits of the child’s friends can alert the nanny to possible problems as kids like to imitate their friends. That penchant for imitation underlines the importance of the nanny and parents to act as role models in all matters relating to eating and body image.