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Advice for parents, guardians and carers on how to support a child or young person if you’re concerned about their eating problems or that they may have an eating disorder

Many parents, guardians and carers are concerned about how their children, whatever their age, are feeling at the moment. We have lived through almost a year of the COVID-19 pandemic and social restrictions which have affected us all.

Some of our children have been unable to attend school, college and universities and students will continue to be away from for some time. For those who can access face to face teaching, the environment is very different which can cause anxiety, worry and stress.

At this time, it is understandable that children and young people may be feeling anxious and upset. Their life may feel unpredictable and out of control and their usual mechanisms of support through friends, family members and professionals more limited.

Children and young people’s attitudes to eating are affected by a range of factors and their appetite may change at different ages; this is normal. Problems can start to emerge when a child or young person feels under pressure. They may lose their appetite; or they may turn to food for comfort and eat even when they are not hungry; their worries about food may be related to their size or body shape or can be more about their emotions and self-esteem. Young people’s problems with food can begin as a coping strategy or a way of feeling in control but may lead to more restrictive or unhealthy patterns of eating or other harmful behaviours to lose weight, such as vomiting or exercising excessively.

During the COVID-19 pandemic, NHS services are working as usual so please ask for help if you or your son or daughter needs it. It’s important to access help early for anyone who may be developing an eating disorder.

What are the signs and symptoms?

The signs and symptoms of eating problems can vary from person-to-person. However, if you notice a combination of the following signs in your child then speak to them about your concerns and access additional advice and support:

  • Preoccupation with checking calorie or other ingredient content in food
  • Eating a restricted amount or range of foods
  • Binge eating
  • More controlling behaviours such as rules about eating, insisting on making their own meals or only using certain utensils and cutlery
  • Negative self-image about their weight and/or appearance
  • Secretiveness or avoiding eating with others
  • Feeling guilty after eating
  • Repeatedly weighing themselves
  • Vomiting after eating, or going to the toilet immediately after eating
  • Compulsive or excessive exercising
  • Abnormally low or high weight or changes in weight or body shape
  • Long-term weight stagnation or failure to grow
  • Complaining of poor concentration, dizziness, tiredness or feeling cold
  • Getting stressed at mealtimes
  • Low mood, anxiety or irritability
  • Social withdrawal

What should I do if I am worried about my child’s eating problems and I think it’s getting serious?

  • Take time to talk to with the child or young person you care for: Young people may find it difficult to accept that they have a problem or that may need help. Some young people may find it easier to talk while doing something together such as playing a board game or engaging in a craft or other activity. Find a time when you will not be disturbed and both of you feel calm. If they find it difficult to talk to you, encourage them to talk to another trusted adult such as a family member, teacher or GP.
  • Make time to listen to them: Create a calm safe space where they can communicate how they are feeling without judgement. Try to avoid saying things that could feel accusatory, critical or dismissive.
  • Try to understand the problems and provide reassurance that you have heard them and are there to help: Ask how they are feeling rather than focussing all the conversation on their eating or weight as this can often be more productive. Complimenting them on things other than their appearance can help the young person feel valued and is less likely to be interpreted negatively.
  • Encourage regular mealtimes as a family: Sitting down together for regular mealtimes as a family can help encourage social and healthy eating behaviours and help monitor any concerns about eating problems. Keep the conversation neutral.
  • Keep an eye on the young person you care for. Consider if eating problems persist, deteriorate and/or are impacting on the young person’s day to day living: Seek specialist health advice and support and increase vigilance, including checking if the young person is losing weight, developing secondary physical health symptoms (see list above) or accessing websites/social media content that is pro-eating disorders.
  • Help the child or young person you care for do positive activities which means they aren’t isolating themselves: Positive activities including safe contact with family and friends can provide a distraction from negative and intrusive thoughts and may help the young person open up about their feelings.
  • Provide structure and routine (including for sleep): Frequent changes to routine and restrictions can cause some children and young people to feel more anxious and upset. Many children and young people may also experience difficulties with their sleep. Providing structure through the development of daily and weekly timetables, including bedtime routines can be helpful in providing some predictability for young people in this unsettled time and distraction from negative thoughts.
  • Support children and young people with disabilities: Children and young people with disabilities including those with autism spectrum disorder or learning disabilities may find the impact of COVID-19 particularly difficult to manage. It is important to explain change and manage any anxiety and distress they may be experiencing as this may impact on their eating behaviours including restrictive patterns of eating or overeating. Seek advice if they are already in contact with specialist health and social care services or contact your GP. The National Autistic Society have helpful advice on their websiteon how to deal with this uncertain time.
  • Seek specialist advice and support quickly if you think the young person you care for has physical symptoms secondary to weight loss, suicidal thoughts or are self-harming: It is important that you do not ignore these and that you speak to a GP or crisis mental health help line urgently to get the right help and support – or contact some of the services detailed below.
  • Finally, as a parent or carer, look after your own mental health too: This will help you to best support yourself and those you care about. Remember to talk to your family and friends about how you are feeling and seek help for yourself from the NHS and other support services if it’s all getting too much.

What can I do if I am worried about my child right now?

During the COVID-19 pandemic services are still there for you, so don’t hold back asking for help.

If your child is currently being supported by your local Children and Young People’s Community Eating Disorder team, Children and Young People’s Mental Health Services (sometimes known as CAMHS), Paediatric Services or Children’s Social Care then you can talk to them if you are worried about them. ​ 

If your child needs urgent mental health support or advice, you can contact your local 24-hour mental health helpline. You can call the helpline for 24-hour advice and support for you and your child, to speak to a mental health professional or for an assessment to help decide on the best course of care.

For any other concerns about your child’s eating problems, mental health or physical health needs, you can contact your local Children and Young People’s Community Eating Disorder team or contact your GP for advice.

Where else can I get help and support?

It’s okay not to feel okay and looking after a child or young person who is unwell with their mental health can be very worrying. The NHS has online information on how to access help and support. Remember to look after yourself as well as your loved ones.

There are other support services available, too:

  • Public Health England’s Better Health Every Mind Matters campaigncan also provide you with helpful tips for yourself and children that can help maintain good mental wellbeing.
  • BEAT has designated pages to help parents and carers spot the signs that young people may be struggling with an eating problem including an eating disorder and also provides advice. You can also ring their helpline on 0808 801 0677.
  • MindEd for families; a helpful resource to increase awareness and understanding.
  • SHOUTprovides free, confidential, 24/7 text message support in the UK for anyone who is struggling to cope. Text 85258 for SHOUT the UK’s first 24/7 crisis text service on, free on all major mobile networks, for anyone in crisis anytime.
  • YoungMinds Parents Helpline is available for parents, guardians and carers and you can call them on 0808 802 5544; 9.30am to 4pm on weekdays.
  • Samaritans are an organisation you can ring if at any time of the day or night. You can ring them on 116 123. You can also email them: jo@samartians.org
  • If you are struggling with feelings of anxiety or depression, NHS talking therapies can help. Speak to your GP, or you can refer yourself online at nhs.uk/talk.

The NHS has also produced advice for children and young people, which you can find here.

Dr Prathiba Chitsabesan

Dr Prathiba Chitsabesan is the Associate National Clinical Director for Children and Young People’s Mental Health for NHS England.

Prathiba is a Consultant in Child and Adolescent Psychiatry working in a large mental health and community trust (Pennine Care NHS Foundation Trust). Lead consultant since 2005, she became Clinical Director in 2015 and continues to work clinically within a community child and adolescent mental health service in South Manchester. She graduated from Medicine (University of Manchester) before completing her MD, inspiring her interest in the needs of children and young people in contact with the criminal justice system.

Over the last 12 years she has published in journals and books and contributed to national reports and guidance for the Youth Justice Board and Office of the Children’s Commissioner.

She has contributed to the development of the Comprehensive Health Assessment Tool across the youth justice secure estate for the Department of Health and NHS England and continues to be research active as an Honorary Research Fellow and Lecturer for the Offender Health Research Network (University of Manchester).

As a clinical advisor (Greater Manchester and East Cheshire Strategic Clinical Networks), she has also promoted the development of regional clinical guidance across Greater Manchester.