May 31, 2008

Can a 3-year-old have an Eating Disorder?

I recently received an e-mail from a concerned stepmother. She was concerned that her 3-year-old may have an eating disorder due to genetic factors such as anorexia nervosa. Her stepdaughter was having some resistance to eating certain foods – especially healthy foods.

This question is potentially fraught. The danger is not that her 3-year-old may have a disease that manifests itself fully in adolescence, but that the family could be too focused and become transfixed by the concern that this is an “eating disorder”. This can result in struggles at every meal regarding food, and could indeed, in my experience, perhaps increase the likelihood that the child could ultimately develop an actual eating disorder.

Dear Dr. Fishman,

I was wondering if it’s possible for a mother to pass on an eating disorder to her daughter even if the daughter has never really known her mother. My partner’s daughter is 3-years-old and refusing to eat. She won’t eat anything except for potatoes and spaghetti, but even that is a struggle. We have tried a lot of different methods to try and get her to eat but she’s just not interested and often gets upset over it. It’s now at the point where she’s not gaining weight and losing her hair.

I am taking here to the doctor this week as I feel it can’t go on. Any ideas would be gratefully appreciated.

Concerned Stepmother,
Amanda*

*Not the stepmother’s name, which has been kept private for confidentiality reasons.

My reply was as follows:

Dear Amanda,

This is not an eating disorder like anorexia nervosa. It sounds like she does eat – just not the right things. And her eating gets more reluctant when the struggle emerges. It is a fine line to be concerned and vigilant and yet not have every meal turn into a power struggle. Your GP should be helpful in advising you of her ideal weight according to the norms for her age and build.

When there is enough food on the table, no child starves. They have a built-in hunger mechanism. For children this young, the parents are the ones who control the access to food. Limit the choices to better foods – but be flexible. In moderation, even occasional sweets are alright. The important point here is that meals don’t become battle grounds. That in itself is more dangerous than ice-cream!

Regards,
Dr Charles Fishman

9 Responses to “Can a 3-year-old have an Eating Disorder?”

  1. Gerald says:

    Hi Amanda, I’ve been searching the web for cases like this – my son demonstrates all the same symptoms though it has not yet reached a stage where he’s started losing hair. Meals are very regularly a struggle regardless of what the meal is. We now ask him what he wants for lunch / dinner and make that. But even then he looks at whatever is prepared and starts gagging.

    This usually ends up with him making himself throw up. His diet is severely limited to rice mixed with soup, nutrigrain (only recently accepted) and bread. He doesn’t eat any meat, nor vegetables and goes into the gagging-throwing up cycle if he sees either. We’ve tried lots of different foods prepared in lots of different ways but he either refuses to try them, or else will take a miniscule nibble then start gagging / throwing up.

    In the last week this has extended to drinking warm milk as well, which he nows absolutely refuses to touch (after a week of the gagging / throwing up routine). I have considered taking him to a child psychologist as I have never come across another case of children this young gearing themselves up mentally to be physically sick from looking at food / drink.

    We’ve also tried just not giving him anything to eat to work up an appetite but he has gone a day without eating and still isn’t interested when we give him something to eat after that. And I’m afraid if we do that his stomach will shrink and he will eat even less. This has been going on intermittently for about a year and a half, but seems to be slowly escalating month by month.

  2. Lisa says:

    We two have a 3 1/2 girl who makes herself throw up and to get her to eat is like pulling hair so to speak.she will tell us that she cannot eat and you ask her why and her reply is that she cannot eat. She will tell us she is hungry but when you give her the food she just looks at it and refuses to eat. she is starting to lose her hair and we are beside ourselves. even drinking milk she has a problem with it. How do you get counseling from a physcotherapist at three years old when they cannot even tell you what is going on? We are at an absolute loss as to what to do. As one replied, this behavior is getting worse by the day.

  3. Dear Christy,

    It sounds like your child has an acute, perhaps infectious problem.

    Eating disorders are chronic processes.

    Hopefully with a little time, input from your GP–and your loving attention, this should be readily resolved.

  4. cassie says:

    I have a three year old daughter who is going through the same things as alot of the other people have wrote on here, she gags at all foods, refuses to eat and is already very slim, but we have not noticed any hair loss. I grow more and more worried about this as she is very pale sometimes saying that she is constatly tired and seems to get ill very quickly (even though she may her her low immunity from me) I love her so much it kills me to see her not eat her food, she will eat fruit, infact loves bananas and grapes but then it comes to dinner or tea, the fight is on and she would rather sit there all night than to eat. Her 1 year olod brother eats EVERYTHING, and has a far better appetite, and i dont know if she is trying to rebel againt this??
    Im lost and dont know where to turn, there are tears, crying, tantrums, gagging, vomitting every single time we eat.

    My other half does not think doctors will be able to help and i suspect he think i am exaggerating the situation. But I want to be sure that there is no under lying problems that i am missing.
    Plus i read above that family stress can be the cause? My other half got “laid off” a year ago and has been unable to find anything in the current climate, obviously things are tight and pressure is high to provide for our children. I hope we have not caused this ourselves, i will be heart broken.
    Any advice is more than welcome x thank you

  5. Dear Cassie,

    Your daughter doesn’t have an eating disorder like anorexia. She’s too young. But I think I’m hearing that that you don’t seem to have a doctor you are comfortable with. That’s the first crucial step – finding a doctor.

    The problem may be stress related but getting a doctor you can relay on will be an important first step in decreasing some of your stress.

    May I ask where you live?

  6. christy hunter says:

    My daughter has not eaten solid for for 7 days she will only eat things like yogurt, tomato soup and baby food. If the food has an apple sauce like consistansy or any thing in it period she freaks out. Every time i mention food she panics. the doctor says she has a sore throat but she won’t even chew gum and she loves gun……. i am so worried this is something more than a sore throat

  7. Elizabeth says:

    My 3 year old sister in law is currently on the floor throw a fit about eating. Her accepted food list is: kraft easy mac, spaghetti, and uncle bens rice. But, if she sees any of the spices in the uncle bens or spaghetti, she declares its yucky and wont eat. Sometimes, and very rarely, she will try something new, and the last time that happened was thanksgiving. I’ve tried everything that I can think of to try (I’m a psych major in college), and nothing works. For the past 3 months, my mother in law has been babysitting a newborn, who is usually fussy and screams all the time. There is a lot of family tension, and its to the point where I find myself stressed too. Also, my mother in law doesn’t eat very much, and at the table she will use the same excuse as the baby: “I don’t like that”. I am picky as well, but I try not to mention when I don’t like something, I just don’t put it on my plate. My sister in law is adopted, so if it is not genetic from my mother in law. I just don’t know what to do anymore. It’s so frustrating. She is skin and bones as it is, and I know it will only get worse. I’m worried that if we punish her if she doesn’t eat (like making her stay at the table or sending her to bed) it will cause her to see eating as a bad thing, and translate to anorexia nervosa in her teens. I’ve tried bribing her with candy, toys, etc, and she just fusses. I’m at my wits end. Any advice? Anything is welcome.

  8. Thanks for you comments.

    Isolation can make eating disorders worse.The educational component of this site is the importance of address conflictual situations, which are involved in exacerbating eating disorders. A richer social network, and especially a good friend to support while you address conflictual issues can be invaluable.

    Everyone, please share you progress and even difficulties trying these ideas.

  9. Dear Lisa,
    First your medical doctor has to see and evaluate her–to be sure that their is no medical reason that should be addressed. If nothing is found, then stress in the family relationships should be assessed.

    Kids are very, very sensitive to stress in the family. A family therapist in your area should be able to help.

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Book: Enduring Change in Eating Disorders

Enduring Change in Eating Disorders - Book Cover

Dr Fishman is the author of 'Enduring Change in Eating Disorders – Interventions with long -term results' (Brunner-Routledge 2004).

This book presents the powerful and proven effective model of Intensive Structural Family Therapy and its application to the treatment of eating disorders.