Child Psychology Clinic Illawong  + 61 2 9541 1177

Child Psychology Clinic Westmead  + 61 2 9541 1177

The Feeding, Eating & Body Image Clinic

The causes for feeding and eating issues are complex. In some cases, feeding issues may be associated with a developmental delay or a neurological issue. In other cases, eating and body image issues arise from a combination of societal and individual factors interplaying. We live in a society which gives us messages about the importance of size and shape, we are constantly bombarded with messages that 'we aren’t good enough as we are' and 'the need to try this new diet/product/regime' to rectify this. For some people, specifically young people, being constantly surrounded by these messages and experiencing an individual life stressor such as peer pressure, unrealistic self-expectations, life crisis or transition focusing on their body or what they eat can become a way of coping or getting through these difficult times.

When the body is exposed to periods of restriction, starvation, binging or purging it endures a significant amount of distress. The medical and physical risks are significant even if the eating issue/disorder has only been experienced for a short time. This is especially the case in children and adolescents.

Early identification of an eating issue/ disorder is essential in children and young people since developmental milestones are not yet met, and the presence of an eating issue/disorder during adolescence can have a major impact on brain and body development.

At AzzA's clinic,  we receive many referrals in relation to Feeding issues in children (e.g. avoidant-restrictive, picky eating), Body Image issues in adolescents (e.g. binge eating/ yo yo dieting/ refusal to eat) and Eating Disorders in young adults (e.g. Anorexia, Bulimia, Binge eating). We provide several different types of psychological treatments which can be undertaken with an experienced psychologist via structured sessions. 

About The Feeding, Eating & Body Image Clinic

The Feeding, Eating & Body Image Clinic is a sub clinic of AzzA's Child Psychology Clinic that delivers individual, group and family based therapies to children and adolescents, who may be experiencing any type of eating issues/disorders including:

  • Anorexia Nervosa
  • Bulimia Nervosa
  • Binge Eating Disorder 
  • Avoidant and Restrictive Food Intake Disorder (ARFID)
  • Other Specified Feeding or Eating Disorder (OSFED)

We also take a much wider definition, assisting children, adolescents and young adults who may also have an unhealthy relationship to food or body image. E.g.:

  • Food is categorised as 'good' or 'bad'
  • Food control as a coping strategy
  • Yo-yo dieting
  • Food and/or how we look becomes primary focus of our lives

Taking a broader definition allows us to capture the bigger issues associated with the development and perpetuation of eating issues/disorders.

The clinic is supervised by Senior Psychologist Ms. Amanda Kenyon who holds extensive experience in working with children and young people with eating issues/ disorders delivering individual, group and family based therapies. Given the significant impacts eating disorders have on the physical body, the clinic usually works with mild-moderate cases and would refer out to other suitable services whilst working closely with General Practioners and hospitals.

We use evidence based therapies including Cognitive Behavioural therapy (CBT), Bevioural Therapy, Maudsley family therapy and Acceptance and Commitment Therapy (ACT) to assist children, adolescents and young adults. Our clinic works with you, for you and by your side to assist you and any of your family members' struggle against an eating issue/disorder. At our clinic, you and your loved ones will feel supported and guided throughout the treatment program towards a healthier mind and a healthier lifestyle.

Typical Versus Atypical Eating in Young Children

Assessing the underlying reasong behind "picky" or "selective" eating can be tricky when doing so independently. That is why, our therapists  working as part of our eating disorders sub clinic are able to assess underlying reasons, provide psychoeducation and further support, intervention and direction as needed. The following provides a helpful summary of the complexity of feeding and eating issues in young and school aged children:

What is typical eating?

There is significant variance in the development of eating habits, amount of food consumed and the types of food consumed that would fall within 'typical' eating habits of children. Children's eating habits are also very different to adults therefore we cannot use the same criteria to compare. Typical children's eating habits include the following:

  • They may eat one food item at each meal rather than a mixture
  • They may eat far less or far more than 'recommended' but still be healthy and developing appropriately
  • They prefer carbohydrates such as bread, pasta (which is needed for fueling growth and activity.)
  • Intake varies significantly depending on energy and activity such as during growth spurts or at times of illness
  • There is a normal decrease in intake when leaving the growth spurt phase of infancy
  • Children will refuse previously eaten foods and come back to them naturally on their own months later
  •  Learning to eat solids is a process that takes 2-3 years starting from approximately 6 months old (adjusted for prem babies)
  • Children with developmental delays will take longer to learn to eat.

As a child develops they pass through a few developmental food milestones as described below:

  1. Infants (6mo to 15 mo) – This stage is characterised by the transition to solids and self-feeding.
  2. Toddlers (15m to 4 years) – This stage is characterised by 'Caution and control', it is a stage of developmentally appropriate picky eating. Children are learning that they are individuals and have some control over what they do (and eat).
  3. Preschoolers and older (3-10 years) – This stage is characterised by 'Competence and Relationship'. At this stage children are motivated to please their parents, learn and try new things and feel competent.

How do I differentiate typical eating from feeding and eating disorders?

In order to differentiate typical eating from being something more, we can ask ourselves the following.

Are there emotional signs of distress around food??? – does the child cry or become upset around food, do they feel bad about eating.

Are there physical signs of nutritional deficiencies???- are they falling off their growth curve, do they have low energy or frequent meltdowns when hungry.

Are their social experiences impacted???- are they unable to go to or participate in social gatherings, sleep overs, restaurants, are they teased by their peers or getting excessive attention from family or teachers.

If you answered yes to any of these questions it may be worth further exploring your child's eating.

Why do feeding and eating disorders start in children?

Feeding and eating disorders can begin for a range of reasons as summarised below:

1. Medical – allergies, reflux, eosinophilic esophagitis (allergy related to erosion of esophagus), severe constipation, cardiorespiratory or muscular conditions effecting breathing (congenital heart defects, chronic lung disease, muscular dystrophy). All these conditions will make eating more difficult for a child.

2. Oral motor impairments – any issue that makes it difficult to get food into the mouth, chew, breathe, swallow or sit up can be a reason to avoid food or food groups. For eg: cleft palate, malformation of the trachea/oesophagus, dental issues, enlarged adenoids or tonsils or tongue tie. Also any jaw malfunction which impacts coordinated movements of the tongue and cheek, Poor chewing technique (biting and chewing with front teeth only) or limited movement of tongue (especially if unable to move side to side). 

3. Sensory processing disorder – Means that sensory input is experienced in a more intense or dulled way. Children may crave certain sensory experiences (spice, sourness, crunch) or be unaware of the sensation of food in their mouth. Some children with SPD will only eat uniform textures (all smooth or all crunchy).

Examples of sensory presentations:

  • Taste/Smell – only eating bland or strong flavours, same few flavours preferred, turned off by strong smells.
  • Tactile – wants hands wiped of any mess, or unaware of food all over face, not mixing textures, preference for crunchy, distracted by feet dangling at meal times, prefers food at certain temperatures.
  • Visual – only eats certain brands, finds patterns distracting, doesn't like bright lights.
  • Auditory – reacts to noise more than peers, prefers steady background noise, stressed long after after unexpected noise ends.
  • Sensory seeking – crave intense sensory input particularly seeking out strong and intense flavours, can be unaware of foul tasting foods, often bite tongue, drool or eat with mouth open.

4. Temperament/Mood – Children with feeding or eating disorders are often highly verbal and intelligent. They tend to be independent natured and want to do things 'on my terms, in my own way'. This can lead to them becoming increasingly frustrated when things don't work. They often feel and express intense emotions. They also tend to be sensitive to their parents agenda and pressure leading to increased risk of experiencing anxiety. Food refusal also links to shyness, emotionality and irritability. (Children with this independent temperament also often have toilet training issues and constipation for similar reasons).

5. Negative Experiences – If in the past eating or feeling hungry has resulted in an uncomfortable or scary experience, such as choking, food poisoning, vomiting, forced feeding or illness, appetite can decrease.

By: Amanda Kenyon, Psychologist at ACPC, Adapted from resource: Helping your Child with Extreme Picky Eating. By Katja Rowell.

Signs of Disordered Eating in Young People

The following lists some of the early warning signs of disordered eating:

  • Constantly think about eating or not eating
  • Feel out of control around food
  • Feel nervous or guilty about eating
  • Fear gaining weight
  • Exercise excessively
  • Binge eat, followed by feelings of guilt, disgust, or failure
  • Restrict food intake or starve for periods of time
  • Saying my stomach hurts, I'm not hungry often
  • Constantly talk about food but eat infrequently
  • Attempt to get rid of food by vomiting, taking laxatives, or exercising
  • Find that the scales establish how they feel about themselves
  • Eat according to a set of rules they have created and not according to when they feel hungry
  • Feel compelled to exercise even if they are tired, unwell, or injured
  • Feel that their body is never quite 'right'.

What to do if you are concerned?

A – ask to speak with the person privately

C – confront with concern and care

T – tell them what you see and why you are concerned

N – never continue with the conversation if it becomes too emotional

O – use conversation as an opportunity to learn about the persons experience

W – when you finish the conversation put a plan in place

Please seek professional opinion if you are concerned about your child/teen.

For any enquiries about our services please do not hesitate to contact our clinic

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Call: +61 2 9541 1177

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