1.1- Causes, signs and characteristics of Eating Disorders

What is an eating disorder?
Eating disorders are identified through an irregular attitude towards food which can cause any child to change their eating habits and their behaviour towards food. A child with an eating disorder may focus immensely on their body shape such as how they look and how much they weigh which can cause them to make seriously unhealthy choices about how they eat, resulting in a child damaging their overall health. Although some children might not know that they have an eating disorder. a

Eating disorders can come in many different forms such as excessive eating or not eating at all, of which can affect many different children throughout the world no matter their age, gender, religion, ability, etc. Some forms of eating disorders include:

  • Anorexia Nervosa

This type of eating disorder can have a serious impact on a child’s mental health due to it’s an eating disorder where they keep their body weight as low as possible by limiting the amount of food they consume and occasionally vomiting or over exercising. This type of disorder often develops out of anxiety of the fear of being fat and the wanting to be thin. Many children with this type of disorder sees themselves as being fat when they are not.

This type of eating disorder is more common in teenagers although it can occur  in children as young as 7 or 8 years of age. Estimated 90% of young children diagnosed with anorexia are female and the other 10 percent are male, however, these statistics are changings as more males are now being diagnosed.

  • Binge Eating Disorder (BED)

This eating disorder is when an child often has episodes of eating large quantities of food within a short period of time due to they lose control. Many children with this disorder eat even when they are not hungry but after they have binge eaten they feel guilty and even disgust. Binges are often planned in advance and can involve an individual buying “special” binge foods.

Children are who are overweight or obese tend to develop this disorder as they find comfort in consuming a large amount of food in a short period of time. Children especially when they are growing tend to eat more food as they find themselves needing more for energy and growth.

  • Bulimia Nervosa

Individuals who have bulimia try to control their weight by severely restricting the amount of food they eat, then binge eating and purging the food from their body by making themselves vomit or using laxatives. People with bulimia tend not to seek help or support very readily and can experience swings in their mood as well as feeling anxious and tense.

Often female teenagers will develop this type of eating disorder. Children with bulimia often maintain healthy weight or they can even be overweight but the way they proceed to lose weight is severely unhealthy.

  • Night Eating Syndrome (NES)

Night eating syndrome is not the same as binge eating disorder, although individuals with night eating syndrome are often binge eaters. Night eating syndrome is diagnosed when a child eats during the night with full awareness and may be unable to fall asleep again unless he/she eats. An individual may not eat anything that whole day until late in the evening and at night.

Some children with this type of disorder tend to have trouble sleeping which causes them to eat at night as they have no official routine. Children with this disorder tend to eat smaller amounts of food many times during the night almost like snacking constantly.

Causes of eating disorders in children
There are many different factors that can cause eating disorders in children. Some factors include:

  • Media
  • Family history
  • Low self esteem
  • Peer pressure
  • Difficult relationships
  • Stressful situations
  • Death of someone you care about
  • Traumatic experience

Signs and symptoms in children

  • Missing meals/ Not eating as much/ Saying their full after a few bites of food
  • Complaining of being fat, even though they have a normal weight or are underweight
  • Repeatedly weighing themselves and looking at themselves in the mirror (teenagers)
  • Making repeated claims that they’ve already eaten, or they’ll shortly be going out to eat somewhere else and avoiding eating at home (teenagers)
  • Cooking big or complicated meals for other people, but eating little or none of the food themselves
  • Only eating certain low-calorie foods
  • Feeling uncomfortable or refusing to eat in public places
  • The use of “pro-anorexia” websites (teenagers)
  • Sudden or rapid weight loss
  • Frequent changes in weight
  • Sensitivity to the cold (feeling cold most of the time, even in warm environments)
  • Signs of frequent vomiting – swollen cheeks/ jawline or damage to teeth
  • Fainting, dizziness
  • Fatigue – always feeling tired, unable to perform normal activities
  • Social withdrawal or isolation from friends, including avoidance of previously enjoyed activities
  • Change in clothing style, such as wearing baggy clothes (usually teenagers)

 

Importance of placement having this information8ffa05008ac150cc7120bdb8a169b3b4
It is crucially important that early years setting are provided with information on eating disorders as it allows them to become more aware of a common problem that can affect children of all ages. Through the promotion of more awareness it enables the staff within the setting to look out for any signs and symptoms of this condition so that they can help to support a child as soon as possible so that the child is able to get the necessary support immediately. By providing early years setting with information on eating disorders it enables them to work in partnership with the children and their families through the use of communication, for example: if a child is diagnosed with an eating disorder they can work together to promote self- esteem and self-confidence so the child is hopefully able to overcome this condition through time and support.

Also early years setting will be able to update their policies and procedures so that they included children who have an eating disorder, so that they are still included within the practice but the necessary adaptions are made. Some of the time children often feel that because they have an eating disorder they are different from everyone else and will isolate themselves from others, through educating early years setting it will enable them to prevent this as they will be able to reassure the child and provide them with the attention and care that they need so that they wont feel different from everyone else. Early years setting will be able to get appropriate training  so that they are able to respond appropriately when they are faced with a difficult situation. Early years setting need to know if a child has a medical condition as a school nurse will be able to draw up an individual health care plan for pupils with medical conditions.

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1.2 – Diagnosis and professionals involved

There are many different types of eating disorders known which can make it difficult for identifying a specific type. Early diagnosis in children plays a key role in helping to identify and for providing the correct support to possibly overcome the disorder and a quick and full recovery, but left untreated can result in the short and long term effects worsening overall having serious consequences on a child’s health.

When trying to diagnose a disorder a doctor will use physical and psychological evaluations. You must meet the criteria for a specific type of disorder in order to be diagnosed with an eating disorder.b

Physical exam– during a physical examination your doctor will check your height, weight, vital signs and also listen to your heart and lungs as eating disorders can cause high or low blood pressure, slow breathing and slow pulse rate. Also an examination of your abdomen may take place. Your doctor may also check your skin and hair for dryness, look for brittle nails. He/ she may ask about any other problems, for example: a sore throat or intestinal problems which could be possible symptoms of bulimia. Your doctor may also get an X-ray to look for broken bones which can be a sign of bone loss from anorexia or bulimia. An electrocardiogram can check for heart irregularities. Your doctor may examine your teeth for signs of decay, which is also a symptom of an eating disorder. 

Tests– Eating disorders damages the body especially the vital organs of which doctors may run different tests, which may include: a complete blood count, a liver/kidney/ thyroid function test and urinalysis. 

Psychological evaluations– a series of psychological assessments must be completed by a mental health doctor in order to appropriately diagnose an eating disorder. The doctor will ask multiple questions in relation to a persons eating habits. the overall goal is for them to understand your attitude towards food and eating but also how you perceive yourself. 

Professionals involved
There are many different professionals involved in the diagnosis and treatment of eating disorders in children, some of which include:

  • Doctor: this is the first person who you will see in the process of trying to identify a condition. A child’s personal doctor will conduct a serious of examinations to identify what eating disorder he/she have of which they will send the child on to another specialist who specifies in that profession.
  • Therapists:  These professionals plan and undertake therapy sessions and may practice various forms of psychotherapy, such as Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Family-Based Therapy, and more.
  • Dietitians:  These professionals specialize in nutrition rehabilitation and work with children and their parents to create and maintain a balanced meal plan so that the child can begin to become healthier again.
  • Physicians:  These professionals supervise and oversee any medical complications that may have resulted from the eating disorder, such as heart conditions.
  • Psychiatrists:  These health professionals prescribe medications and manage drug therapy. 
  • Councillors: This professional will communicate with the child and talk to them about how they are feeling and getting on with recovery, etc. 

(Roles of professionals involved listed above, 2.2: Pingback here)

Psychological counselling is generally seen as one of the most important eating disorder treatment as it involves seeing a psychologist and a psychiatrist who specialises in psychotherapy or another mental health counsellor on a regular basis. This helps the individual to be provided with the necessary support in order for them to change their attitudes and behaviour. Your psychologist or counsellor may ask you to do homework, such as keep a food journal to review in counselling sessions, and identify triggers that cause you to binge, purge or do other unhealthy eating behaviours. Counselling can help you to:

  • Normalise your eating patterns
  • Exchange unhealthy habits to positive ones
  • Learn how to monitor your eating and your moods
  • Explore healthy ways to cope with stressful situations
  • Improve your relationships
  • Improve your mood

Children’s treatment may involve a combination of different types of counselling, such as:a

  • Cognitive behavioural therapy= This short-term, structured treatment focuses on addressing behaviours, thoughts and feelings related to your eating disorder. After helping the individual to normalize eating behaviours, it helps you learn to recognize and change negative thoughts.
  • Family based therapy= With family based therapy, family members learn to help you restore eating patterns and achieve a healthy weight until you can do it on your own. This type of therapy can be especially useful for parents learning how to help a teen or a child with an eating disorder.
  • Group cognitive behavioural therapy= This type of treatment involves meeting with a psychologist or other mental health provider along with others who are diagnosed with an eating disorder. It can help children depending on their age to address thoughts, feelings and behaviours related to your eating disorder, learn skills to manage symptoms, and regain healthy eating patterns all in the comfort of a group who are experiencing what the individual is experiencing.

Guidelines for staff
Within any childcare related setting it is important that all staff members are aware of a child’s medical condition as there may need to be medication administered or in the event of an emergency a first aider or nurse must be present. If a child has an eating disorder it is important for staff to understand the condition by being able to identify signs and symptoms, know who is involved and what treatment is needed but also how to administer it. The staff members that work with the children must be aware of a child’s condition in the event that something serious happens such as the child refuses to eat or the emergency services have to be called for something more serious such as if the child faints. By providing the staff with guidelines it can reduce the chances of something serious occurring but also it provides them with knowledge about the condition.

2.1 – Process of referral

Once an individual has discussed with their doctor and he/she has undertaken some
examinations to identify if they have an eating disorder and what category they would fall under, such as under eating or over eating. Once your doctor has identified which category referring-doctor
you would fall under he/she will refer you to a specialist in that particular area. When you visit the specialist he/she will work with you to help identify the cause of the problem and treatment but also provide you with information about treatment options including, inpatient/ outpatient treatment, day programs ad community based support, or the specialist will involve other professionals such as therapists, etc to work with you to gain
the best treatment possible.

An eating disorder treatment team requires a multi disciplinary approach to address the physical elements, the behavioural and the psychological process of the condition. Each member of the team will vary depending on the needs of the patient but ensure that safety is promoted throughout treatment as rapid deterioration can occur in people with eating disorder and also heart problems from those who eat too much. A team could include a range of professionals depending on individual needs and treatment plans set in place. 

Specialist interventions may also be required by some patients to treat a wide range of physical health conditions such as gastrointestinal disorders, malnutrition, osteoporosis, damage to the teeth, infections, cardiac problems, kidney problems, diabetes, etc.

2.3 – Evaluate the importance of early diagnosis an intervention.

Early diagnosis and intervention is extremely important for the overall successful recovery of the patient due to it allows professionals to assist them in the treatment procedures so that they can hopefully overcome the disorder through time with the correct support provided but also educating them on their condition so that they can be more aware of how it can affect them.

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With an eating disorder it can not only affect a person physically but mentally which can cause a lot of pain and suffering. Diagnosis and intervention will allow the person to be relieved of pain both mentally and physically as they can talk with a psychiatrist to identify when and why the problem might have started but also help them physically through treatment reducing the amount of pain inflicted on themselves. 

An eating disorder would prevent an individual from participating in any sporting activity as they may feel ashamed of their body but also physically they would be unable, for example: if a person was extremely underweight they would be more likely to break bones or bruise easily or if a person was extremely overweight then they would find it difficult to keep up or participate because of other medical conditions they might have been diagnosed with such as asthma or depression. 

Also it could affect their education/ work as they will constantly be sick due to a low immune system, this can result in days off work/ school this can affect how well they do and what they learn. This can affect them in the future as it can be hard to get a job if they have no knowledge and ask of qualifications. 

The longer period of time the condition goes on without being identified and treated the more chances that the condition will worsen or other conditions can develop. This can be even more dangerous to health overall as it can cause a person to be physically or mentally unable to make rational decisions or the individual might make wrong decisions towards their health, for example: self harm. This in the long term can result in the individual from never being able to make a full recovery. 

3.1 -Evaluate a range of preventative measures to protect children against an eating disorder.

Eating disorders can have serious consequences to a child’s overall physical and mental health which is why it is vitally important to prevent it in the early stages of childhood so that the children can continue to grow and develop without any risk of injury both externaleating-disorder-3 and internal.

This condition cannot be prevented by immunisations as it is developed through how a person thinks and relates food to appearance which can change their behaviour. To prevent an eating disorder in children you must focus on behavioural strategies. For example: screening tests. Even before children are born there are different screening tests carried out to identify how well a child is growing, for example: an ultrasound or 3D image may be taken to see how the child is developing in the womb. Also when children are born a range of health professionals conduct certain examination to identify if they are meeting their milestones such as weighing them when they are born and underrating regular visits to see how much weight a child has put on or off.

There are many different types of behavioural preventative strategies that are put in place in order to protect children against an eating disorder. 

1. Meetings – Meetings between practitioners or parent- teacher meetings are important as it allows both staff and parents to communicate with each other or any issues that they feel may be causing the child to behave in certain ways. This allows the parents and school teachers to come to an arrangement of the methods they could use both in the school or home environment that would be the best alternative for influencing a positive behaviour towards food and appearance. Meetings enable the parents and teachers to evaluate the methods used by looking at how well the child’s behaviour is adapting when being in difficult situations. Meetings allows practitioners and parents to discuss how the child is progressing either positively or negatively by providing their feedback.

However, meetings can be difficult as they would have to be regular, almost everyday to be able to discuss how a child is developing as a child can have good and bad days of which is why parents and teacher must know to be able to put strategies in place for that day but also to be aware that the child is having difficulties. 

2. DiariesDiaries enable either a parent to write a description each day for a long period of time to see if the child’s behaviour in relation to food has progressed with the use of behavioural strategies being used within the home or school environment. From this it can be assessed by evaluating if the strategies are working by looking at how the child has progressed from the start until present day and the strategies that were used. Diaries allow the adult to write down what they see the child doing or saying, how or if the child eats that day, etc. 

Diaries can also present many problems due to they would have to be filled in everyday and some parents or childcare practitioners don’t have time to be filling out lots of information about how the child’s day went especially if it is a setting which all of the children are sent home with diaries. also if the child is old enough to read it can cause complications as he/she might not like to be talked about making them feel more self conscious. 

3.  Education- Parents and childcare practitioners can help to protect children from an eating disorder by being a positive role model themselves, for example: eating healthy, being productive and promoting self confidence but also educating the children that being different is good and that you don’t need to be skinny to look beautiful. Education is important as it allows children to accept themselves and how they look which results in high self confidence. bodyimage3

However, if there is a lack of education or the wrong type of education it can lower children’s self esteem but also they won’t be able to learn that difference is a positive thing. It can be hard to educate a child who already suffers from an eating disorder as they already believe that they are not “perfect” and seen as a waste of space, meaning that it can be hard to change their opinions. 

Prevention of cross- infection
Eating disorder cannot be passed on physically to another child through touch, etc. However, other children can develop over time this disorder through listening to other and imitating behaviour, for example: a child refusing to eat food and other children listen gin and then copying that behaviour over time, such as a child saying “I down like that” then another child saying the same thing even though they do. This can cause children to become picky eaters and develop bad habits. 

3.2 – Describe the policy for administrations of medicines

The administration of any type of medicine is extremely important as too little will have no healing effects and too music can result in an overdose. Within all childcare settings their is a policy for administering medicine correctly, my placement policy includes:medication-management

From time to time, parents request that the school should dispense medicines that need to be administered at regular intervals to children. These requests fall into three categories:

  1. Children who are suffering from casual ailments (coughs, colds etc)
  2. Children who require medication on a long term (cystic fibrosis)
  3. Children who require emergency medication (for example, adrenaline auto-injectors for anaphylaxis, salbutymol inhalers for asthma or emergency epilepsy medication).

Teachers and other members of staff are advised by their professional organisations not to administer medicine to children. Therefore, parents are responsible for the administration of medicine to their children and if a child needs a dose of medicine at lunchtime, ideally the parent should come to school to administer the medicine. For casual ailments it is often possible for doses of medication to be given outside school hours. The school does not administer medicines for casual ailments. If it is unavoidable that a child has to take medicine in school for treatment for a long-term illness to be effective then each individual case will be considered. Teachers are not required to dispense medicines as part of their contracts and any involvement would be purely on a voluntary basis.

For the school to agree to assist in administering medication:

  • Parents must complete authorisation forms
  • In the specific case of asthma, we are only willing to deliver the blue reliever inhaler, brown inhalers will be sent home again. You must request and complete a school asthma form, and return it to school. By doing so you will be asked to agree to keep and maintain a spare reliever inhaler and spacer in school at all times, and give us consent to use the emergency salbutymol inhalers if their own inhaler is missing for any reason.
  • The medicines must be brought into school in a properly labelled sturdy container which states: The name of the child, the name of the medicine, the expiry date, the dosage and the times of/ conditions when to administer.
  • Where possible the medicine should be self-administered under the supervision of an adult and stored in an appropriate place.
  • Care plans MUST be sent to school for all children with emergency medication. We are not legally allowed to administer emergency medication unless the Care Plan is in date and the medication matches that on the care plan.

Where long term needs for emergency medication exist, the school will require specific guidance on the nature of the likely emergency and how to cope with it while awaiting paramedical assistance. Written authorisation to administer emergency medication should also be provided by the child’s GP.

Procedure to administer medication:
Anaphylaxis.
It is imperative that all medication for anaphylaxis is:

  • In date
  •  Prescribed for the child in question.
  • The correct brand mentioned in the care plan.

Every class with a child with anaphylaxis will have a copy of the school procedure. This should be put on the wall in a clear and visible place for all staff to see. Please follow the school procedure exactly if there is a reaction. Prompt administration is vital for the effectiveness of anaphylaxis.

Asthma.
Asthma guidelines:

  1. Calm the child and loosen ties and top buttons.
  2. Make any child who is having difficulty sit backwards in a chair allowing their elbows to support their weight on the chair back.
  3. Get the child’s blue reliever inhaler from the store and administer 2 puffs using the spacer.
  4. DO NOT ASK THEM TO WALK ANYWHERE AT ANY TIME.
  5. Allow the child to use the inhaler up to four more times. If there is no improvement, send a message to the office to call an ambulance and the child’s parents.
  6. Allow the child to use the blue reliever as much as is needed until the ambulance arrives. They cannot overdose, and can do no lasting harm.

If a child is suffering from asthma and does not have their inhaler in school, then send for the emergency asthma kit at the office. All children suffering from asthma should have completed a consent form allowing the use of emergency inhalers. When using the emergency inhaler always inform parents that you have administered emergency salbutymol inhalers to their child.

Epilepsy
Only specially trained members of staff should administer emergency epilepsy medication for children. These children will already have a full care plan in their room with their emergency medication. This care plan must be strictly adhered to.

Evaluate a range of treatments and care routines for children with a type of eating disorder.
There are many different types of eating disorders which results in different methods used for helping to treat a child. In general there are some treatments available to children to help overcome an eating disorder. These treatments and routines include:physician-addiction-10-26-12

Routines – care routines such as breakfast, lunch and dinner can help to promote positive attitudes towards food, especially when a child is involved in the preparation as they can feel a sense of achievement. Parents can ensure that the children eat by providing healthy lunches and educating them on the importance of food but also being positive role models by eating healthy themselves. 

However, this can cause some complications when the child goes to school as he/she may refuse to eat because their parent is not there or they think that they can get away with it because teachers are not looking. 

Physical examinationBy undertaking physical examinations it allows for practitioners and parents to be able to identify if a child is gaining a steady weight, too much weight or not enough for their age and height. Physical examinations also enables you to see if there are any other medical problems that may be internal or external.

However, physical examination can also cause some problems because they would have to be done regularly resulting in a lot of time being spent in doctors surgeries to ensure that the child is putting on enough weight and eating enough food to ensure that they are getting the nutrients they need for proper growth and development.