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Information and resources to support children and young people with eating disorders in education and care.
Eating disorders are not a lifestyle choice or a cry for attention. Eating disorders are serious mental illness that have the highest mortality rate of any psychiatric illness affecting around 9% of the Australian population. Many people experiencing an eating disorder suffer from depression and/or anxiety. Suicide rates for people with anorexia are 32 times higher than the general population.
Eating disorders do not discriminate by age, gender, ethnicity or socio-economic status. Eating disorders not only impact on the person experiencing the disorder, but also on their family, friends and community. Eating disorders are particularly dangerous in young children, as they can escalate quickly and permanently stunt growth and development. They can be difficult to diagnose as children's body weight and nutrition requirements vary as they experience growth spurts. Eating disorders are not the same as fussiness, picky eating or eating difficulties.
Regardless of age, eating disorders are about underlying emotions, not food. Changes in behaviour with food could signal that a child is experiencing emotional, social or developmental issues such as depression, teasing, bullying or abuse. Often the eating disorder develops as a way for a child to feel in control over what's happening in their life.
Where there are concerns a child has an eating disorder the family should be encouraged to seek help from a health professional. Early intervention is important.
An emotional wellbeing care plan HSP400 (DOC 111KB) can be developed by a treating health professional in consultation with parents to describe additional care or supports required for children and young people with eating disorders in education and care services.
Types of eating disorders
Anorexia Nervosa is characterised by restrictive energy intake that leads to a person unable to maintain a normal and healthy weight. People experiencing Anorexia Nervosa have an intense fear of gaining weight or becoming overweight no matter what their current weight and appearance is.
Bulimia Nervosa is characterised by repeated episodes of binge eating followed by compensatory behaviours such as purging. People with Bulimia Nervosa also place an excessive emphasis on body shape or weight in their self-evaluation.
Binge Eating Disorder
Binge Eating Disorder is characterised by episodes of binge eating; eating a large amount of food over very short periods of time with no compensatory behaviours and feeling a loss of control during the episode.
Other Specified Feeding and Eating Disorders (OSFED) may present with many symptoms of other eating disorders but will not meet the full criteria for diagnosis of these disorders. OSFED is no less serious.
Disordered eating is a disturbed and unhealthy eating pattern that can include restrictive dieting, compulsive eating or skipping meals. Disordered eating behaviours, and in particular dieting are the most common indicators of the development of an eating disorder.
What causes eating disorders?
Eating disorders are complex mental illnesses with medical complications and it’s unlikely that an eating disorder will develop as a result of one single cause. It’s much more likely to be a combination of risk factors, including genetic vulnerability, psychological factors and socio-cultural influences.
Signs of an eating disorder
General signs that can indicate the onset or presence of an eating disorder can include:
- rapid weight loss or frequent changes in weight
- fainting or dizziness
- lethargic, low energy
- feeling cold, even in warm weather
- preoccupation with eating, food, body shape and weight
- feeling anxious around meal times
- changes in emotional and psychological state (depression, stress, anxiety).
The National Eating Disorders Collaboration (NEDC) have an extensive list of physical, psychological and behavioural warning signs.
Eating disorders and autism
The Autism Research Centre has identified new research that indicates girls with anorexia have an above average number of autistic traits and an above average interest in systems. This profile resembles that seen in many people with autism. Both conditions share similar alterations in structure and function of brain regions involved in social perception.
Autism is more often diagnosed earlier in males. This new research suggests that a proportion of young females with autism may be being overlooked or misdiagnosed because they present with anorexia.
The research provides new possibilities for intervention and management. For example, appreciating their interest that seems connected to body weight and dieting, may actually be more a sensory issue, a connection to ‘not noticing the need to eat’ and so on. Therefore, working on these issues helps to refocus the direction of any intervention. Recognising some people with anorexia may need help with developing social understanding and communication, as well as with adapting to change, is a primary reason behind anxiety.
Refer to the autism spectrum page for further information on autism.
Eating disorders and sensory processing
Sensory Processing Disorder (SPD) occurs when the brain has difficulty processing information through the senses. It is a spectrum that can affect one or more of the senses and usually with a combination of sensitivities. Many children who struggle with SPD are sensitive to things such as tags on the inside of a shirt, the sound of a vacuum, or might be uncoordinated. Many are picky eaters and orally defensive when dealing with taste, smell, sound and texture of foods.
Eating a meal is a complex sensory experience consisting of foods with ranging appearance, odours, textures and tastes; as well as other people contributing to conversation and hearing senses during meal times.
An association between feeding issues and SPD suggests that they are picky eaters, rarely eat the same meal as the rest of family, do not want foods to touch and may have aversions to tastes, textures and refusal of food due to odors. These are similar traits found with eating disorders. A severe dislike of foods due to texture, odour or taste can occur as the brain struggles to incorporate sensory messages regarding taste, sight, smells of foods. Lack of sensory regulation may emerge as avoidance around certain vital foods and nutrients.
The sensory overview support plan HSP431 (DOC 389KB) can be completed by the education and care service in consultation with the parents and child or young person. The sensory overview provides a detailed understanding of the individual sensory issues and assists in developing strategies to minimise sensory overload in the education or care setting during mealtimes.
Eating disorders and interoception
Interoception is a sense that helps you understand and feel what is going on inside your body. Children and young people who struggle with interoception may have trouble knowing when they feel hungry, full, hot, cold or thirsty. Poor interoception awareness is often a key feature of eating disorders.
Research suggests that improving interoceptive awareness and body responsiveness can help facilitate intuitive eating, decrease self-objectification, improve body image, and increase effective communication of emotions. The introduction of interoception into class activities can assist children and young peoples with eating disorders improve interoceptive and overall presence in and acceptance of the body.
An interoception support plan HSP421 (DOC 170KB) may be completed by the education or care service, family and the child or young person (where possible). This will provide a detailed understanding of the interoception issues and support the development of individualised strategies to increase interoception.
Refer to the interoception 101 (PDF 3MB) for strategies to incorporate interoception into class activities.
Refer to the interoception guide (PDF 610KB) for a summary of interoception, activities and benefits.
Children and young people with eating disorders may look like model students, often leading the class and being very self-demanding. Others may show poor academic performance. When children and young people with eating disorders are preoccupied with body image and controlling their food intake, they may have short attention spans and poor concentration. These indicators may also be due to a lack of nutrients from fasting and vomiting.
These children and young people often lack the energy and drive necessary to complete assignments or homework. Other implications for education include:
- absences for treatment of health problems because of eating habits
- side effects of malnutrition such as lethargy, forgetfulness and poor judgement
- possible periods of hospitalisation
- difficulty concentrating
- social withdrawal-mood swings/irritability leading to behavioural problems and social isolation
- failure to complete tasks or assessment because of increased perfectionism.
Early intervention is key to improved health and quality of life for people affected by eating disorders. Education professionals are ideally positioned to detect early signs and symptoms of eating issues and disorders.
The National Eating Disorders Collaboration (NEDC) have developed a guideline eating disorders in schools: prevention, early identification and response to assist education and care staff to understand eating disorders, promote health and wellbeing, recognise and response to eating disorders and support children and young people undergoing treatment for an eating disorder.
The Butterfly Foundation have developed an information sheet for education and care services to support students experiencing an eating disorder.
The Butterfly Foundation offers training and development for education and care services to support positive body esteem and resilience in young people.
Media Smart is an evidence based 8 lesson media literacy program developed by Flinders University suitable for girls and boys in late primary school or early high school. Media Smart targets media internalization which refers to when people believe they must look like the ideal images presented in the media. The program is suitable to be taught in a range of classes including English, Study of Society, Home Economics, Physical Education, Pastoral Care and Home Group.
An emotional wellbeing care plan HSP400 (DOC 111KB) may be completed by a health professional in consultation with parents or legal guardians for children and young people requiring support to manage eating disorders.
An oral eating and drinking care plan HSP210 (DOC 254KB) may be completed by a health professional in consultation with parents or legal guardians when a child has a high risk of choking or requires their food consistency to be modified or they need to be fed. Generally a child with an eating disorder does not require an oral eating and drinking care plan.
Health support agreement
A health support agreement HSP120 (DOC 243KB) and safety and risk management plan HSP121 (DOC 147KB) may be completed where a parent indicates their child has an eating disorder and requires additional support and assistance. There does not need to be a care plan completed by a health professional in place. The support agreement is completed by the parent and education or care service to document specific risk minimisation strategies, individualised management and treatment for the child in the context of the education or care service.
The Health Support Agreement should clearly identify cultural, spiritual and language needs.
Educational adjustments are designed to support children and young people on an individualised basis. Adjustments should be determined by the parents and education and care service and documented in the support agreement.
Examples of adjustments may include:
- avoiding high levels of competition
- identification of cues and triggers for anxiety
- identification of key school-based issues and development of appropriate strategies
- identification of a school mentor with regular contact
- recognising small achievements using positive reinforcement, communication strategies and feedback
- provision of a special area at school to eat lunch
- reduction of subject load, with regular reviews
- encouragement of independent study
- when returning from hospitalisation or time out of school due to the illness, plan for a successful return by reducing stress and providing accommodations as necessary
- work with the parents to understand how the disorder manifests for this young person
- extended time for tests and exams
- negotiated attendance arrangements
- access to regular counselling services from external agencies such as Child and Youth Mental Health Services
- access to regular support from guidance officer or other support services.
The Butterfly Foundation national helpline have counsellors that are experienced and trained in supporting people affected by an eating disorder. They can provide information, guidance and referral pathways over the phone 1800 334 673, online or by email.
Flinders University services for eating disorders offers a 10-session cognitive behavioural treatment to improve symptoms of disordered eating, such as binge eating, purging, fasting, and preoccupation with weight and shape. To find out more email fused [at] flinders.edu.au.
The Statewide Eating Disorder Service (SEDS) is a specialised mental health service for all South Australians. SEDS offer assessment, care and information for people with an eating disorder or where an eating disorder may be developing. SEDS provide quality assured evidence based care, education, training, professional liaison and carer support.
Child and Adolescent Mental Health Service (CAMHS) is a free community based mental health service provided through the Women’s and Children’s Health Network.
The Women’s and Children’s Health Network Child and Youth Health have developed information specifically for children about eating disorders.
ReachOut is Australia’s leading online mental health organisation for young people. Resources are available for young people, parents and schools.
- Eating disorders provides children and young people information about specific disorders and support services.
- ReachOut schools provides resources and information for teachers and school-based professionals.
- Schools resource information pack with a guide to curriculum links.
- HSP400 Emotional wellbeing support plan (DOC 111KB)
- HSP210 Oral eating and drinking care plan (DOC 254KB)
Health support agreement
- HSP120 Health support agreement (DOC 243KB)
- HSP121 Safety and risk management plan (DOC 147KB)
- HSP122 Offsite safety and risk management plan (DOC 148KB)
Planning and management tools
- Interoception 101 (PDF 303MB) - interoception explanation, interoception tracking sheet and interoception activities
- Interoception guide (PDF 610KB)
- Eating disorders in schools: prevention, early Identification and response
- Support students experiencing an eating disorder
- An eating disorders resource for schools
Disability and complex needs team
Phone: 8226 3620
Email: education.health [at] sa.gov.au