Children with special needs are at greater risk of developing eating disorders

Children with special needs are at risk of developing avoidant or restrictive food intake syndrome, since, according to neuropediatrician at HM Nens Hospital, Dr. Miguel Angel Hernandez, “ritualized, restrictive and obsessive behaviors observed in disorders such as Autism Spectrum Disorder (ASD) and Obsessive Compulsive Disorder (OCD), affecting eating behavior, cause the appearance of symptoms typical of this disorder.

In particular, children with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), cognitive functional diversity, obsessive-compulsive disorder (OCD), and especially generalized anxiety disorder (GAD) are more likely to develop food avoidance or restriction disorder (TERIA), more commonly known in the community as childhood eating disorder.

The rigid, restrictive and obsessive behavior that they usually exhibit is an important factor in the emergence of this eating disorder (ED), which is usually diagnosed between the ages of 2 and 6. Thus, according to the Spanish Association of Pediatricians, 80 percent of the child population with any of these problems develop TERIA.

Although more knowledge and research on TERIA is needed, studies conducted to date indicate that the incidence among ASD cases is 18 percent; among ADHD individuals, 20 percent; and among TAG individuals, 60 percent.

THERIA is characterized by a high sensitivity to certain sensory characteristics of certain foods, restriction of the amount of food consumed, or the occurrence of traumatic experiences such as choking, vomiting, or other gastrointestinal symptoms, and is differentiated from anorexia or bulimia nervosa. There is no distortion of body image or fear of gaining weight. However, it may slow growth, cause significant changes in weight (loss, overweight, or obesity), and nutritional deficiencies.

Joana Toran, one of the nutritionists at HM Nens, explains that “these are children who usually do not feel very hungry, they show no interest in food or they have a phobia of foods they don’t like and they react very intensely.” “Their aversion may be related to texture, color, aroma, brand, etc. or to having experienced a traumatic experience such as gastroenteritis, choking or vomiting,” he adds.

The onset of TERIA usually occurs between the ages of two and six, but it can be treated and overcome. Treatment should be done with a nutritional approach to establish weight, growth patterns, as well as nutritional status and behavior, since it entails an impact on the patient’s functions and social life (refusal to eat at school, outside of school, unwillingness to go to camps, etc.).

Therefore, each case must be approached individually and multidisciplinary, requiring the participation of pediatricians, neuropediatricians, psychotherapists, endocrinologists, gastroenterologists, nutritionists, nurses and the family, which plays a decisive role.

Silvia Fernandez, head of psychological services at Her Majesty’s Hospital Nance, points out that “children suffering from TERIA are a source of frustration for families because they suffer when they see that they are not eating and they fear for their child’s health, so they need to learn appropriate behavior patterns to break the usual rules of behavior at home, and sometimes this is not easy. In many cases, these are overprotective families who have difficulty setting limits, which leads to the empowerment of the child, which in this case makes them a space, bad relationships are born in the family unit.”

In addition to family therapy, the child undergoes behavioral therapy based on food games to give them the opportunity to try them. It is important to involve them in their meals and give them decision-making power as they need to gain autonomy. Reward techniques are usually very effective. Cognitive behavioral therapy is also used to calm the anxiety that may arise when you know that mealtime is approaching or you have to sit at the table.

At HM Nens, children are treated through awareness groups. Games and activities are organised with a maximum of five patients, the aim of which is to touch food, put it in their mouth, notice it, appreciate it and finally taste it. They need to be gradually accustomed to it. Another campaign is Foodchaning, a method that involves establishing a chain between similar products. For example, if the child likes chicken nuggets, move on to breaded chicken, fried chicken, breaded fish, etc.

Coordination with schools is also very important to overcome children’s fear of food at school and outside the home. Thus, the HM Hospitales Monographic Children’s Hospital in Barcelona collaborates with educational centers and families so that children and school canteen staff are aware of the disease and know how to care for the patient.