[MUSIC PLAYING] My favourite food is pepperoni. Lasagna. Pizza. My favourite food is steak. Spaghetti. Oreos. My favourite food is cupcake. Don't like celery. I really don't like strawberries. Onions. Mushrooms. Baked beans. I don't really like cauliflower. It's just disgusting, I guess. [MUSIC PLAYING] Fussy eating is a relatively normal thing among children. I often think of it a bit like wetting the bed. All children wet the bed up to a certain age. And fussy eating is no different in the sense that it's one of the tasks of developmental learning, is to learn to in your mouth, to learn to process textures, and that can often manifest as fussy eating. Food is a vehicle that children use to explore their environment and to explore ideas around independence and control. Because it's one of the ways that they interact with their caregivers. It's also a way of expressing frustration and anger and distrust and so on. So you can also get periods of temporary fussy eating when a child is upset or angry. So it can be an expression of emotion in that sense, and also of learning to control the self and others. So when we start to call something an eating disorder is when those feelings and eating behaviour have got tangled up with each other to the extent that it's starting to influence somebody's physical and emotional well-being. So what happens in anorexia nervosa is somebody becomes very intensely fearful of being fat and of weight gain and become quite determined to lose weight in quite a deliberate way. So it's not a loss of appetite. It's a determined losing of weight. And, obviously, that can become quite dangerous. So the reason that people might know most about anorexia nervosa is that, unfortunately, in some situations, that can become life-threatening and require a young person to need to be in hospital. In bulimia nervosa, there are a lot of these similar thoughts and feelings to when a young person has anorexia nervosa. The difference is that there's a tendency in people with bulimia nervosa to overeat, and sometimes that can be exacerbated by emotions. So if somebody is feeling particularly upset or angry, that may lead them to overeat more. What happens in bulimia nervosa is that there comes a time when those overeating might be associated with feeling guilty, feeling bad, feeling ashamed of your eating behaviour, and that might lead a young person to decide that they need to eliminate that food. And that can include forms of purging, such as making yourself sick, but it might also include things like starving yourself to compensate for the fact that you haven't eaten or forcing yourself to do excessive amounts of exercise to compensate for the fact that you feel that you've overeaten. And those feelings of shame and guilt are what drives that vicious cycle between overeating and then purging behaviours. Binge-eating disorder is what it sounds like. It's binge-eating behaviour but without the purging and the compensatory behaviours. It sort of follows on from bulimia nervosa in that it, again, describes behaviour in which a young person, a child, has lost control over their eating behaviour. ARFID, or avoidant restrictive food intake disorder, is different from the others in that it isn't associated with thoughts and feelings about body weight and shape in the same sort of way. The three main types that we talk about are avoidance of food for sensory reasons. So this would be when fussy eating does start to veer into becoming harmful. So if somebody is so fussy that they are unable to eat in a normal social situation or if they're unable to eat enough of the types of foods that they need to for normal brain development or for normal physical development, that's when fussy eating has become a type of ARFID. And when I say sensory reasons, I mean things like the texture, the smell, the taste, the colour, the packaging of food might be what's making it difficult for a child or young person to eat that particular type of food. The other types of ARFID that have been described are phobic type of food avoidance. So, for example, if somebody suddenly develops a fear of being sick as a result of eating or a fear of choking, and that might be triggered by some experience that they've had, so they may have some sort of traumatic event, that would be-- and then they stop eating because they become fearful of eating because of the consequences. But those consequences are not about the impact on their weight and their shape. That's another type of ARFID. And then the third broad type are children who aren't really aware of their appetite, don't really get the signals and cues to eat, and so they become malnourished as a result of a lack of what we call interoceptive awareness, being able to read your bodily cues. Most people think that change in weight is one of the key signs of somebody developing an eating disorder, but, actually, that's quite a late sign. Because it often takes a little while for noticeable weight loss. And so the first thing a parent might notice is either a child beginning to be self-conscious about their body in terms of the way they dress, avoiding mirrors, not wanting to get changed in public, those sorts of things. And, of course, it's difficult to disentangle that from the normal self-consciousness that adolescents develop about their bodies as they change through puberty. In terms of changes in eating behaviour, with anorexia nervosa, what you might start to see is the institution of some rules about eating and rigidity about eating. So only being prepared to eat certain types of foods at certain times, in certain ways, prepared in certain ways, with certain people, and particularly avoidance of wanting to isolate and cut off from social interaction around eating. As it progresses, you might start to notice things like hiding food. Or in the case of bulimia nervosa, you might find that large amounts of food have gone missing, but very much secretively. So you might then find that somebody's been purging on a regular basis. So if somebody has been, for example, eating happily at a mealtime but then always disappears to the loo afterwards, that might raise your suspicions, particularly if it's associated with negative self-talk about the self and the body and changes in mood, changes in irritability, a sign that things aren't OK emotionally, wanting to withdraw from interactions, wanting to withdraw from your peer group. Those are the sorts of things that might make you think that something is not right emotionally. And if it's coupled with changes in eating behaviour and how somebody is behaving around their body weight and shape, those are the sorts of things might make you think, is this person starting to develop an eating disorder? As a parent, one of the things you can most do is help people think about their bodies in terms of what their bodies can do rather than what their bodies look like.