Eating disorders in children and teens often develop slowly over time. It’s not uncommon for parents to miss the symptoms of eating disorders.
Claire Kinney, MA, LMHC, NCC, CRC, child and adolescent eating disorder recovery therapist, and Mercade Millis, RD, LD, CEDS, child and adolescent eating disorder dietitian at Rogers in Tampa, share how to spot the warning signs and support recovery.
What are eating disorder symptoms parents should look for when it comes to children and teens?
Early warning signs of eating disorders include:
- Reduced intake of overall food volume or quantity: Your child may give excuses for not eating such as, “I already ate” or “I’m not hungry. I’ll eat later.”
- Fixation on “health and wellness”: You may notice your child following diets or fads, being preoccupied with appearance or weight, or eliminating entire food groups like carbs, sugars, or fast food
- Weight loss: Your child fails to meet expected targets on growth charts for height, weight, or body mass index (BMI). This can be concerning, even if the child’s BMI is still categorized as “normal” or was initially noted as “overweight,” especially if your child has fallen off those curves to a lower percentile. Work closely with your pediatrician before growth and development becomes significantly stunted.
- Heightened concerns about body image: Children are exposed to many messages about weight, food, and diet. While some body image concerns are normal for a teenager, parents should take notice if they become a daily focus, produce extreme distress, or lead to significant efforts to change their appearance.
Ultimately, parents know their child best, and if they have concerns, they need to trust their instincts and reach out to their pediatrician or an eating disorder specialist for help.
How do I encourage my child to accept treatment?
Accepting help is difficult due to stigma and shame surrounding mental health and treatment. Eating disorders involve a lot of secrecy. Often the person with the eating disorder doesn’t view their condition as problematic and may not be ready to give it up. As dangerous and detrimental as an eating disorder can be, it often provides a sense of safety, comfort, and control, which can make agreeing to treatment difficult.
Parents can help by:
- Remaining calm while explaining the process of entering treatment, why it’s needed, and how it will work
- Giving your child as much input as is appropriate and safe. Examples are touring a program’s facility together, sitting in on the screening call, or looking into treatment options online with them
- Reinforcing that you’re seeking treatment out of love and concern, even if it doesn’t feel like it. Try not to take it personally if the child lashes out or gets angry. That’s the eating disorder talking, not your child
At the end of the day, parents and caregivers have the final say. Eating disorders can be deadly, and parents need to make sure their child gets treatment, even if they’re not fully ready. They will eventually understand why their parents had to make the hard decision to initiate treatment.
How are parents involved in treatment?
Parents play an integral role in treatment plans and recovery. Eating and food is very social and important to a lot of families, which means they’re often on the front lines of eating disorder recovery.
Family Based Therapy: One of the most effective treatments for eating disorders in young people is Family Based Therapy, or FBT. FBT empowers parents to make decisions around their child’s eating with the support of the treatment team. Parents are well-equipped to feed their child — they’ve been doing it since birth. Additionally, they’re often in the best position to make the healthiest and most rationale choices around food when their child is grappling with an eating disorder and can’t do so on their own.
Cognitive behavioral therapy: Cognitive behavioral therapy, or CBT, is another effective treatment approach for eating disorders. It helps people change the behaviors and thoughts that maintain their symptoms. Even though CBT is a more individual approach to treatment, for young people, it’s still critical that parents are involved and supporting their child in practicing the CBT skills they’re learning.
At Rogers, eating disorder treatment is based in CBT. We incorporate FBT principles when working with young people and their families.
With the help and guidance of therapists and dietitians, parents are active participants in their child’s treatment and recovery journey through:
- Weekly meetings with members of the treatment team, such as doctors and dietitians
- Caregiver groups where they can learn from clinicians, share experiences with other parents, and receive support
- In outpatient programs, real-time learning and support through seeing first-hand the therapists and dietitians working with their child to having family meals with on-the-spot coaching by the treatment team
What are strategies for parents to support their child in eating disorder treatment?
We hear from many parents that they feel afraid or anxious because they don’t know what to say or do to support their child in eating disorder treatment.
We have five ways parents can help:
1 . Be mindful about how you talk about food and weight
Parents can say things about food or diets without realizing that it can reinforce unhelpful attitudes and beliefs for someone with an eating disorder, especially in recovery. Comments like “I shouldn’t eat that because it has too many carbs or is too high in sugar, fat, or calories” or “I could lose a few pounds” can unintentionally teach children to view food or their bodies negatively.
2. Move toward a neutral stance on food
Change language from “junk food” and “health food” to “fun foods” and “nutrient-dense” foods. Instead of saying, “Don’t just have chips for a snack; that’s junk food and not good for you,” try “Let’s have a cheese stick with our chips to add some protein and fat, which will make us full and energized.” Help children understand that ALL foods have a place.
3. Ease mealtime stress
Mealtimes can be challenging when you have an eating disorder. Trying to make food and eating fun again is a big part of recovery. Parents and caregivers can help by making the meal more enjoyable through light-hearted conversation or playing games to reduce any anxiety related to food and eating.
4. Watch how you talk about your body
When it comes to body image, we can model neutral body statements such as, “My legs allow me to walk and be active” instead of “My legs look too fat and have too much cellulite.” Express gratitude for WHAT our bodies do for us instead of HOW they look.
5. Share what you value about your child beyond their appearance
Saying things like “You’re a good sibling,” or “I appreciate how helpful you are” can help children learn that they’re so much more than their appearance and create well-rounded self-esteem.
How can parents partner with a child’s treatment team to reinforce progress at home?
Parents can partner with a child’s treatment team by:
- Working closely with the child’s therapist and dietitian to learn skills and feel confident providing support after treatment
- Practicing and modeling the same things as the treatment team
- Asking questions and being involved: You don’t have to be perfect in this process, but you do need to be present
What does eating disorder recovery look like for children?
Recovery varies from person to person depending on the type of eating disorder, the child’s age, and their motivation.
The goals of recovery from an eating disorder include:
- Achieving full weight restoration when needed, which means either restoring lost weight or catching up from failure to gain weight appropriately
- Being healthy and stable nutritionally, medically, and metabolically
- Building a positive body image to navigate our diet-centered culture. This doesn’t mean that the child will 100% love every aspect of their body or never struggle with an eating disorder or diet-centered thought again, but it does mean they’re more secure in themselves, their ability to combat those diet messages, and know that the least interesting thing about them is how they look.
How can loved ones stay hopeful and encouraging throughout the journey?
Remaining hopeful and encouraging can be one of the hardest things to do.
Due to the nature of eating disorders, those suffering are often very resistant to getting help and agree only when their situation becomes serious. Relapse rates are high: one-third to one-half of patients relapse within the first year after recovery.
Despite these challenges, there is hope! Understanding what recovery looks like can help parents best support their child:
- Recovery is not linear. There are ups and downs, but it doesn’t negate the progress and hard work that both parents and patients put in. Remembering this can help the tougher times seem a little more manageable.
- Recovery takes time. Since an eating disorder likely progressed slowly, recovery will take some time as well. Recognizing this can help alleviate some of the pressure parents feel to “fix” the problem immediately.
- Recovery involves small wins. Focusing on the end goal of full recovery like weight restoration, returning to “normal” before the eating disorder, or not dealing with food or body image anxiety, can feel overwhelming. Celebrating small wins, like using a coping skill during a meal, eating one bite of a fear food instead of totally refusing it, or even needing one less ounce of a supplement at a meal can help fuel that feeling of hope and help keep a sense of progress in recovery.
Rogers provides eating disorder treatment
When it feels hard to see a way forward, we can help. Our compassionate teams provide treatment that works.
Call 833-308-5887 for a free, confidential screening.
Early signs can include eating less, avoiding certain foods, focusing heavily on “healthy” eating, or becoming more concerned about weight or appearance. These changes can be subtle at first, so it’s important to trust your instincts if something feels off.
It’s common for children and teens to feel unsure or resistant to treatment. Stay calm, show care and concern, and keep the focus on their health and safety. Even if your child isn’t ready, parents can take steps to get support and guidance.
Focus on creating a calm, supportive environment. Use neutral, non-judgmental language about food and bodies, and try to make mealtimes as low-stress as possible. Stay involved with your child’s treatment team and practice the same skills at home. Small, consistent actions, like offering encouragement and recognizing progress, can make a big difference in recovery.
