How to Help a Child With an Eating Disorder

Millions of people are affected by eating disorders, including children. Learn the warning signs and how you can help.

• National Eating Disorders Association (NEDA): With a toll-free hotline, chat room, and both online and text-based support, the National Eating Disorders Association is a great resource for those living with eating disorders and their families.

• National Association of Anorexia Nervosa and Associated Disorders (ANAD): Looking for help? A mentor? Perhaps you want peer-based support? The National Association of Anorexia Nervosa and Associated Disorders offers various resources and a treatment directory.

• F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders): Designed specifically for parents, F.E.A.S.T. will help you understand your child's disorder. They will give you the tools you need to support them in their recovery process, and F.E.A.S.T. can even help you find an appropriate treatment center or plan.

I’ll never forget the first time I thought I was “fat.” I was sitting on the steps of my Florida home, playing with dolls and bubbles and coloring with chalk. The air was hot, humid. Sweat poured from my brow and pooled between my legs, and it was those legs that struck me. Those legs which bothered me. Those sweaty legs which upset and unsettled me in a way I never knew.

Because I didn’t see any ol’ legs. I didn’t see strong legs or able legs or even scratched and scarred legs, which looked that way from playing kickball, football, and basketball. From climbing dozens (if not hundreds) of trees. I saw thick legs, ones which flattened as I sat—swallowing the rainbow-covered sidewalk and blocking out the yellow sun I drew that morning. Smothering it with a large swath of skin. I saw wide legs, which dimpled and puckered. Which were not “cute” like my classmates, all thin, smooth, and flat.  And I saw bulk. Chunk. Heft.

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Initially, I pushed the thought aside. I was distracted by Barbie’s big adventure with Skipper and Ken. But as the days, weeks, and months went on, things changed. My perception of my body changed, and what started out as a minor annoyance morphed into full-blown obsession. Before long, I was two knobby knees deep in an eating disorder.

Of course, I am not alone. Millions of people live with eating disorders. According to the National Eating Disorder Association (NEDA), more than 30 million Americans have anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, or other specified feeding and eating disorder (OSFED)—and many of them are children. Nearly 95% of those living with an eating disorder are between the ages of 12 and 25, though symptoms may present sooner.

"The typical onset of anorexia used to be 13 to 17 but it's dropped to 9 to 13," says psychotherapist Abigail Natenshon, author of When Your Child Has an Eating Disorder, and director of Eating Disorders Specialists of Illinois, a clinic in Highland Park. What’s more, the very youngest patients are getting younger.

"We're treating 6- and 7-year-olds with anorexia, and 11- and 12-year-olds with bulimia—a problem that used to be almost nonexistent in children," adds Ovidio Bermudez, M.D., medical director of child and adolescent services at the Eating Recovery Center in Denver. "It baffles the mind." The pressure is also growing for boys, who make up 5 to 15% of anorexia and bulimia cases.

The number of children dieting or complaining about their body—considered "gateway" behaviors to anorexia and bulimia—is rising too, says Lynn Grefe, CEO of NEDA. "We're hearing about first- and second-graders who ask, 'Mommy, do I look fat in this?'" she says. "More children are displaying an unhealthy concern about food and body image."

Here’s everything you need to know about eating disorders in children, from what they look like to how you can help your kid.

What Is an Eating Disorder?

According to the National Eating Disorders Collaboration (NEDC), eating disorders are serious, complex, and potentially life-threatening mental health conditions. “They are characterized by disturbances in behaviors, thoughts, and attitudes to food, eating, and body weight or shape,” the organization explains. “Eating disorders have detrimental impacts upon a person’s life and result in serious medical, psychiatric, and psychosocial consequences.”

What Are the Signs of Eating Disorders in Children?

Children with eating disorders may exhibit a wide range of symptoms. For example, those living with these conditions may have a fear of gaining weight or a distorted sense of self. They may exercise often and/or be overactive in sports, and most children with eating disorders have a preoccupation with food. They binge, avoid it entirely, or eat smaller portions.

There are other, more subtle signs of eating disorders, too. These include, but are not limited to:

• Personality changes. Those with eating disorders may strive for perfection and/or obsess over routines.

• Behavioral changes. Behavioral changes are common in kids with eating disorders. You may notice your child obsessing over numbers, for example. With things like calories in, calories out, clothing sizes, and/or their weight. Taking an extreme interest in grocery shopping or cooking can also be a sign something is amiss, and frequent trips to the bathroom usually signals a problem. Withdraw or avoidance—of life, social activities, family, and friends—is also common.

• Physical changes. Physical changes can also occur. Some people will lose their menses, for example, or experience the delayed onset of puberty. Others may experience hair loss, rapid weight fluctuations, or brittle nails, and constipation and digestive problems can also be signs of an eating disorder.

• Other. While most children with eating disorders will experience many of the aforementioned symptoms, adolescents may exhibit other signs. Grade fluctuations are common at this age. Wearing baggy clothes can also be a sign, and it’s important to note that youth eating disorders usually present in tandem with other conditions, like depression, anxiety, and self-harm.

How Are Eating Disorders Diagnosed?

Because eating disorders vary widely—in their presentation and symptoms—there is no one way to diagnose an eating disorder. Still, most doctors will follow a series of steps to determine if your child has an eating disorder, including a physical exam, a psychological exam, and a review of both the child’s familial and social history.

Physical exam

While there is no singular test to diagnose an eating disorder, your child’s doctor will perform an examination to rule out other medical issues. This will likely include taking their temperature, pulse, and blood pressure—and measuring their height and weight. They may also order lab work and/or other blood tests.

Psychological exam

Most psychological examinations involve a series of questions, and your child’s doctor (or mental health professional) will ask about their dietary habits. They will ask them to disclose more information about their thought processes and feelings, particularly as they pertain to their body’s weight, shape, and size; and your child may be asked to complete a psychological self-assessment or questionnaire.

Family history

Your child’s familial history will also be reviewed. This is done to determine if eating disorders, obesity, alcoholism, depression, and/or other mental health conditions run in the family.

Social history

Certain social situations are considered risk factors for eating disorders. Teasing, bullying, limited support, and acculturation, for example, can contribute to eating disorders. For this reason, it’s important for doctors to get a full understanding of a child's home and school life as well as their outside activities.

What To Do if You’re Concerned Your Child May Have an Eating Disorder

Whether your child has been diagnosed with an eating disorder or you’re concerned about their relationship with their body and/or food, there are things you can do to support them.

Listen to your child, without shame or stigma

It’s important to listen to what your child has to say. It’s also equally important to validate their emotions and repeat back what you’ve heard. “The most important way to support your child is to listen to them in a nonjudgmental way,” says Jan Hamilton, M.S., PMHNP-BC, CEDS, psychiatric nurse practitioner and certified eating disorder specialist from Embark Behavioral Health and Doorways Arizona. Ask them what they are feeling. Use open-ended questions, and encourage a stigma-free conversation. Let them know you are here to listen and help.

Ask questions—and offer support

According to Kara Becker, LMFT, clinical director for eating disorders at Newport Healthcare, conversations about eating disorders may be difficult or uncomfortable to have with your child, but they should occur. “Approach the conversation by making sure that your child understands that you are there to help and that you’re concerned about them, not judging or criticizing them. Use phrases such as ‘I care about you’ or ‘I’m worried about you.’ And ask questions. The goal is not to try to talk them out of the behavior,” she adds, “but rather to encourage them to seek help from a trained professional.”

Spend time with your child

According to Fairwinds Treatment Center, an addiction and eating disorder recovery center in Clearwater, Florida, “spending more time with your child is a great way to show your love and support. Choosing shared activities that you and your child can enjoy together is a good start.”

“Parents can also help their child find healthy coping mechanisms,” Becker adds. “Invite your child to spend time in nature, go to a yoga class, listen to music, or make art with you. Activities that create a sense of joy, flow, serenity, and safety help to change the neurological pathways in the brain. They can also rebuild the parent/child connection.”

Educate yourself about eating disorders

One of the best ways to support your child—and better understand what they are going through—is to educate yourself about eating disorders. Fairwinds suggests reading books, journal articles, and studies about adolescent eating disorders; listening to podcasts on the subject; and meeting regularly with a registered dietitian to discover “how you can plan therapeutic meals and select foods.”

Be mindful of the language you use

While it might not seem serious to you, the way you describe food and your body can have an impact on someone with an eating disorder. Avoid phrases like “I used to be so skinny” or “Does this make me look fat?” These statements may stir up feelings of guilt and shame in your child. It’s important to also look at the way you speak about food at home. Labeling food as “good” or “bad” can send confusing messages to children. Parents can role model a positive relationship with food and their bodies at home.

Get help, for you and your child

Once you’ve spoken to your child and educated yourself on the matter, it’s imperative that you seek professional support. “Getting your child to an eating disorder professional for an initial assessment is key,” says Hamilton. This can help them receive a proper diagnosis and, more importantly, proper treatment. You should also plan to get help for you and other members of your family.

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“After diagnosis, family involvement in treatment is essential,” says Becker. “Treatment that involves the entire family has been shown to be particularly effective for eating disorders.” It can also help you better understand your child’s mentality and what they may be going through.