Eating Disorders In Children: Treatment Approaches
Eating disorders in children treatment approaches aim to address the underlying concerns and needs of a child or adolescent struggling with an eating disorder. An eating disorder is a mental illness that causes adverse changes in eating behavior that are detrimental to physical and mental health, impacting one's health, emotions, and daily functioning.
When unaddressed, a child's unhealthy relationship with food can develop into a serious mental health condition, so holistic and intensive multidisciplinary interventions are often used to promote recovery. Below, learn about treatment approaches for children and adolescents and ways to support a child's recovery while fostering your mental health as a parent or caregiver.
Understanding eating disorders in children
Eating disorders in children are viewed as medical and mental health conditions that can affect anyone regardless of age, body size, or background. According to the Journal of Pediatrics, eating disorders affecting children and adolescents involve a range of behavioral conditions consisting of serious disruptions in eating habits and accompanying distressing thoughts and emotions. Eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder (BED), and avoidant restrictive food intake disorder (ARFID), among others.
Signs and symptoms of eating disorders in children
According to findings, around 22% of children and adolescents globally experience an eating disorder, and health visits for those under 17 with eating disorders doubled during the years 2018 to 2022. Signs and symptoms of an eating disorder in children include the following:
- Significant weight loss or rapid weight changes
- Intense fear of weight gain
- Weighing oneself repeatedly
- Preoccupation with body size, shape, and appearance
- Appearing distressed during mealtimes
- Tiredness and weakness
- Missed periods in females
- Increased sensitivity to cold weather
- Proneness to dizziness
- Excessive or compulsive exercising behaviors
- Arranging food unusually, such as cutting portions into tiny bites
- Avoiding participating in social gatherings involving food, such as going to a restaurant
- Frequently excusing oneself to the bathroom after eating
- Expressing the notion of being overweight when one is not
Having an eating disorder can pose medical concerns, including low heart rate, hormone changes, breathing difficulties, lethargy, changes in blood pressure, anemia, and mental health disturbances.
Common eating disorders in children
Children can be diagnosed with many of the eating disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Common eating disorders in children include the following:
- Anorexia nervosa: Anorexia is a condition in which one tries to lose weight by restricting food and excessive exercising, with possible intermittent binge eating and purging through vomiting or taking diuretics or laxatives.
- Bulimia nervosa: Bulimia causes a strong urge to eat extensive quantities of food (binge eating) followed by compensating behaviors for overeating. Compensating behaviors may entail purging through vomiting and taking diuretics or laxatives.
- Binge-eating disorder: Binge-eating disorder is characterized by being compelled to eat extensive quantities of food within a short time. Unlike bulimia, a person with BED does not attempt to purge food. Distress and feelings of shame or guilt often accompany binge eating.
- Avoidant-restrictive food intake disorder (ARFID): Children with restrictive food intake disorder may limit food intake for reasons unrelated to a wish to lose weight, such as low desire for food, aversion to certain foods and their textures or smells, or fear of the consequences of eating, such as choking. This food limiting may cause weight loss and malnutrition and impact a child's well-being and functioning.
- Other specified feeding or eating disorders (OSFED): Conditions classified under the OSFED category often meet other criteria for diagnosis but fall outside some parameters. For example, a teenager may have atypical anorexia nervosa by displaying all the features of anorexia without being underweight.
Causes of a child's eating disorder
Addressing eating disorders in children
Eating disorder treatment for children usually encompasses a holistic, multidisciplinary approach, including psychological, nutritional, and medical care to address possible complications resulting from malnutrition and other purging. For example, vomiting and the use of diuretics and laxatives may cause gastrointestinal problems. A pediatrician may screen for a suspected eating disorder with questions about changes in eating and exercise patterns and body image satisfaction. They may also review the child's medical, nutritional, and psychiatric history and provide a physical examination and psychosocial assessment.
Following assessments that confirm an eating disorder
Once a child receives an evaluation and possible diagnosis for an eating disorder, they can be oriented toward a treatment plan. Typically, treatment and recovery depend on the whole family to provide consistent support. Parents may be encouraged to monitor their child's eating behaviors, for example, and stay proactive in ensuring their child follows the treatment plan.
Treatment approaches for eating disorders
Once a diagnosis is made, children with mild dysfunctions may be treated by a pediatrician and therapists, receiving referrals for nutrition counseling and therapy with mental health professionals specialized in addressing eating disorders. Day treatment programs or residential settings may also be recommended for those who may benefit from more intensive treatment, and medication may be suggested for adolescents struggling with a mood disorder, such as depression. However, those who present an urgent need for medical care might be referred to a hospital or inpatient program.
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Therapeutic approaches for eating disorder treatment
Various types of therapy may be recommended by a provider, including but not limited to the following modalities.
Family-based treatment (FBT)
Family-based treatment is a type of psychotherapy (talk therapy) that involves the whole family unit in the recovery process. The main principles of FBT are that parents are not responsible for their child’s condition, eating disorders do not stem from dysfunctional families, and parents have a significant role in their child's recovery.
There are three main phases of recovery. The first phase focuses on restoring weight and nutrition, the second phase places some responsibility on the adolescent for their eating patterns, and the third phase involves more general concerns about the child or adolescent's psychological and social development. The child or adolescent undergoing FBT therapy may be weighed by the therapist, not a pediatrician.
Parent-focused therapy for addressing eating disorders in children and adolescents
As an adapted form of family-based therapy, parent-focused therapy focuses on the parents or guardians to limit the child's disordered eating behaviors and restore their weight. The therapist only meets with the parents after the initial meeting, during which the patient is also present. However, the child might continue to see a nurse or physician for mental health concerns and weight assessment.
Cognitive-behavioral therapy (CBT)
CBT for eating disorders seeks to reduce the distress associated with eating by changing the beliefs or behaviors that contribute to the eating disorder. For example, a teenager undergoing CBT may be encouraged to pay attention to thoughts around food and body image and how they react to uncomfortable situations and feelings that make them want to binge eat. They can learn healthier coping mechanisms to use instead of harmful behaviors.
Anorexia nervosa in children
The treatment of anorexia nervosa in children and adolescents may include nutritional counseling to restore healthy eating habits, medical care to address physical complications resulting from malnutrition, and therapy to examine the underlying factors contributing to the child's eating disorder. Often, a multidisciplinary treatment plan will seek to address physical as well as psychological aspects of anorexia nervosa.
Treatment for anorexia nervosa in children and adolescents
Therapeutic approaches to addressing anorexia in children and adolescents often involve the family. Considered the first-line approach for addressing anorexia nervosa in children and adolescents, FBT aims to provide a supportive environment to restore weight and improve eating habits, including the family unit in the treatment process. With FBT, parents or guardians are encouraged to monitor and restore their child's eating habits.
Other approaches for addressing anorexia nervosa or another eating disorder include but are not limited to the following:
- Adolescent-focused psychotherapy
- Cognitive-behavioral therapy
- Systemic family therapy
Parental mental health and a child's eating disorder
Taking care of a child with an eating disorder can present challenges to one's mental health and well-being, so families may find seeking support from friends, family members, or a therapist helpful in managing these challenges. Staying informed about possible ways to support a child struggling with an eating disorder and seeking guidance from healthcare professionals can also help. Moreover, watching out for your mental health may enable you to support your child's healing journey better.
Self-care tips to foster mental health while addressing a child's eating disorder
Self-care is a way for a loved one of a child with an eating disorder to protect their own well-being. Practicing self-care can mean the following:
- Doing activities that bring you joy and help you relax, such as taking a walk, taking a bath with essential oils, or getting a massage
- Seeking support from friends and other family members
- Considering joining a support group to share experiences with other parents navigating similar challenges
- Eating nutritious meals
- Getting adequate sleep
Considering therapy for mental health
Caring for a family member with an eating disorder can be emotionally challenging. Speaking with a therapist may help you devise solutions if you are concerned about your mental well-being. If in-person therapy is inconvenient or hard to access, online therapy through platforms like BetterHelp may be an option, allowing you to have sessions with a licensed therapist from the comfort of your own space. Through the platform, you can speak to a therapist by phone, video, or live chat, allowing you control over how you receive support.
Several studies support the use of cognitive-behavioral therapy delivered online to address mental health conditions like anxiety and depression. One study evaluated the effectiveness of internet-delivered CBT (I-CBT) in supporting the well-being of people who provide care for family members. The study's findings suggest that therapist-guided I-CBT may improve quality of life and reduce caregiver burden, anxiety, depression, and stress levels.
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