Recognizing Eating Disorders In Children: What Parents Should Know

Recognizing the signs of an eating disorder in your child can be crucial for early intervention and effective treatment. Here, you’ll find a guide to recognizing eating disorders in children, including key symptoms for which to watch, common behaviors, and how to talk to your child about your concerns. You may find it helpful to speak with a therapist to learn how to more effectively support your child throughout their recovery journey.

Understanding eating disorders in children: An overview

Eating and feeding disorders generally refer to mental health conditions involving abnormal eating behaviors. Some tend to be rooted in body image concerns (like anorexia and bulimia), while others may involve psychological components like food aversion (ARFID) or overconsumption (binge eating).

Eating disorders appear to be growing increasingly common in children and adolescents, with more cases arising in groups that were previously less affected, such as younger children and males. 

These disorders typically develop around age 12 and often co-occur with other mental health conditions, including mood and anxiety disorders.

Recognizing signs of disordered eating

While some food-related behaviors may stem from a desire to improve well-being, those that become obsessive or extreme may be a sign of a deeper concern. Parents should be aware of patterns that could indicate disordered eating, including the following:

• Skipping meals regularly or fasting for extended periods
• Excessive preoccupation with calorie consumption
• Eliminating, rather than limiting, entire food groups
• Engaging in short-term “diets” rather than progressive lifestyle improvements
• Eating large amounts of food in a short period (binging)
• Purging behaviors (e.g., vomiting, using laxatives or diuretics)
• Excessive exercise specifically aimed at burning calories
• Guilt or shame associated with certain foods or eating in general
• Fixation on “clean eating” 

Causes and risk factors

The causes of eating disorders can be complex, often involving a mix of genetics, environmental triggers, and personal experiences. It may help parents to understand how these factors can put a child at risk, especially during puberty, when certain physical and social changes normally occur.

• Genetics: Genetics may predispose some individuals to traits like perfectionism, inflexibility, and anxiety, which can become more pronounced around puberty, potentially contributing to disordered eating. As such, parents might consider teaching and modeling healthy coping behaviors, which may mitigate the effects of these traits.
• Hormones: Hormones that affect hunger and energy levels (such as leptin, ghrelin, and cortisol) may also play a role, with certain hormonal abnormalities contributing to different types of eating disorders. Sex hormones that fluctuate in both males and females during adolescence have also been linked to the onset and progression of these disorders.
• Social media exposure: Recent research indicates that social media exposure may impact body image and self-esteem, particularly among children and teens. Parents should be aware of how constant exposure to idealized images, filters (digital tools that alter or enhance a person’s appearance), and messages about beauty standards may negatively affect young minds.
• Unhealthy weight loss strategies: Extreme or fad diets have frequently been linked to the development of eating disorders, as they often promote restrictive and unsustainable practices. Although updated evidence may be needed, studies on medically-guided weight control programs suggest that eating habit interventions focusing on overall well-being—rather than quick fixes—may reduce the risk of developing an eating disorder.

Diagnosing eating disorders in children and teens

Eating disorder types and symptoms: Anorexia nervosa, binge eating disorder, and more

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) recognizes a range of eating disorders. Though they can vary in severity and presentation, eating disorders are serious mental illnesses and can be fatal. Parents should seek evaluation by a healthcare professional if they notice concerning behaviors.

Anorexia nervosa

Anorexia nervosa is usually characterized by extreme food restriction, significant weight loss, and an intense fear of gaining weight. People with anorexia often have a distorted body image—they may perceive themselves as overweight even if they are underweight. 

A person can also be diagnosed with anorexia nervosa if they are of average or above-average weight. This condition is usually referred to as atypical anorexia nervosa.

Bulimia nervosa

Bulimia nervosa typically involves cycles of binge eating, in which a person consumes large amounts of food quickly, followed by vomiting, fasting, or excessive exercise to prevent weight gain. Parents can recognize bulimia by noticing if their child frequently goes to the bathroom after meals, or if they have cuts or calluses on the hands from purging, a common indicator known as Russell’s sign. 

Binge eating disorder (BED)

Binge eating disorder (BED) generally involves recurring episodes of consuming large amounts of food quickly without compensatory behaviors like purging (as seen in bulimia). These binges can involve a sense of being out of control, as well as feelings of shame and guilt. Weight gain, eating in secret, and frequent large meals or snacks are commonly seen in children with BED.

Avoidant/restrictive food intake disorder (ARFID)

ARFID usually involves extreme avoidance of certain foods due to sensory issues, fear of choking, or lack of interest in eating. Unlike picky eating, ARFID can cause severe nutritional deficits, often resulting in weight loss and problems with growth and development. It may be important for parents to differentiate between selective eating behaviors common in children and the more extreme food avoidance seen in ARFID.

Other eating disorders

The DSM-V recognizes several other eating and feeding disorders:

• Rumination disorder: This is a distinct but less common eating disorder generally characterized by the repeated regurgitation of food, which may be re-chewed, re-swallowed, or spit out. Unlike bulimia, this behavior is not usually driven by a desire to control one’s weight and does not involve binge episodes.
• Pica: Pica can be characterized by the persistent consumption of non-food substances like dirt, chalk, or paper. In general, this behavior is not culturally or developmentally appropriate and can lead to serious health issues, including nutrient deficiencies, poisoning, and gastrointestinal problems. 
• Other specified feeding or eating disorders (OSFED): This category can include atypical or borderline cases of anorexia and bulimia, as well as distinct disorders like night eating syndrome (in which a person binges at night) and purging disorder (in which a person purges to prevent weight gain, but does not binge). 
• Unspecified feeding or eating disorder (UFED): This label may be used when a person shows signs of disordered eating, but their symptoms don’t fit neatly into the more well-known categories like anorexia or bulimia. It can be a way for doctors to acknowledge that something serious is going on with your child’s eating habits, even if their symptoms don’t match the criteria for a specific disorder.

How to approach your child if you suspect an eating disorder

If you suspect your child may be living with an eating disorder, it can be important to understand the sensitive nature of the conversations ahead. Approaching with judgment or criticism could trigger defensiveness, but open, empathetic communication can encourage honesty and foster a supportive atmosphere. Here are some tips for starting a productive dialogue.

1. Practice empathy

While you may not fully understand your child’s feelings and experiences, recognizing the limits of your understanding and practicing empathy can be helpful. Try to understand that their secrecy may stem from their illness, rather than how they feel about you.

2. Be calm but direct

Approach the conversation with a steady demeanor, addressing concerns clearly without overwhelming your child or inadvertently sparking tension. It may help to reiterate that your parenting decisions come from a place of love and concern, rather than anger or frustration.

3. Avoid talking about their appearance

It may be advisable to center your child’s emotional and physical well-being. Comments about appearance can reinforce unhealthy behaviors and potentially exacerbate existing body image issues. 

4. Use “I” statements

Express your concerns by speaking from your own perspective. Phrases like “I’ve noticed…” or “I’m worried because…” may prevent your children from sensing they are being blamed or attacked.

5. Educate yourself

Learn about eating disorders to better understand what your child may be going through. The more informed you are, the better able you may be to offer effective support. 

Treatment options and support for children with eating disorders

Addressing eating disorders usually requires a comprehensive approach, including medical and nutritional interventions, as well as ongoing mental health support. Medical doctors specializing in eating disorders generally recommend a personalized nutrition plan and regular monitoring to ensure your child’s body receives the necessary nutrients during recovery.

Psychotherapeutic approaches like cognitive behavioral therapy (CBT), exposure therapy, and family-based treatment (FBT) are commonly used in the treatment of eating disorders. These approaches can help your child reframe negative thoughts and develop healthier eating habits. With FBT, you can expect to be actively involved in the therapeutic process.

Preventing eating disorders in children: Tips for discussing food and body image

As a parent, you can play an important role in helping your child develop a healthy relationship with food. Here are some tips to help prevent eating disorders:

• De-emphasize weight: Rather than focusing on the impact of habits like sleep, nutrition, exercise, and mental self-care on weight, emphasize how healthy habits can provide us with energy and clear minds.
• Promote self-compassion: Encourage your child to love and appreciate their body for what it can do, not just how it looks. Teach them to treat their body with kindness by keeping it nourished, active, and well-rested. 
• Lead by example: Children often mimic their parents’ behaviors and attitudes, so try to model healthy habits and demonstrate a positive relationship with your body.
• Limit media exposure: Minimize screen time and discuss how media, advertisements, and social media can distort views of attractiveness.

Mental health support for parents

It can be painful to see your child struggle with a mental health disorder, and it may not always be clear how to effectively approach intervention and treatment. Moreover, these parenting challenges can be mentally and emotionally draining. Many parents find it beneficial to seek mental health support of their own, as therapists often have valuable insights about eating disorders, family dynamics, and coping with stress. 

For a convenient and affordable support option, it may be worth considering online therapy. You can book sessions that align with your schedule, even outside of traditional office hours, and connect with a licensed professional who has experience helping parents of children with eating disorders.

According to a 2023 study, online therapy for parents can have “positive effects on reducing emotional symptoms in children and adolescents.” Therefore, attending therapy sessions online may equip parents with the tools they deserve to manage their own emotions and effectively support their children in healing from eating disorders.