How to Help a Child with an Eating Disorder

Teen and Tween NutritionPediatric Nutrition
Written By Malina Malkani
How to help a child with an eating disorder

If you are a worried parent thinking your child may be struggling with an eating disorder or disordered eating, first, take a breath. You are not alone, and the fact that you are reading this article is a big step toward truly understanding your child and how to help. 

As a pediatric dietitian and mom of three girls, I have heard countless concerns and fears from parents in counseling sessions and personal conversations about their child’s eating behaviors. Sometimes questions include statements like, “My child has not been eating as much, and I am unsure if it is just a phase,”  or “I heard my child go downstairs late at night to hide and eat large amounts of food. Is this a sign of disordered eating?” 

The hard truth is that eating disorders, aside from binge eating disorder, are more prevalent in female tweens and teens, and as parents, it is okay (and even necessary) to ask questions at a young age to help prevent eating disorders from progressing. 

Eating disorders and disordered eating may not always clearly appear in the same light, as there is a range of different diagnoses. However, it is comforting to know that they are treatable, especially when interventions happen during the early stages. 

In order to best help a child who is struggling with disordered eating behaviors, it is important to get familiar with the most common eating disorders seen in children and adolescents, warning signs to keep an eye out for, what to do if you think your child might be struggling with disordered eating or have an eating disorder, and how to establish a strong support system to help them heal in body, mind, and heart. In this article, my goal is to help provide you with an actionable foundation of knowledge that will help make your next steps clear, should your child need help.

While this article focuses on general guidance for children of all ages, please see this article specific to female tweens or teens, which also includes detailed help on how to navigate their journey to recovery. 

Common Eating Disorders in Children

The prevalence of eating disorders among the general population doubled from 2000 to 2018 until it reached 7.8%, and the prevalence of eating disorders and disordered eating is apparently at 22.36% in the period from 1999-2022. 

In my career as a pediatric dietitian, I have noticed that families are often blindsided by how eating disorders can develop in their children in secret. 

The most common eating disorders among children include anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and avoidant/restrictive food intake disorder (ARFID). Other eating disorders seen in children that are not as common are pica and rumination disorder. 

While each eating disorder has its stark differences, they all embody a complex relationship with food and nutrition, physical, mental, and emotional health, familial support, and overall well-being.  

Any child can experience an eating disorder or disordered eating, and it is our job as parents to identify the signs and symptoms as early as possible to provide our children with the best support possible. With that in mind, let’s dig deeper into some of the more common types of eating disorders seen in children.

Avoidant Restrictive Food Intake Disorder

If your child only eats a handful of foods or reacts strongly to certain textures, smells, or even the idea of trying something new, as a parent, you might be feeling worried, overwhelmed, or even frustrated. While this may seem like “picky eating,” it can sometimes mean something more. 

Avoid Restrictive Food Intake Disorder, also known as ARFID, is an eating disorder that is characterized by limited food intake, often due to sensory sensitivities like specific textures, smells, or trying new foods. It is also associated with an anxiety or fear of eating or choking, and other food intolerances. 

ARFID is being diagnosed more often these days in toddlers and children, and while it may affect your child’s eating habits, nutrition, and quality of life, the good news is that interprofessional treatment teams are here to help. With a team-based approach that includes caring and compassionate therapists, psychiatrists, dietitians, and pediatritians, children with ARFID can open up to food again and learn to nourish their bodies in a way that allows them to thrive. 

Binge Eating Disorder

While ARFID is rooted in sensory issues and food fear, other eating disorders, like binge eating disorder, are often driven by increased emotions and stress. Binge eating disorder, or BED, is defined as overeating in a short amount of time past the feeling of fullness, where the individual has a loss of control over the amount of food consumed and often eats in secret. This disorder is often seen as a coping strategy for when the individual feels overwhelmed or has strong, heightened feelings. 

Children turn to binge eating as a way to cope with overwhelming emotions like anxiety, sadness, or stress. There may be subtle signs at first, such as eating in secret, sneaking and hiding food, or withdrawal or isolation after meals. Other signs may be unhealthy eating habits, such as not eating throughout the day or eating once a day.  For children with BED, food often becomes a safe haven and a temporary escape from feelings they cannot express out loud.

As a pediatric dietitian who works with mothers on a daily basis, I want to reiterate that this condition is not a parenting failure, but a call for help that your child needs compassionate and caring support. 

Anorexia Nervosa

Anorexia nervosa (AN) is a serious eating disorder that is characterized by the intentional restriction of food intake, leading to decreased body weight. Individuals with AN have a fear of weight gain associated with body dysmorphia. As a concerned parent, it can be heartbreaking to witness your child become anxious around food, avoid meals, or become increasingly obsessed with their weight or body image. 

These patterns happen gradually over time and can be mistaken as “healthy eating” or a more “active lifestyle,” but in reality, they may be early signs of restriction and AN. Just know that your child is not seeking attention or control; AN is very complex and not one’s choice. This eating disorder typically stems from other mental health conditions, such as anxiety, stress, or perfectionism. 

However, you do not have to navigate this alone. With the right support, healing and recovery for your child are within reach. 

Warning Signs of Anorexia Nervosa 

It may be important to familiarize yourself with the signs and symptoms of AN, especially if you are uncertain if your child is experiencing this behavior change. Some warning signs of AN include: 

  • Weight loss 

  • Fatigue 

  • Weakness 

  • Arm or leg swelling 

  • Stomach aches 

  • Decreased bowel movements 

  • Mood swings 

  • Anxiety 

  • Stress fractures or low bone density 

  • Difficulty concentrating or focusing 

  • Low appetite 

  • Low food intake  

Atypical Anorexia Nervosa

While anorexia nervosa is characterized by low weight status, there’s another form of this disorder that can be more difficult to detect. Atypical anorexia nervosa is similar to anorexia nervosa in that it is recognized by fear of gaining weight, body dysmorphia, and food intake restriction, except that individuals with atypical anorexia nervosa live in a weight range that is considered not underweight. 

While these individuals may be living in larger bodies, the eating disorder should be taken just as seriously and deserves the same level of care. Atypical anorexia nervosa involves the same physical health risks, emotional pain, and mental toll as anorexia nervosa. Please see this article for some clinical manifestations of atypical anorexia nervosa. 

Bulimia Nervosa

Bulimia nervosa is an eating disorder that involves binge eating followed by purging. Purging can include vomiting, laxative misuse, or exercise. Oftentimes, this eating disorder can go undiagnosed, as children can maintain a normal weight or often binge and purge in hiding. 

Some physical signs of and medical complications associated with bulimia nervosa include erosion of tooth enamel, swollen cheeks or jawline, salivary gland inflammation, and Russell’s sign (calluses or cuts to the knuckles) from self-induced vomiting. Other symptoms your child may be experiencing are abdominal pain, nausea and reflux, bowel irregularity, or fatigue. 

Additionally, you may notice other behaviors such as food obsession, increased bathroom use, wearing baggier clothes or more layers, or social and familial isolation, especially after meals. These signs and symptoms may go unnoticed, which is why it is important to keep an eye out and, if needed, offer your child support.

Signs of Eating Disorders in Children and Teens

As a parent, it can be hard to know what is typical and what might be a sign of something serious. While there may be more obvious signs of eating disorders, other signs may be subtle and easily overlooked. 

Consequently, it’s important to know what to look for: 

  • Fatigue, light-headedness, fainting, or dizziness 

  • Hair thinning or hair loss 

  • Mood swings 

  • Weight gain or weight loss 

  • Sweating or hot flashes 

  • Excessive food intake in a short amount of time 

  • Physical activity immediately after eating 

  • Excessive exercising

  • Restrictive eating

  • Hiding or throwing away food 

  • Social isolation 

  • Self-induced vomiting or use of laxatives

  • Large amounts of food disappearing from your home

  • Spending time in the bathroom during or immediately after meals

  • Wounds on the knuckles and hands

Mental Health Disorders

Often, eating disorders coexist with mental health conditions such as anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD). Supporting mental health through therapy and having open conversations with your child can help your child with recovery and promote resilience. Just know that these conversations are never just about food, but also must include your child’s mental and emotional health. 

For children, eating disorders and disordered eating are often used as a coping mechanism when trying to process difficult emotions. As a pediatric dietitian, I have seen firsthand the importance of combining emotional and nutritional care when it comes to eating disorder and disordered eating treatment.

**The intersection of care between mental and physical health is where real, hopeful recovery begins. 

Mental Health Professionals in Eating Disorder Treatment and Recovery

If your child is struggling with an eating disorder or disordered eating, no one healthcare professional can do it alone. It takes a village to treat an eating disorder, including a team of therapists, mental health professionals, doctors, and dietitians to provide children with the compassionate care they need for eating disorder treatment and management. We all bring a unique perspective and scope of practice to the table, and as a whole, provide necessary interdisciplinary care to create the right care plan for your child. 

With a team-based approach, mental health meets nutrition rehabilitation and meal support to give children a holistic treatment plan and path to recovery. Therapists help your child talk out their internal thoughts, stressors, fears, or traumas that may be associated with the eating disorder. Dietitians, like myself, support and guide your child back to a healthy eating pattern and ensure they’re getting adequate nourishment. Psychiatrists may also help with emotional and mental health and provide your child with any medicinal interventions as needed to create a stable foundation. 

As an interprofessional team, what we care about most is that your child and your family feel seen, safe, and supported throughout this journey. Therefore, with a coordinated team, we can meet you and your child where you are enter the path to recovery. 

Cognitive Behavioral Therapy 

Cognitive behavioral therapy (CBT) is one of the most gentle yet effective forms of treatment used to help children and adolescents heal from eating disorders and disordered eating. The core of CBT is to help your child explore their emotions and thoughts that might be detrimental to their relationship with food. If your child is experiencing fear around food or feelings of guilt and shame, CBT may be the answer. 

For children, eating disorders are typically not about food but about the underlying emotions. CBT helps children to come in tune with those thoughts, such as body dysmorphia, weight gain, or negative self-talk, and gently change them with more positive, realistic perceptions. Alongside nutrition counseling, CBT can make a huge impact on your child’s road to recovery. 

Feeding and Eating Disorders of Infancy or Early Childhood 

While picky eating or irregular mealtime patterns can be part of normal infancy and childhood development, there are certain feeding patterns and conditions that can be concerning early on in a child’s life. Two not-as-common but important feeding disorders that may occur during early development are pica and rumination disorder, both of which can impact nutritional status.

Pica 

Pica is defined as “eating non-nutritive, non-food substances over a period of at least one month.” This behavior must also be beyond socially or culturally acceptable norms and not associated with the child’s actual developmental stage. 

While some babies and toddlers are exploring different textures and tastes with their mouths, this goes beyond developmental behavior and can have some serious physical health concerns, such as choking, indigestion, or exposure to toxic substances. The most common non-food substances are hair, dirt, paper, or even paint chips.  

Pica can actually be related to some underlying factors, such as nutrient deficiencies, developmental delays, or sensory processing inabilities. For example, children with zinc or iron deficiencies may eat ice, soil, or clay. Additionally, pica can be used as a coping mechanism when your child is feeling stressed or anxious, which is why it is important to approach this disorder with compassion and open-mindedness. 

Rumination Disorder 

Rumination disorder can be difficult to identify, as it can be mistaken for nausea and vomiting or a food intolerance. This disorder is characterized by the repeated regurgitation of food, where food is often re-chewed and re-swallowed or spit out. That said, this disorder is a feeding and eating disorder that is frequently misunderstood. 

In many cases, rumination disorder can develop in infancy or early childhood and may be correlated to emotional or environmental distress. Your child may find regurgitation as a coping mechanism, especially if they have anxiety, sensory overload, or trauma. At first, the regurgitation may be involuntary, but after a period of time, this can develop into a disorder. 

Therefore, with the support of trained healthcare professionals, children and families can learn how to create new coping strategies and form a healthy relationship with food. 

Resources for Support and Next Steps 

If you are worried that your child may be struggling with an eating disorder or disordered eating, just know that you are not alone and there are steps you can take starting today. With early intervention, recovery and healing are within reach. 

Start by talking to your child’s pediatrician. Pediatricians can provide immediate interventions and screen for next courses of action, including consults to qualified healthcare professionals, including therapists, psychiatrists, and dietitians. Children will benefit from an interdisciplinary approach. 

Take time to explore trusted information from reliable resources: 

If you are unsure which level of care is the right fit for your child or you feel the need to urgently discuss options, a support organization or helpline may be the best choice at hand. Remember, asking for help is not a sign of weakness, but a sign of love and advocacy. As a concerned parent, you are taking the right path by being present, learning, and finding support for your child. 

Final Thoughts… 

If you are reading this, this means you care deeply about your child. Bottom line: watching your child struggle with their relationship with food and their body can feel stressful, but help is available.

Eating disorders and disordered eating are complex, but when intervened at the right place and time, your child can heal and thrive back to their normal self. Your dedication, presence, questions, and most importantly, your advocacy are powerful. Keep showing up, keep asking difficult questions, and turn to trusted clinicians and communities that can help guide you and your child forward. 

Thank you to my Dietetic Intern, Inna Espinoza, for contributing to this article.

Malina Malkani
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