As parents, we fed their bodies and minds before they took it upon themselves. Now, we may need to ID their new needs and reframe the narrative at home.

If you’ve seen signs of disordered eating in your child, or perhaps they’ve received an eating disorder diagnosis, find out how you can support treatment within your home in this article.

In Part 1 of this guide, we focus on strategies for preventing the development of eating disorders in children.

In Part 2, we turn to the warning signs of eating disorders, how to get help, and some online resources for families wanting direction.

One of the best ways to help treat an eating disorder is to catch it early. If your child is developing an unhealthy relationship with food and eating, there are often signs that can indicate whether they may need some help.

Signs at school

It’s not uncommon for parents to miss the initial signs of an eating disorder. You know your kids so well, but that also means they know you. They know how to hide the things they may not want you to see.

This is why it might be a teacher, school nurse, or administrator who first brings concerns about your child’s relationship with food and their body to you.

Eating disorder flags at school

According to the National Eating Disorders Association (NEDA), school officials might report any of the following eating disorder signs to you:

  • obsessive behavior and perfectionism in all areas, from academics to food choices
  • sudden weight changes
  • changes to the eyes, either dark circles, bloodshot eyes, or burst capillaries
  • cuts, bruises, or calluses on the knuckles
  • pretending to eat, only to throw food away
  • frequent trips to the bathroom
  • suddenly wearing baggy clothing that hides their body
  • excuses to avoid the cafeteria, or works though lunchtime whenever possible

It can be jarring to have someone else approach you with concerns about your child, especially about things you feel like you should have noticed before an outsider.

But try not to get defensive if the school reaches out and suggests your child may have an issue.

Remember: They see your child in a setting you don’t. They have experience working with hundreds, sometimes thousands, of kids at a time — which means they’ve probably dealt with this before.

Signs at home

At home, you may or may not notice the above signs yourself. As we mentioned, kids are very good at hiding things from their parents when they want to.

Eating disorder flags at home

If you do suspect your child may be developing disordered eating habits, other signs you might notice at home include:

  • obsessively talking about, and trying to control, food intake and weight
  • suddenly refusing to eat certain foods they happily ate before
  • making up excuses to avoid meals with others
  • adopting new food rituals, such as only eating from certain food groups or avoiding certain food types altogether
  • intense focus on weight and weighing themselves
  • complaints of stomach cramps or nausea
  • dizziness and fainting
  • the growth of fine hair or what looks like “peach fuzz” on their face and body
  • complaints of feeling cold all the time
  • an increase in tooth decay and cavities
  • hiding food, which you may notice initially as excessive amounts of food disappearing from the kitchen

In your child 12 years old or younger

Most people assume that eating disorders start in the teen years. But many of the markers for eating disorders can be spotted in kids under 12 years old.

These signs of potential issues down the line include:

  • a history of being bullied
  • concerns about diet and weight
  • a preoccupation with food and establishing strict food rules
  • hoarding food and eating past the point of being full
  • the development of an anxiety disorder

Disordered eating patterns can start in the tween years, but there are other eating disorders that are known to appear much earlier in childhood. These include:

Both ARFID and pica can start as early as the age of 2, increasing in severity as a child grows older.

For these reasons, it’s important to never dismiss your gut feelings about what you’re witnessing in your own child.

If you’re noticing signs that your little one may be developing an unhealthy relationship with food, it’s never too early to reach out to your pediatrician and see what they think.

In your teen

The teen years are when most kids naturally start pulling away from their parents, even hiding pieces of their lives from the same mom and dad to whom they used to tell everything.

This is such a normal stage of development that it can sometimes be difficult for parents to separate signs of a potential eating disorder from those of the typical teenage need for privacy and independence.

Still, the teenage years are when signs of anorexia, bulimia, and binge eating disorder often become most apparent. In fact, researchers calculate that approximately 5.2% of girls will meet the diagnostic criteria for these conditions between the ages of 12 and 20, according to NEDA.

And 13.2% of girls will meet the criteria for nonspecific eating disorder symptoms during those same teen years.

That’s not to say teen boys don’t experience eating disorders, because they do. While reported cases may not be as many as reported cases for girls, about 25% of anorexia diagnoses do involve males.

And because their symptoms are often overlooked, they also have a higher risk of dying as a result of these conditions.

Both male and female athletes tend to have a higher risk for eating disorders in the teen years, especially athletes competing in sports that put a focus on maintaining a certain weight and body type, like wrestling or ballet.

But the teenage years themselves can be a risk factor as many kids struggle to fit in and figure out where they belong.

When to be concerned

Hearing your teenager talking about wanting to lose weight with their friends isn’t necessarily a reason to sound the alarm.

But it may well be a reason to sit down and talk with your teen about food and body image issues, if only to gain some insight into how they’re feeling.

When to call a doctor

If you notice any of the following, however, it’s time to call a doctor:

  • sudden or extreme weight loss or gain
  • food avoidance (e.g., no longer eating meals with the family)
  • hearing them say things like “I am so fat” or “My stomach is disgusting,” especially if these phrases are commonly repeated
  • finding hidden food stores in your child’s bedroom
  • finding food that seems to have been discreetly chewed up and spit back out, suggesting your child is only pretending to eat
  • hearing your child vomiting when they don’t tell you they are ill (can be common for people with bulimia to vomit with the shower or sink running in an effort to drown out the noise)

One of the common misconceptions about eating disorders is that they’re all driven by a desire to lose weight.

And even then, there are usually underlying factors — like the need to feel in control of something — that can come into play.

The truth is, eating disorders are about the brain, not the food. The various manifestations of eating disorders have a neurological foundation that presents in different ways but surrounds the topic of food and body.

Anorexia

Anorexia is what most people probably think of when they first hear the term “eating disorder.”

This condition is marked by extreme food restriction to maintain as low a body weight as possible.

Symptoms can include:

  • sudden and dramatic weight loss
  • food avoidance
  • always feeling cold
  • dressing in layers and baggy clothes
  • establishing strict food rules
  • excessive exercise after eating
  • an intense fear of weight gain
  • an unrealistic idea of what their body looks like

Avoidant restrictive food intake disorder (ARFID)

ARFID, unlike anorexia, isn’t tied to a desire to lose weight.

Symptoms can include:

  • sudden and dramatic weight loss
  • refusing to eat all but a few select, and specific, food items
  • fear of choking or throwing up

Binge eating disorder

Binge eating disorder is marked by repeated episodes of overeating and an inability to control what you eat.

Symptoms can include:

  • avoiding eating around others
  • hoarding and hiding food
  • expressing shame and guilt after binges
  • extreme fluctuations in weight
  • intense focus on food and eating habits

About 40% of those with binge eating disorders are male. The condition typically begins in the teens and early 20s, though it has been seen in even young children.

Bulimia

Like binge eating disorder, bulimia often involves eating a large amount of food at one time. Unlike binge eating disorder, binge episodes are followed by purging. Types of purging may include intentional vomiting, excessive exercise, laxative use, or a combination of these types.

Symptoms can include:

  • large amounts of food disappearing unexpectedly
  • frequent trips to the bathroom
  • foul breath or bloodshot eyes from vomiting
  • cuts or bruises on the knuckles from forced vomiting
  • drinking large amounts of water and other low- or no-calorie beverages
  • discolored, stained, or quickly eroding teeth

Symptoms appear to be presenting in increasingly younger kids underrepresented groups than in previous decades.

Pica

Another condition that can develop in early childhood, pica is generally diagnosed when a child repeatedly eats nonfood items over a period of a month or more beyond the toddler years.

Symptoms can include:

  • eating nonfood items, such as pebbles, chalk, hair, paper, or paint
  • being unable to stop eating these items, even when told that doing so could be dangerous or unhealthy

Other specified feeding or eating disorders (OSFED)

OSFED can be a bit of a catch-all diagnosis for feeding and eating symptoms that disrupt healthy mealtimes and weight but that don’t necessarily fit into one of the other prominent eating disorders.

OSFED can be just as serious and potentially life threatening as the other eating disorders already discussed.

Symptoms can include:

  • obsession with weight, diet, and food control
  • restriction of certain foods or food categories
  • trouble with constipation or abdominal pain
  • evidence of bingeing and purging
  • rigid exercise practices
  • mood changes
  • frequent dieting
  • dramatic fluctuations in weight

A note on concerning symptoms

Just because your child’s symptoms don’t line up perfectly with one of the more commonly recognized eating disorders does not mean they don’t have an eating disorder.

Any signs and symptoms of disordered eating habits, or a disordered relationship with food or their body, is a reason to call your child’s pediatrician.

If you’ve recognized any signs of an eating disorder in your child, of course you’re going to want to help them in whatever way possible.

The good news is, there are treatment options available — and there’s plenty of support for families caring for a child who has disordered eating behaviors.

Treatment

The American Academy of Pediatrics suggests pediatricians can, and should, play a large role in organizing and monitoring care for a child with an eating disorder.

If you suspect your child has an eating disorder, call their pediatrician. They can help you evaluate your child’s symptoms, determine how severe their condition may be, and consider next steps for treatment.

Treatment will depend on both the type and severity of their eating disorder.

For instance, ARFID is often treated with both speech and occupational therapy. Its goal is to address sensory feeding issues that may be leading to restrictive eating.

Severe cases of anorexia and bulimia may require a stay at an in-patient treatment center.

A child with a severe eating disorder may require more monitoring and care initially to get to a safe and stable place.

Your child’s treatment team will work together to ensure the best treatment plan is crafted for your child’s individual case. Mental and physical health will be addressed. Your entire family may benefit from the services provided.

Support

Your child needs support in seeking treatment and restoring health, and you may need support in processing the emotional weight that can accompany parenting a child through disordered eating to a positive self-concept.

As your child begins their treatment journey, remember it’s never too early or too late for you to begin your own.

Eating disorders for a child have a higher likelihood of developing if someone within, or close to the family, also has an eating disorder.

Family therapy can bring clarity and affirmation to help you work through your feelings about your child’s eating disorder and strategize coping strategies as they heal.

Support groups for parents of children with eating disorders can offer help, too, like Families Empowered and Supporting Treatment of Eating Disorders (FEAST). Family and friend sessions may be offered through your child’s treatment center as well.

A solid support system actually starts with cultivating a home full of transparency and free of judgment.

You can learn more about how to do that in Part 1 of this guide.