More Than Food: Eating Disorders in Children and Teens, and How Families Help

It started as "eating healthier". At 14, Leah stopped having dessert, then snacks, then most of what was on the family table. She began running before school and took her plate to her room "to study". At first her parents admired her discipline. By the time her mother noticed how cold her hands always were, any mention of food could start an argument within seconds. If something like this is happening in your home, you did not cause it, and you have not missed your chance. Eating disorders are serious illnesses, and they are treatable, especially when they are caught early and parents are part of the team. This guide explains the main types, how they differ from ordinary food phases, and what the evidence says helps.

At a glance

Eating disorders are illnesses, not choices. The US National Institute of Mental Health (NIMH) puts it plainly: "Eating disorders are not a choice." They can be life-threatening, and with treatment, people recover.
They are more common than many parents think. In a national survey of more than 10,000 US teenagers aged 13 to 18 (Swanson and colleagues, 2011), about 3 in 100 had had an eating disorder, binge-eating disorder was the most common type, and most had never received treatment specifically for their eating.
Any child can be affected. The American Academy of Pediatrics (AAP) stresses in its 2021 clinical report that girls and boys of all ages and backgrounds can develop eating disorders, and that boys are often recognized late. The UK's National Institute for Health and Care Excellence (NICE) notes that risk is highest between 13 and 17.
Families are part of the first-line treatment. For children and young people with anorexia or bulimia, NICE's first choice is family therapy focused on the eating disorder.
It works. In a 2010 trial of 121 teenagers with anorexia (Lock and colleagues), about half of those who had family-based treatment were in full remission a year after treatment ended, compared with about a quarter of those who had individual therapy.

What it is, and what it isn't

Many children go through phases with food: a toddler who only eats pasta, a ten-year-old who refuses anything green. These phases come and go while the child keeps growing, eating with friends and enjoying life. An eating disorder is different. NIMH describes eating disorders as serious illnesses marked by severe disturbances in eating, often with a fixation on weight, body shape or control over food. They affect body and mind together, and rather than fading, they tend to tighten their grip.

The AAP report describes four main types, using the standard diagnostic definitions:

Anorexia nervosa: severely restricting food, driven by an intense fear of gaining weight or a distorted view of one's own body.
Bulimia nervosa: repeated binge eating followed by attempts to "make up for it", such as vomiting, laxatives, fasting or excessive exercise. Weight often looks average, so bulimia can stay hidden for a long time.
Binge-eating disorder: regularly losing control and eating an unusually large amount, often in secret, followed by shame and guilt, without purging.
Avoidant/restrictive food intake disorder (ARFID): eating too little, or too narrow a range of foods, not because of body image but because of fear (for example of choking or vomiting), a strong reaction to textures or smells, or very little interest in food.

ARFID or picky eating? Picky eating is common and usually harmless: the child grows well, eats enough from a limited menu and slowly accepts more foods. ARFID is diagnosed when the restriction has consequences. Under the definitions the AAP report uses, that means weight loss or not growing as expected, a nutritional deficiency, needing supplements or tube feeding, or eating problems that seriously disrupt daily life, such as being unable to eat at school. NIMH describes one sign as picky eating that gets steadily worse instead of better.

How it can look at different ages

Eating disorders can begin at any age, and the signs shift as children grow. The warning signs NICE lists for professionals are a useful guide for parents, too.

Younger children: a list of accepted foods that keeps shrinking; gagging, panic or refusal after an episode of choking or vomiting; very long meals; stomachaches with no medical cause. NICE notes that in children an eating disorder may first show up as faltering growth or delayed puberty. These patterns are typical of ARFID, which is not about body image.
Preteens and teenagers: NICE lists rapid weight loss, dieting that worries the family, a change in eating that family members notice, avoiding situations that involve food, preoccupation with weight or shape, periods stopping, dizziness, fainting and excessive exercise. The AAP adds a pattern that is easy to miss: becoming ever stricter about the quality of food rather than the amount, spending hours planning meals and feeling intense guilt when food routines are disrupted.
Signs of bingeing or purging: food disappearing, hidden wrappers, bathroom trips straight after meals, and the sore throat, swollen glands near the jaw and worn tooth enamel that NIMH lists among the effects of bulimia.
Boys: the AAP notes that boys are often identified late because eating disorders are wrongly seen as a female problem. Their focus may be on leanness and muscle, sometimes with purging or muscle-building supplements.
Higher-risk situations: NICE flags activities such as professional sport, dance and modelling, and difficulty managing a condition that affects diet, such as diabetes, where skipped insulin can be a sign.

Why it happens

There is no single cause. NIMH explains that eating disorders arise from a combination of genetic, biological, behavioral, psychological and social factors.

Biology and genes. Some children carry a higher inherited risk; eating disorders are illnesses of brain and body, not habits or attitudes.
Other mental health conditions. In the Swanson survey, most teenagers with an eating disorder also had at least one other condition, such as depression.
Dieting as a trigger. The AAP's 2016 report on preventing obesity and eating disorders notes that most teenagers who develop an eating disorder did not have obesity beforehand, but that some develop one while trying to lose weight. A diet, puberty or a stressful change can be the moment an underlying risk becomes an illness.
Teasing and bullying. NICE asks professionals to stay alert to bullying and teasing, and the AAP advises families to avoid weight talk and weight teasing at home.

Parents do not cause eating disorders. NICE instructs family therapists explicitly not to blame the young person or the family, and to treat the family as the main resource for recovery.

How it is assessed

Start with your child's doctor, and say exactly what you have seen. NICE recommends assessment and treatment at the earliest opportunity, and the AAP notes that the earlier an eating disorder is detected, the better the chance of a healthy outcome. The doctor will check heart rate, blood pressure, growth over time and blood tests, looking for the effects of restricting or vomiting. NICE also asks doctors to check for depression, anxiety, self-harm and obsessive-compulsive symptoms, which often come alongside.

One number does not decide it. NICE warns against using a single measure, such as body mass index or how long the problem has lasted, to decide whether a child needs treatment, and against relying on a screening questionnaire alone.

Referral. If an eating disorder is suspected, NICE recommends referring straight away to a specialist service for young people. The AAP prefers a team, usually a doctor, a therapist, a dietitian and often a child psychiatrist, with urgent hospital referral if a child is medically unstable.

What helps the assessment. Write down what you have noticed and when it began: skipped meals, food rules, exercise, bathroom trips after meals, mood changes, periods. Mention any family history of eating disorders, anxiety or depression. Expect your child to play things down; NICE notes that people with eating disorders often find it distressing to talk about and feel deep shame. This is part of the illness, not defiance. Only a qualified professional can say whether your child has an eating disorder; recognizing signs here is a reason to ask, not a diagnosis.

Treatment: what the evidence supports

Anorexia: family-based treatment first. For children and young people with anorexia, NICE advises considering anorexia-focused family therapy first, typically 18 to 20 sessions over a year. The therapist works with the whole family and supports parents to take charge of meals for a while. As health recovers, control is handed back step by step, until the young person has the independence that fits their age. NICE stresses that the parents' central role is temporary and that no one is to blame. In the Lock trial, this approach roughly doubled the rate of full remission a year after treatment compared with individual therapy. If family therapy is not suitable or does not work, NICE suggests individual cognitive behavioral therapy for eating disorders (CBT-ED) or adolescent-focused psychotherapy, each with family sessions.

Bulimia: family therapy, with CBT as an alternative. NICE recommends bulimia-focused family therapy for young people, typically 18 to 20 sessions over six months, in which parents and teenager work together to restore regular eating and reduce bingeing and purging. If that is not suitable, NICE recommends CBT-ED. In a 2015 trial of 130 teenagers (Le Grange and colleagues), about 4 in 10 who had family-based treatment had stopped bingeing and purging by the end of treatment, against 2 in 10 with CBT; a year later the gap had narrowed. Both help, and involving the family brought faster results.

Binge-eating disorder: CBT-based treatment. NICE recommends the same treatments for young people as for adults: guided self-help based on CBT, then group or individual CBT-ED if needed. NICE adds that weight loss is not a goal of this therapy, and advises against dieting during treatment because it is likely to trigger more binge eating.

ARFID: tailored care, with research catching up. ARFID became a formal diagnosis only in 2013. A 2018 review by Thomas and colleagues found no single proven psychological treatment for all its forms yet; approaches in use include family-based treatment, parent training and CBT adapted for ARFID, and trials are under way. In practice, a team helps the child try new foods in very small steps and keeps growth and nutrition safe meanwhile.

When hospital is needed. Most treatment happens at home and in outpatient appointments. NICE recommends emergency medical care for severe malnutrition, severe dehydration or dangerous changes in blood salts, and warns against discharging someone only because their weight has improved.

Medication. NICE is clear that medication should not be the only treatment for anorexia, bulimia or binge-eating disorder. A child psychiatrist may sometimes recommend medication for a condition that comes alongside, such as depression or anxiety, usually together with therapy. This is a medical decision made with the family.

What helps at home

Separate your child from the illness. Anger at the table or untrue answers about eating are often the illness speaking. Say so: "I'm not angry with you. I'm angry with the eating disorder, and we'll fight it together."
At meals, follow the team's plan and stay calm and kind. During treatment, parents usually decide what and when, and the child's job is to eat. Sit together, keep conversation away from food, weight and bodies, and do not negotiate at the table. "I know this is really hard. Food is your medicine right now, and I'm staying right here with you." Stay together for a while after the meal, especially if purging has been a concern.
Take weight and diet talk out of the house. The AAP recommends discouraging weight talk and weight teasing at home and promoting a healthy body image. No comments on anyone's body, including your own, no "good" and "bad" foods, no praise for weight loss, no family diets. "In this family we don't comment on bodies. We eat together, we move because it feels good, and every body here is welcome."
Eat together as often as you can. The AAP describes regular family meals as protective, and they let you see how your child is eating without turning meals into an inspection.
With ARFID, go slowly and without pressure. Keep one safe, familiar food on the plate and offer a tiny amount of something new without demanding it is eaten. Praise small steps, such as touching or smelling a new food. Bribes and battles make the table feel less safe; let the team set the pace.
Look after yourself and the rest of the family. NICE recommends support for family members, including those not in therapy. Take turns at meals with another adult where you can, give siblings time of their own, and ask the team about parent support groups.

Myths and facts

"It's a diet that went too far, or a teenager being vain." NIMH is clear that eating disorders are not a choice. They come from a mix of genetic, biological, psychological and social factors, and NICE notes that restoring nutrition is key to the psychological changes recovery needs. A malnourished child cannot simply decide to eat normally.

"You can tell by looking." NIMH notes that people with eating disorders can be underweight, average weight or above, and that even people who appear healthy can be extremely ill. This is why NICE warns against deciding on treatment from weight alone.

"Teenagers need independence, so parents should step back." With an eating disorder, the evidence points the other way for a while. NICE's first choice for anorexia and bulimia in young people is family therapy in which parents temporarily take charge of eating. Independence returns step by step, as health returns.

When to get help right away

Get urgent medical help, the same day, if your child:

faints or nearly faints, has chest pain, or a heartbeat that races, flutters or seems unusually slow;
is confused, extremely weak, very cold or unusually pale;
has stopped eating, or is drinking very little;
is vomiting repeatedly, misusing laxatives or diet pills, or, with diabetes, skipping insulin;
is losing weight rapidly;
talks about not wanting to live, or is harming themselves.

The Swanson survey found that every type of eating disorder was linked to more suicidal thinking, so if you are worried, ask your child directly. If your child talks about wanting to die or you believe they are not safe, call your local emergency number or go to the nearest emergency department, and stay with them.

In one sentence

Eating disorders are serious illnesses that no child chooses, and the sooner a child has a medical check and specialist treatment, ideally with parents at the center of the team, the better the chance of full recovery.

Sources

National Institute of Mental Health (NIMH), "Eating Disorders: What You Need to Know"
Swanson S.A. et al., "Prevalence and correlates of eating disorders in adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement", Archives of General Psychiatry, 2011
American Academy of Pediatrics (AAP), Hornberger L.L., Lane M.A., "Identification and Management of Eating Disorders in Children and Adolescents", clinical report, Pediatrics, 2021
American Academy of Pediatrics (AAP), Golden N.H. et al., "Preventing Obesity and Eating Disorders in Adolescents", clinical report, Pediatrics, 2016
National Institute for Health and Care Excellence (NICE), "Eating disorders: recognition and treatment", NG69, 2017, updated 2020
Lock J. et al., "Randomized clinical trial comparing family-based treatment to adolescent focused individual therapy for adolescents with anorexia nervosa", Archives of General Psychiatry, 2010
Le Grange D. et al., "Randomized Clinical Trial of Family-Based Treatment and Cognitive-Behavioral Therapy for Adolescent Bulimia Nervosa", Journal of the American Academy of Child and Adolescent Psychiatry, 2015
Thomas J.J. et al., "Cognitive-behavioral treatment of avoidant/restrictive food intake disorder", Current Opinion in Psychiatry, 2018

General information, not a diagnosis or medical advice. Only a qualified professional can assess a child.