Childhood eating disorders: rates, risks, and treatment

Childhood eating disorders have become a major concern, and parents are understandably panicked when their child needs to be hospitalized and begin treatment for these life-threatening mental disorders. Anorexia is now the third most common chronic illness among adolescents. Eating and feeding disturbances affect about 19.8% of kids ages 11-17 and often begin earlier.

We are facing increased rates of childhood eating disorders. Hospitalization rates for eating disorders doubled in 2020 compared to the prior two years. For comparison, previous studies showed that eating disorder related hospitalizations increased by 18% from 1999 to 2005. And hospital stays for eating disorders now last about 50% longer than before, suggesting more severe eating disorders. Meanwhile, there was no difference in outpatient visits or hospitalizations for other mental health conditions. This suggests that eating disorders are unique in their increase.

If you are facing childhood eating disorders, you’re not alone. Here’s some information about childhood eating disorders to help you navigate this tricky chapter of your life.

Types of eating disorders in childhood

Binge eating disorder: the most common type of eating disorder. It involves periods of restriction followed by periods of binge eating. Most people only look for the binge eating part. But it’s important to look carefully for the restriction that often precedes it, as it is an essential part of the cycle and should be addressed during treatment.

Bulimia nervosa: the second-most common type of eating disorder. Bulimia nervosa involves periods of restriction followed by binge eating and purging. Purging behaviors may include vomiting, laxatives, overexercise, and other attempts to expel calories consumed. As with binge eating disorder, there is a danger in only worrying about the binge-purge cycle without attending to the restrictive cycle.

Anorexia nervosa: the deadliest eating disorder. Anorexia nervosa involves periods of restriction. This may involve cutting out entire food groups like sugars, carbs, meats, and fats. It often involves skipping meals and eating tiny meals, extreme food rules, and fears that worsen over time. Most assume anorexia has a physical look (emaciation). However, someone can meet all the criteria for anorexia, including physical symptoms like low heart rate, and not meet the minimum BMI criteria.

Avoidant/restrictive food intake disorder (ARFID): the earliest-onset childhood eating disorder. ARFID involves a lack of interest in eating, extremely picky eating, and food avoidance due to reasons other than weight loss. A major indicator is a constantly-shrinking list of safe foods and increasingly limited food flexibility.

What are common eating disorder risk factors?

Weight orientation: Most people who have eating disorders have a weight preoccupation. Our society is weight-focused, so this is a risk factor for almost every child. Children who have parents who worry about their kids’ weight are at higher risk of eating disorders.

Chaotic and/or rigid eating: People with eating disorders may be very chaotic in their eating habits, which means not eating regular meals, sneaking food, and eating larger or smaller quantities than would be considered normal. They may also have rigid rules dictating which food is acceptable and cut out foods.

Dieting: Teens who diet are up to 18x more likely to develop an eating disorder, and the most common precursor to an eating disorder is starting a new diet or “healthy lifestyle.”

Body image: Kids who are worried about their body image are more likely to develop an eating disorder.

Over-exercise: A sudden increase in exercise, including rigid exercise schedules and a need to constantly move to burn calories is a risk factor and a symptom of eating disorders.

Family history: Having another family member with an eating disorder is a risk factor for eating disorders. Additionally, family member mental illness, including anxiety, depression, and substance use disorders, can indicate a genetic predisposition to eating disorders.

High anxiety: Children with high anxiety, poor distress tolerance, and low emotional regulation are at higher risk of eating disorders.

ADHD/ASD: There is a strong correlation between ADHD and ASD and eating disorders.

LGBTQ+: Children who identify themselves as or suspect they may be LGBTQ+ are at higher risk of eating disorders.

Health conditions: Health conditions requiring dietary control like diabetes, cystic fibrosis, inflammatory bowel disease, and celiac disease put a child at higher risk of eating disorders. 

Vegetarianism: People who are vegetarian are more likely to have eating disorders.

Certain sports: some sports have been highly associated with eating disorders, including swimming, gymnastics, and running. 

What parents should do about childhood eating disorders

It’s understandable if the list of risk factors is alarming to you. Young children are at risk of eating disorders, and they are not rare. However, prevention is possible, eating disorders are not a life sentence, and effective treatments are available. The earlier they are caught, the greater chance of recovery. 

If you want to prevent eating disorders: 

Not all eating disorders are preventable. However, many are. Given the massive increase in eating disorders over a short period, we cannot blame eating disorders on genetics alone. Therefore, here are the things parents can do to prevent eating disorders in their homes.

1. Don’t diet or control your weight.
2. Don’t focus on weight as a standard of health, and teach children that low weight is not a requirement for health, success, beauty, etc. 
3. Don’t allow dangerous behaviors like cutting out food groups (e.g., carbs, grains, meat, sugar, etc.), dieting, skipping meals, over-exercising, and spending excessive time in the bathroom, particularly after eating. Talk about these behaviors and set limits to secure your child’s safety. Don’t worry that talking about things will make it worse. Address problematic behaviors quickly and consistently.
4. Practice emotional literacy and emotional regulation. Eating disorder behaviors help people cope with their emotional states, so training your child to have good emotional regulation is a major protective factor. 
5. Have at least one family meal per day. Family meals are protective against eating disorders.

If you suspect an early eating disorder: 

1. Take your child for a physical exam and check weight, heart rate, and other vital signs. This is not the only way to find early eating disorders, but it is an essential step. 
2. Seek individual therapy and/or family therapy to discuss disordered eating and treat other mental health conditions like anxiety, ADHD, ASD, etc.
3. Do not allow dietary changes like low-carb or vegetarianism or new, intense exercise programs. 
4. Work on family connection and belonging. Positive family dynamics always improve mental health, so create more opportunities to strengthen your relationships.

If your child has been diagnosed with an eating disorder: 

1. Get treatment for your child as soon as an eating disorder is diagnosed. This may include hospitalization, residential treatment, or outpatient programs. Your child should see a doctor, therapist, nutritionist, and possibly a psychiatrist, especially if there are other psychological conditions like anxiety, depression, ADHD, ASD, etc.
2. Get support and education for yourself. Find a coach, therapist, or support group to help you learn about eating disorders. You’ll need to change your behavior to create a pro-recovery household. You may also need to implement feeding programs like Family Based Therapy (FBT). It is very hard to do these things without guidance and support. You want to make sure that you are making significant changes alongside your child. 
3. Increase emotional validation. A child facing a mental health crisis needs increased emotional validation. You are not validating the behaviors, but you are validating their feelings. Get some support and guidance for increasing your skills in this area. 
4. Have clear and consistent boundaries. A major issue for parents facing a child’s mental health condition is that it’s very hard to set and hold clear boundaries. This is because the child is so distressed that it can feel cruel to hold them to expectations. However, boundaries are an essential part of recovery. Your child needs to know that you are strong enough to hold boundaries even when they are in distress. Also, you need boundaries for the sake of your own mental health. It will help nobody if you exhaust yourself in attempting to help your child. Parental burnout is a major risk factor for ongoing mental health problems, so your own care must also be a priority.

See Our Guide For Parenting a Young Child With An Eating Disorder