How to help your child with an eating disorder stay safe

Nicki reached out to me when her daughter Kiara was scheduled to return from residential treatment for her eating disorder. “My biggest concern is her safety,” said Nicki. “And I mean both physically and emotionally. I’m just so scared that she’ll come home and slip back into the disorder. I worry that all the hard work she’s done so far will be for nothing.”

I get it. It’s scary to have a child return from treatment, and of course you want it to stick. All most parents want is for their kids to be healthy and happy. Nicki’s concerns for Kiara’s emotional and physical safety are valid and important. 

Here are 4 things parents can focus on to help a child in eating disorder recovery stay safe:

1. Feeding structure

Most kids with eating disorders don’t want parents to impose a feeding structure; quite the opposite! They’ll ask for more flexibility and try to negotiate around any eating boundaries you create. And yet a feeding structure is vital to physical and emotional safety during eating disorder recovery.

Early recovery rests heavily on weight restoration, and any dips in weight are a reason for concern. Many experts say that the psychological work of eating disorder recovery can’t truly begin until full weight restoration is attained. 

The best way to minimize the risk of weight loss in recovery is to insist upon a feeding structure. This means parents take over feeding responsibility (plating and serving meals and snacks) completely in the beginning. As kids reach recovery milestones, parents can gradually and with checks and balances shift responsibility in an age-appropriate manner.

No, your child will not like you insisting on a feeding structure. But it’s like the seatbelt in a car: it’s not optional. Just because a kid tells us they don’t need to wear a seat belt every time they’re in our car, we still insist that they wear one. We insist because not doing so is a risk we’re not willing to accept. A parent-led feeding structure is necessary to help your child stay safe during eating disorder recovery.

2. Professional support

Monitoring your child’s physical and mental health in recovery should continue for a substantial amount of time after full weight restoration is achieved. Ideally, your child should see a medical doctor, a registered dietitian, and a therapist. The schedule and format of these check-ins vary widely. You can ask each provider for their recommendation in terms of how often your child should see them. 

As long as your child is under 18, under your care financially and/or physically living with you, you can insist on a minimum level of ongoing check-ups. You’ll want professional providers to monitor your child’s physical and mental health for as long as possible. 

I’m a big fan of therapy, but most parents tell me their teens don’t like going to regular therapy appointments. If this is the case with your child, you can possibly be more flexible with therapy. However, this applies only if your child is steadily improving in other areas of their recovery. 

For example, if they’re meeting weight restoration goals and being monitored by a medical doctor and dietitian, at least one of whom has specific training in eating disorder treatment. In these cases, psychotherapy may be less essential right now. Another option if your child doesn’t want to go to individual therapy is family therapy. Family therapy can be just as helpful, sometimes even more so, as individual therapy.

3. Relational safety

Someone with an eating disorder is struggling to feel emotionally safe and secure. Anxiety and worry about weight, food, and exercise typically linger even when you’re seeing a reduction in other symptoms. It takes time to fully recover and enjoy life without those worries. And they’ll usually also have anxiety and worry in other areas of life. Luckily, parents are well-equipped to provide emotional safety and security to their kids. Children are born seeking security in a relationship with their parent. Our ability to soothe our kids is hardwired in their nervous system. 

That said, when an eating disorder is in the picture it can be really hard to soothe your child. It’s not unusual for kids to seek support in confounding ways. They often behave in ways that are frustrating, irritating, or even infuriating. For example, kids with eating disorders can be argumentative, highly emotionally reactive, aggressive, withdrawn, or a combination of these things. The important thing is to recognize their behavior is communication and an attempt to connect with and be soothed by you. 

When you see your child’s behavior as a form of communication that you can interpret and understand, you’re more likely to respond in a way that helps them calm down and feel safe in your presence. Feeling safe with you can be the foundation on which your child’s recovery is built, so the more you can build your skills in this area, the better. A great book to help with this is The Power of Showing Up by Daniel J. Siegel and Tina Payne Bryson.

4. Social engagement

We tend to focus on eating, exercise, and weight when we talk about health, but it turns out that the most important factor in health is actually the quality of our social connections. Long-term meta-analyses (considered by many to be the most reliable form of scientific analysis) have shown that social relationships are more important than health behaviors like not smoking, avoiding alcohol, and getting a flu shot. 

And many people are surprised to learn that social relationships FAR outweigh the impact of diet, exercise, and BMI on our health. 

Kids with eating disorders have high rates of social isolation, loneliness, and a history of feeling different, even being bullied by peers. They’re also more likely to have social anxiety. Their social skills are further compromised by eating disorder symptoms. 

A key way parents can help kids be safe during eating disorder treatment and recovery is by helping them build social skills and expand their social engagement. Investing your time and energy in supporting your child’s social development is a worthy effort and will help recovery.

See Our Guide To Parenting A Child With An Eating Disorder