After reading through this page, you will be able to:
This webpage provides a summary of information and resources based on the author’s informal research and lived experience only and does not constitute or substitute for professional medical advice. Do not rely on this webpage to diagnose or treat your child. If you suspect your child is suffering from an eating disorder, please seek appropriate medical attention, including emergency medical care.
Many eating disorders begin with seemingly “healthy” eating makeovers triggered by a variety of external influences, like exposures to diet culture, athletic training pressure, and social media and peer/family validation of thin-bias and fatphobia, as a few examples. You may notice your child:
Depending on how long a child has been engaged in restriction, bingeing and/or purging behavior, your child may:
Purging can take the form of exercise or any other kind of movement. You may notice that your child:
Your child may already experience anxiety, depression, or other mood disturbances prior to eating disorder onset or they may develop new changes in mood with the eating disorder. It is easy to dismiss these changes as typical child, pre-teen or teenage moodiness, but it is important not to overlook your child’s:
Activities, events or subjects that your child may have previously been passionate about may no longer interest your child. Or, your child may exhibit increasing interest in:
Even if you do not have concrete evidence of your child’s eating disorder, changes in their vital signs may indicate their illness is more severe than you suspect:
No child or adolescent should experience weight loss. It is appropriate to be concerned if you notice:
Previously known as the Female Athlete Triad (when our understanding of eating disorders did not appropriately include the prevalence of eating disorders in males), RED-S, which stands for “relative energy deficiency in sport,” occurs when a child either intentionally or unintentionally does not consume enough calories to meet their energy needs. In other words, there is low energy availability in the child’s body. Energy needs, in the case of children and adolescents, include not only the amount of energy needed to sustain the body’s regular functioning and be available for sports activity, but also the incredible amount of energy it takes to fuel puberty and associated growth. A child does need to intentionally restrict their intake, lose their period (amenorrhea), or experience disordered eating or thoughts to have RED-S. This syndrome can occur simply when there is a negative energy balance, i.e., the amount of energy expenditure exceeds the amount of calories consumed and intake is less than what is needed to support healthy functioning. Although RED-S is not technically an eating disorder, it can have many of the same damaging physical and mental effects on a child; and, if your child is genetically susceptible to an eating disorder, this negative energy balance can tip them into a life-threatening eating disorder.
Consequences of RED-S can include:
Resources on RED-S:
If you already know your child is not eating, eating very little, purging, exercising compulsively and/or losing weight and exhibiting eating disorder behaviors (e.g., lying, hiding food, refusing to eat, eating secretly, using the bathroom after eating, etc.), any of these signs* may indicate your child needs immediate medical attention:
*This is not an exhaustive list. If you think your child needs medical help, take your child to an emergency department regardless whether you notice these particular signs or symptoms.
One of the hallmarks of medical instability is orthostatic hypotension: a systolic blood pressure drop of 20 mm Hg, a diastolic blood pressure drop of 10 mm Hg, or tachycardia. Unusually low blood pressure also warrants immediate medical attention.
Cold and/or bluish or purplish hands or feet may indicate poor circulation due to heart muscle atrophy from starvation/malnutrition and can also signal heart failure. Cold extremities also may indicate hypothermia.
Chest pain, seizures, dizziness or fainting are not normal and may be signs of medical instability. Seizures can occur with extremely low blood sugar levels. Vomiting blood or trouble swallowing in children with bulimia nervosa or severe sudden onset abdominal pain in children with binge eating disorder requires medical attention.
Bradycardia (low heart rate), a pulse of less than 50 bpm during the day or less than 45 bpm, at night is dangerous and a child may be at risk for sudden cardiac arrest, especially during sleep at night. Tachycardia (high heart rate) in children with anorexia nervosa can be predictive of arrhythmia and sudden death risk.
In more severe stages of illness, a child may not only refuse to eat food, but will even refuse or purge water. Dehydration, electrolyte imbalance, and other risks of malnutrition, including death, mean an ER visit may be necessary.
Suicidality and self-harm as a result of malnourishment alone or in combination with pre-existing comorbidities is a common eating disorder presentation even if not previously typical and emergency help is necessary.
Examples of medical stability care guidelines:
Refeeding Syndrome is potentially life-threatening (including cardiac failure, kidney failure and sudden death) and if your child has not been eating or eating very little, the feeding and re-nourishing of your child often must be closely medically monitored over a period of time until a physician determines they are no longer at risk.
Refeeding syndrome can occur when a starved or malnourished child is fed too quickly and it presents as severe electrolyte or fluid shifts associated with metabolic abnormalities, including hypophosphatemia (low levels of phosphorous), hypokalemia (low levels of potassium), hyponatremia (low concentration of sodium), hypomagnesemia (low levels of magnesium), fluid retention, thiamine deficiency and metabolic acidosis (build up of acid due to kidneys being under strain or failing).
Your child does not need to be eating zero calories to be at risk for refeeding syndrome, which can occur even when they are eating, but just not taking in enough calories to prevent their bodies from shifting into a state where the body metabolizes its own fat and muscle instead of carbohydrates from food.
Not every Emergency Department is equipped to handle child or adolescent eating disorder patients. If you think your child has an eating disorder:
Our experience was not an uncommon one. Watch the video series above to hear about our story of discovery before treatment and the path towards health.
We were not diagnosed and did not learn our child had an eating disorder until he was in critical condition and needed immediate, emergency hospitalization for medical stabilization. Our child seemed fine and even attended school in the morning before he was admitted, but in reality was at high risk for heart failure and dying at night during his sleep. We were admitted and stabilized in time and we hope that the information here will help you:
A child’s labs often can come back normal and the child may still be in a life-threatening situation. Labs can be normal until the moment they are not. In the case of a child who is starving or malnourished, medical stability can turn on a dime. Even if you have been unaware of your child’s restriction or purging until recently, this does not mean they have not engaged in these dangerous behaviors for months or even years and are in critical condition.
Orthostatic vitals are a basic indicator of medical instability and the need to seek immediate medical attention, including emergency services or hospitalization.
Other vital signs that can indicate the presence of an eating disorder are heart rate (often bradycardia, but sometimes tachycardia), pulse (weak), and temperature (sometimes low/hypothermic).
An electrocardiogram can show evidence of sinus bradycardia, irregular heartbeat (arrhythmia), a prolonged corrected QT (QTc) interval, QTc dispersion, left ventricular hypertrophy and other indications of damage to the heart from malnourishment caused by an eating disorder.
These results can provide insight into the status of your child’s iron, glucose, sodium, potassium, magnesium, phosphate, creatinine, blood urea nitrogen (BUN), and other levels that may indicate malnutrition, starvation, liver or kidney dysfunction, electrolyte imbalance, dehydration or evidence of vomiting or use of laxatives or diuretics.
Thyroid hormone testing, which tests levels of TSH, T3 and T4, may indicate the presence of an eating order, as might tests showing abnormal gonadotropin (luteinizing hormone and follicle-stimulating hormone) and estradiol (female) and testosterone (male) levels.
In those children with a genetic vulnerability to eating disorders, involuntary weight loss due to illness can sometimes be enough of a negative energy balance to trigger an eating disorder.
There is also a link between eating disorders and certain illnesses or pathogens and some children may develop Pediatric Auto-immune Neuropsychiatric Disorders Associated with Streptococcus (PANDAS) (typically associated with a Group A strep infection) or Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). PANS and PANDAS are both associated with acute onset and OCD behaviors. Because they are diagnoses of exclusion, they are sometimes missed.
The earlier we identify (and intervene against) our child’s illness, the better their prognosis. It is never too late to help our child, but the sooner we step in and treat their illness, the greater their chances at full recovery, the less damage their eating disorder does to their brains and bodies, and the faster they get their lives back.
Eating disorders affect children and adolescents of all genders, races, ethnicities, socio-economic status, sexual orientation, and body shapes, sizes and weights. (In other words, your child does not need to be Caucasian, come from an affluent background, or be female to be susceptible to an ED). 1 in 3 people with an eating disorder is male. Boys and girls are equally susceptible to disordered eating (and therefore at risk for developing eating disorders if they are genetically vulnerable), and early puberty may be a factor along with other biological and socio-environmental factors.
Still hesitating? These facts and statistics help explain why you should begin treatment now:
Eating disorders and their symptoms, which take several forms and present in many different ways, affect children and adolescents regardless whether we notice, admit to or believe in their existence. It is extremely common for parents to miss the signs of their child’s life-threatening eating disorder for a number of reasons, like attributing eating disorder behavior to standard pickiness, normal eating, dressing or behavior preferences, teenage mood swings, prioritizing athletic performance, becoming interested in “health and wellness,” or developing new cooking or baking hobbies, for example. Opening our awareness to the signs, symptoms, and possibility that our child might have an eating disorder is not always easy or intuitive. We can visit the pediatrician, find a support group where we can ask questions of other caregivers with lived experience, and read up on eating disorder symptoms and treatment. Most importantly, we must start to set aside any fatphobia, thin-bias or “health/wellness” ideas we may have as a natural result of living in and around diet culture and learn to identify and separate out any of our own disordered eating, eating disorder or body dysmorphic lenses in order to clearly see what is happening with our child.
For some parents, it can be difficult to acknowledge and accept that our child has a life-threatening psychiatric illness with serious medical complications and very low rates of remission or recovery. The sooner we can accept this fact, the sooner we will be in a position to support our child in their recovery journey and the sooner they will be on their way to full health. If we or our caregiving partner(s) deny or disbelieve that our child has a deadly illness, we are potentially risking our child’s life and seriously diminishing their potential recovery outcome and ultimate quality of life.
Seeking evidence-based treatment and EDucating ourselves about eating disorder treatment and recovery are the number one priority when embarking on this journey with our child. Wise action in the context of our child’s recovery means meeting the illness head on without judgment and with a clear mind towards doing what it takes to keep our child alive and eventually thrive in their definition of a life worth living. At different times, this may mean doing things like pulling our child from school and/or sports – even if our child is an A student or elite athlete (many ED kids are); cancelling family vacations and regular activities; eating with our child six times a day; supervising our child 24/7 or for long periods of time; adjusting our expectations and being flexible; calling in reinforcements like other family members, school personnel, the police or social services (if physical violence, self harm or suicide attempts are part of the picture or if our child threatens maltreatment claims against us); and seeking support for ourselves.
Walking with our child on the path to eating disorder recovery likely will look very different from most things we already have done with or for our child as their parent. It will require a tremendous amount of sustained strength and resolve that will be unlike any other parenting experience. Since both we, as parents, and our child – and everyone else in our family unit – will be experiencing some type of distress or discomfort because of the severity of this illness and what it takes to get into remission, it is vital for us and any partner caregiver(s) to learn to increase distress tolerance. We need to acquire appropriate coping tools to manage what will feel like hopelessly unmanageable stress, anxiety and worry so that we are in a position to lead our child towards their recovery when they will not be able to see the path or be too scared or sick to walk it on their own.
Refeeding, supervising, and curbing eating disorder behaviors in our child is an enormously intense process that is extended over an extraordinarily lengthy period of time (years, not weeks or months), which means for some families life stops completely for at least the primary caregiver or life for sole caregivers becomes stretched far beyond that person’s capacity. The entire family unit, regardless of its makeup, is subjected to an incredible amount of tension, stress, upset and typically, trauma. Finding support in relationships with peer caregivers, friends, family, a peer coach or therapist and through self-care activities (like walks, naps, tv time, a meal eaten without our child, or scheduled time away when a trusted person can stand in for you) is vital to surviving through our child’s recovery journey. For most of us, caring for a child with an eating disorder can be one of the loneliest, isolating, and most difficult experiences so figuring out a way to build in supportive practices or people into our daily routine will be immensely helpful.
Find support groups here.
Eating disorders and their symptoms, which take several forms and present in many different ways, affect children and adolescents regardless whether we notice, admit to or believe in their existence. It is extremely common for parents to miss the signs of their child’s life-threatening eating disorder for a number of reasons, like attributing eating disorder behavior to standard pickiness, normal eating, dressing or behavior preferences, teenage mood swings, prioritizing athletic performance, becoming interested in “health and wellness,” or developing new cooking or baking hobbies, for example. Opening our awareness to the signs, symptoms, and possibility that our child might not be well may not be easy or intuitive, but will be well worth the effort. Visit your pediatrician, talk with friends, find a support group where you can ask questions, and read up on eating disorder symptoms and treatment. Most importantly, start to set aside any fatphobia, thin-bias or “health/wellness” ideas you may have as a natural result of living in and around toxic diet culture and learn to identify and separate out your own disordered eating, eating disorder or body dysmorphic lenses in order to clearly see what is happening with your child.
For some parents, it can be difficult to acknowledge and accept that your child has a life-threatening psychiatric illness with serious medical complications and very low rates of remission or recovery. The sooner you can accept this fact, the sooner you will be in a position to support your child in their recovery journey and the sooner they will be on their way to full health. If you or your caregiving partner(s) deny or disbelieve that your child has a deadly illness, you are potentially risking your child’s life and seriously diminishing their potential recovery outcome and ultimate quality of life.
Seeking evidence-based treatment and EDucating yourself about eating disorder treatment and recovery are the number one priority when embarking on this journey with your child. Wise action in the context of your child’s recovery means meeting the illness head on without judgment and with a clear mind towards doing what it takes to keep your child alive and eventually thrive in their definition of a life worth living. At different times, this may mean doing things like pulling your child from school and/or sports – even if your child is an A student or elite athlete (many ED kids are); cancelling family vacations and regular activities; eating with your child six times a day; supervising your child 24/7 or for long periods of time; adjusting your expectations and being flexible; calling in reinforcements like other family members, school personnel, the police or social services (if physical violence, self harm or suicide attempts are part of the picture or if your child threatens maltreatment claims against you); and seeking support for yourself.
Walking with your child on the path to eating disorder recovery likely will look very different from most things you already have done with or for your child as their parent. It will require a tremendous amount of sustained strength and resolve that will be unlike any other parenting experience. Since both you and your child – and everyone else in your family unit – will be experiencing some type of distress or discomfort because of the severity of this illness and what it takes to get into remission, it is vital for you and any partner caregiver(s) to learn to increase your distress tolerance and acquire appropriate coping tools to manage what will feel like hopelessly unmanageable stress, anxiety and worry so that you are in a position to lead your child towards their recovery when they will not be able to see the path or be too scared or sick to walk it on their own.
Refeeding, supervising, and curbing eating disorder behaviors in your child is an enormously intense process that is extended over an extraordinarily lengthy period of time (months and years), which means for some families life stops completely for at least the primary caregiver or life for sole caregivers becomes stretched far beyond that person’s capacity. The entire family unit, regardless of its makeup, is subjected to an incredible amount of tension, stress, upset and typically, trauma. Finding support in relationships with peer caregivers, friends, family, a peer coach or therapist and through self-care activities (like walks, naps, tv time, a meal eaten without your child, or scheduled time away when a trusted person can stand in for you) is vital to surviving through your child’s recovery journey. For many, caring for a child with an eating disorder can be one of the loneliest, isolating, and difficult experiences so figuring out a way to build in supportive practices or people into your daily routine will be immensely helpful.
Why don’t we? Why do so many of us end up taken by surprise when we find ourselves in the ER or hospital with our child in dire straits when in the weeks preceding there was nothing apparently severely wrong with them either physically or psychologically? More often than not, it is a combination of these primary factors:
If we have never lived with a child, friend or family member with an eating disorder, we often do not know what an eating disorder looks like. It usually doesn’t present in the way we think it might (like in a TV series we’ve seen or other dramatized portrayal that perpetuates false ideas about eating disorders). Unless we already know eating disorders through actual experience or specialized training, there is no reason for us to be on high alert with our children. Some people liken it to not knowing when they are living with someone with a substance abuse addiction – illness behaviors either go unnoticed because the illness forces the person into (oftentimes very creative) secrecy or the illness behaviors can be rationalized or justified by the person, the parent, or cultural norms.
A common example is when a child is an athlete or is part of a sports team. They might seem to be a wonderfully dedicated and conscientious athlete when they diligently attend all practices and also workout, run or practice drills during their off time. Parents are usually pleased and proud of their swimmer, runner, soccer player, dancer or gymnast. What might be hidden from proud coaches and parents, though, is the child’s eating disorder’s relentless exercise compulsion that requires them to move constantly or the eating disorder’s drive to purge calories through excessive exercise to compensate for calories consumed. This same child also might seem to be developing an interest in “healthy” behaviors related to food, e.g., eating “clean” and staying away from “junk” food. Parents (understandably, given rampant diet culture) typically applaud these “healthy” behaviors. Because of the intense pressure to remain thin ourselves and avoid raising fat kids who are part of the so-called “obesity epidemic,” we parents might breathe a sigh of relief that our child is on the “right path” and encourage – what we eventually find out is – their eating disorder behavior.
It is also hard for us to spot this illness if the eating disorder forces our child to hide their ED behaviors. When the illness takes over, a child whom we have known all their life to be honest and trustworthy may lie directly to our face saying they have already eaten when they have not consumed a thing all day. They may throw away school lunches, hide food in their clothing while at the table with us, spit food into a napkin when we’re not looking, or claim to use the toilet or shower in order to purge instead. We are not aware of the eating disorder’s presence because it forces our child to adopt secretive behaviors they would never choose if they were well. The concept of an eating disorder working on a child’s brain in the same way as alcohol or drugs is not something most people realize until they have experienced it.
For some of us, it is also possible that we never recognized or recovered from our own eating disorder or disordered eating, making it difficult to recognize the signs of an eating disorder in our child. Due to our own orthorexia, fatphobia or disordered thinking we might think our child looks great or feel glad our child has “healthy” eating and exercise habits – until the day we realize that our child is actually in the insidious grip of a lethal eating disorder. It is not rare for parents to catch on to their child’s eating disorder when it’s almost too late and their child has suffered serious physical damage, including damage to the brain, heart, and endocrine system, from malnourishment and other harmful eating disorder behaviors.
Another typical example of how we miss what is right in front of us is when a child adopts “healthy” or “clean” eating habits and starts to eat more vegetables and fruit and cuts out foods they deem “unhealthy” or “junk” food. Over time, we might notice this child starting to cut out entire food groups or macronutrients (e.g., all carbohydrates and/or fats) or move from eating all foods to vegetarianism and then veganism. In another child, the eating disorder might present as “pickiness” that results in only a handful of acceptable foods or developing food rules that make it very difficult for the child to eat the appropriate type and amount of nutrients and energy to sustain their body’s functioning.
We put a lot of faith and trust in our pediatricians or the medical personnel we encounter at the hospital or in the Emergency Room, and under many circumstances we should. When it comes to identifying eating disorders, understanding the urgency of eating disorder treatment, and being knowledgeable about the current first line of treatment in children and adolescents, however, we cannot afford to put blind trust in any person treating our child who is not properly trained. The undeniable fact is there are very few medical professionals (including therapists, registered dieticians, etc.) with specialized eating disorder training. The typical encounter with a medical professional often involves outdated treatment information and sadly, often a casual or cavalier attitude towards both the parent and child either due to lack of eating disorder training, lack of experience with eating disorder patients, or the clinician’s own thin bias or fatphobic attitudes affirmed by organizational mandates to combat the so-called “obesity epidemic.”
A typical encounter with a pediatrician might go something like this: the pediatrician addresses the parent’s concerns and encourages weekly weigh-ins or visits; tells the child to try to eat more; and takes the child’s labs, which seem more or less normal. At each visit, the child’s weight stays the same or the child might lose a pound here or there. The child’s labs might still look relatively normal to the pediatrician, untrained in looking out for eating disorder abnormalities, or the pediatrician might not express concern. The pediatrician might recommend that the child see a therapist or psychologist (which is contraindicated in early eating disorder treatment) and a nutritionist (as opposed to a registered dietician who specializes in eating disorders). The child might have fallen off their growth chart and the gap is growing over time, but the pediatrician insists that adding turkey to a wrap or a glass of milk after sports practice will help get them on the right track. During these critical weeks or days (depending on how long the eating disorder has been present regardless whether the parent or physician was aware of it), the child’s eating disorder – a brain disorder – grows stronger and the child falls deeper and deeper into malnutrition, which prevents their brain from acting normally both in terms of feeding and movement behaviors and the child’s psychological health. At this point a child might go from seemingly normal – which they were not – to falling off the cliff into medical instability or other extreme symptom territory (e.g., self-harm, suicide attempts or ideation, fainting/dizziness, increased withdrawal/isolation, heightened anxiety or OCD symptoms, uncharacteristic or intensified anger, rudeness or dangerous behavior, etc.).
It also is not uncommon for parents to be told their child is not sick enough to require treatment or not sick enough to warrant hospitalization. Children are discharged from the ER when they are still at high risk for medical instability. During office visits, pediatricians frequently miss the signs of eating disorder-caused medical instability, which can come on quickly – almost as if without notice – in children and adolescents who have been malnourished and/or purging. There are many true real-life examples of physicians telling parents to let their kids continue attending school or playing sports when these children are on the cusp of medical instability or are actually already medical unstable and at risk for heart failure or sudden cardiac arrest. Physicians are known to praise children with eating disorders for having a low heart rate due to their “athleticism” or “fitness,” when in fact these children have bradycardia and/or arrhythmias or other cardiac abnormalities, including cardiac muscle atrophy, that put them at high risk of death. This is where a parent becoming EDucated on their own will save their child’s life and improve their child’s chances of full recovery.
It can be difficult to accept that our child has an eating disorder for several reasons: maybe we don’t have an accurate understanding of eating disorders and how deadly this psychiatric illness is; maybe we don’t want to believe that this illness, which affects other children in other families, has come to our home; maybe due to our misunderstanding of eating disorders we think this is a phase that will pass or a coping mechanism that our child chose and can easily shed; or maybe we don’t think eating disorders are real or if they are, then we can simply tell our child to eat and everything will be fine. Maybe we think that mental illness is something to be ashamed of. Maybe we are afraid of having a child with a psychiatric illness. These are all normal thoughts and beliefs – unfortunately, they are unEDucated thoughts and opinions that can have disastrous effects on our children. Although it can feel comforting and safe to believe this will pass with a few extra bites of food or getting to the bottom of the “real” problem, trusting misinformation, failing to become EDucated, or denying our child has a problem only increases their physical and psychological suffering and may lead to fatal outcomes.
It is never too early to act. The earlier we do something, the greater the chances of our child reaching full recovery.
Explore more topics below
Eating Disorder Recovery
Eating Disorder Treatment
Eating Disorder Statistics
Articles, Videos & Audio Recordings coming soon.
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For parent coaching, contact Chrissy. at chrissy[at]chrissywatson[dot]com.
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Chrissy Watson, J.D., M.B.A., CMT-P, founded the Universati™ platform to provide Mindful Education for All and the EDUniversity™ change platform to provide adolescent eating disorder education and advocacy resources.
Chrissy is a former federal criminal prosecutor, civil litigator & research university contracts officer; Mayo Clinic-trained Health & Wellness Coach; Martha Beck-trained Wayfinder Life Coach; an American-born heritage Buddhist; Professional-level Mindfulness Teacher; Certified Mindfulness Meditation Teacher; and mother of two, on a mission to make the mindful way of life accessible to all and EDucate parents, schools and organizations about eating disorder prevention, treatment and recovery.
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© 2022 Christine Watson
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The information on this website is informational only; based on the author’s lived experience and informal research; and does NOT constitute medical or legal advice. You CANNOT rely on this information as a substitute for professional medical advice, treatment or diagnosis or professional legal advice. None of the information on this website is intended to diagnose, treat, cure or prevent any disease or disorder. The author of this website is not a healthcare professional, nutritionist or dietician and does not currently practice law (inactive license status). Seek medical care from a licensed healthcare professional for your child regardless of the information presented or personal opinions expressed on this website and seek legal advice from a licensed attorney.