Eating Disorders in Children and Adolescents: A Parent’s Guide to Early Signs, Treatment, Hospital Admission and Recovery

If you’re worried your child may have an eating disorder, you’re not alone. Here are the early warning signs, the treatment options, when hospital admission may be needed, and why recovery is possible.

Finding out that your child may have an eating disorder is one of the most frightening experiences a parent can face. Many families describe feeling overwhelmed, confused, guilty and unsure where to turn for help.

You may be asking yourself:

• Is this just a phase?
• Should I be worried?
• What treatment should my child be receiving?
• Does my child need to go to hospital?
• Have I done something wrong?
• Will my child ever recover?

These are all normal questions.

As a paediatric dietitian working with children, adolescents and families affected by eating disorders, they are questions I hear every day. The good news is that eating disorders are treatable, and with early intervention and the right support, recovery is possible.

What are eating disorders?

Eating disorders are serious mental illnesses that affect a person’s relationship with food, eating, body image and exercise. They are not a lifestyle choice, a phase or simply “fussy eating”.

Common eating disorders seen in children and adolescents include:

• Anorexia nervosa
• Atypical anorexia nervosa
• Bulimia nervosa
• Binge eating disorder
• Avoidant restrictive food intake disorder (ARFID)
• Other specified feeding and eating disorders (OSFED)

Eating disorders can affect children and young people of any gender, body size, culture or background.

What are the early warning signs?

Every child is different, but common warning signs include:

Physical signs

• Weight loss or failure to gain expected weight during growth
• Feeling cold all the time
• Dizziness or fainting
• Fatigue
• Stomach pain or constipation
• Changes in menstrual cycles
• Difficulty concentrating

Behavioural signs

• Skipping meals
• Cutting out food groups
• Excessive exercise
• Avoiding eating with family or friends
• Becoming increasingly interested in dieting or “healthy eating”
• Eating rituals or rigid food rules
• Spending more time checking body shape or weight

Emotional signs

• Increased anxiety around food
• Irritability
• Low mood
• Social withdrawal
• Perfectionism
• Increased rigidity or inflexibility

If you notice several of these signs, trust your instincts and seek professional advice. Early intervention is linked to better outcomes.

What should I do if I think my child has an eating disorder?

If you are concerned, don’t wait until your child becomes severely underweight or medically unwell.

Book an appointment with your GP and request a comprehensive assessment. Your GP may refer your child to a paediatrician, psychologist, psychiatrist, Accredited Practising Dietitian, Child and Adolescent Mental Health Service (CAMHS), or a dedicated eating disorder service.

The earlier treatment begins, the better the opportunity for recovery.

What treatment should my child be receiving?

For most children and adolescents with anorexia nervosa who are living at home, Family Based Treatment (FBT) is the recommended first-line treatment in Australian guidelines and has the strongest evidence base. It is delivered by a mental health clinician, with the dietitian supporting the nutrition side.

FBT recognises that parents do not cause eating disorders. Instead, parents become one of the most powerful resources in helping their child recover.

If your child is receiving a different treatment approach, it is perfectly reasonable to ask:

• What therapy is my child receiving?
• Why has this treatment been chosen?
• Is Family Based Treatment appropriate for my child?
• What evidence supports this approach?

Every child is different, and there may be valid reasons for alternative therapies. However, families deserve to understand the rationale behind these decisions.

What support services are available?

Depending on where you live, treatment may involve both public and private services. These may include:

• Your General Practitioner (GP)
• Paediatrician
• Child and Adolescent Mental Health Services (CAMHS)
• Community Mental Health Services
• Private psychologist
• Private psychiatrist
• Accredited Practising Dietitian
• Dedicated eating disorder programs

Many families receive care from both public and private providers working together. Medicare can help with the cost through an Eating Disorder Plan from your GP, for those who are eligible.

What medical monitoring should my child receive?

Eating disorders affect every organ system in the body, making regular medical monitoring an essential part of treatment. Your child’s treating team may recommend:

• Weekly GP appointments
• Weight monitoring
• Heart rate and blood pressure checks
• Blood tests
• Assessment of growth and puberty
• Ongoing review of eating disorder symptoms

Parents should know:

• Who is responsible for monitoring my child’s medical health?
• Who is doing the weighing?
• How often will my child be reviewed?
• How is information shared between the treating team?

Are my child’s clinicians communicating?

The best outcomes occur when the treating team works together. This team may include:

• GP
• Paediatrician
• Psychologist
• Psychiatrist
• Dietitian
• Mental health clinician

Good communication ensures everyone is working towards the same goals and reduces the burden on families trying to coordinate care.

When does an eating disorder need hospital admission?

One of the most common questions parents ask is: “How do I know if my child needs to go to hospital?”

Most paediatric hospitals and dedicated eating disorder services have admission criteria that help determine when inpatient treatment is needed. While these criteria vary slightly between hospitals and health districts, admission decisions are based on medical stability, not weight alone.

A young person may require hospital assessment if they are experiencing:

• Rapid or ongoing weight loss
• Significant nutritional restriction
• Very low heart rate (bradycardia)
• Low blood pressure
• Dizziness or fainting
• Electrolyte abnormalities
• Dehydration
• Refusal of food or fluids
• High psychiatric risk
• Failure to progress safely with outpatient treatment

Is there a BMI cut-off for hospital admission?

This is a question many parents ask, but the answer is not straightforward.

There is no single BMI that automatically determines whether a child or adolescent requires hospital admission. Clinicians consider many factors, including:

• Medical observations
• Rate of weight loss
• Growth history
• Nutritional intake
• Blood test results
• Psychiatric risk
• Weight compared with what is expected for your child’s age, height and growth

NSW guidance lists a BMI of 14 kg/m² or less as one indication for hospital admission in adolescents with anorexia nervosa, but it is not a required cut-off for admission. This appears in the NSW Eating Disorders Toolkit (page 11).

The more recent Sydney Children’s Hospitals Network guideline (September 2025) lists a BMI below 14 kg/m², or below the 3rd percentile for age, among possible admission indications (SCHN guideline, page 3).

Admission may be needed at a higher BMI, based on factors such as a slow heart rate, low blood pressure, dehydration, abnormal electrolytes or ECG, rapid weight loss, suicide risk, or deterioration despite community treatment. Weight alone does not determine safety (NSW Eating Disorders Toolkit, page 11).

This is particularly important for young people with atypical anorexia nervosa, who may remain within or above the healthy weight range while still being critically unwell.

If you are concerned about your child’s physical health, seek urgent medical assessment through your GP, local emergency department or eating disorder service.

What happens during an eating disorder admission?

Hospital admission can feel frightening for both young people and their families. Many parents worry that admission means they have failed.

It doesn’t.

Hospital admission is often simply the safest place to begin recovery when the eating disorder has become too medically or psychologically severe to manage in the community. The goals of admission are to:

• Restore medical stability
• Begin or continue nutritional rehabilitation (refeeding)
• Monitor for complications of malnutrition and refeeding
• Support weight restoration where appropriate
• Treat psychiatric symptoms
• Prepare families for ongoing treatment at home

Medical monitoring

Young people may have regular monitoring of:

• Weight
• Heart rate
• Blood pressure
• Temperature
• Blood glucose levels
• Blood tests
• Fluid balance

These checks allow the treating team to identify and manage complications associated with malnutrition.

Nutritional rehabilitation (refeeding)

One of the most important parts of admission is restoring adequate nutrition. Treatment usually includes:

• Regular meals and snacks through the day
• Structured meal plans
• Nutritional supplements where required
• Supervised meals and snacks

Many young people experience increased anxiety around eating during this stage. While incredibly difficult, this is a normal part of recovery.

Meal support

Meal support is a key part of many eating disorder programs. Staff provide encouragement, reduce eating disorder behaviours and help young people meet their nutritional goals.

Parents are often encouraged to participate in meal support, helping build confidence before returning home.

Enteral feeding (nasogastric feeding)

Some young people require temporary nasogastric (NG) feeding when:

• Oral intake is inadequate
• Nutritional requirements cannot be met through eating alone
• Medical risk is high
• The eating disorder prevents sufficient nutrition

Although the thought of tube feeding can be confronting, it is often a temporary and effective treatment that protects a young person’s health while recovery begins.

Family involvement

Modern eating disorder treatment recognises that families are an essential part of recovery. Parents are usually involved in education, treatment planning and meal support throughout admission.

Discharge planning

Hospital admission is only one step in recovery. Before discharge, the treating team will usually develop a plan involving:

• GP follow up
• Dietetic review
• Psychiatric review where appropriate
• CAMHS or community mental health support
• Family Based Treatment where indicated

The goal is to ensure recovery continues safely at home.

Why is refeeding so difficult?

Many parents are surprised that eating often becomes harder before it becomes easier.

As nutrition improves, the eating disorder often becomes louder. Young people may experience increased fear, distress or resistance around food.

This does not mean treatment is failing. It often means the eating disorder is fighting back because adequate nutrition threatens the illness itself.

This is why compassionate, consistent support from families and experienced clinicians is so important.

Is the eating disorder quietly taking over family life?

Eating disorders are incredibly persuasive. Over time, families often begin adapting to the illness without realising it. You may notice that:

• The family no longer eats out.
• Holidays are cancelled because of food concerns.
• Multiple different meals are prepared.
• Family routines revolve around avoiding distress.
• Social events are avoided.
• Siblings begin missing out because so much attention is focused on the illness.

These adaptations are understandable, but they can unintentionally strengthen the eating disorder. Recognising these “eating disorder traps” is an important step towards recovery.

Learning to externalise the eating disorder

One of the most helpful concepts in Family Based Treatment is externalisation. Rather than seeing your child as the problem, the eating disorder becomes the problem.

Instead of saying: “My child won’t eat dinner.”

Try thinking: “The eating disorder is making dinner feel impossible for my child today.”

This small shift allows parents to remain compassionate towards their child while standing firmly against the illness.

Did I cause my child’s eating disorder?

This is perhaps the question I hear most often. The answer is simple.

No.

Eating disorders develop through a complex interaction of genetics, biology, personality traits and environmental influences.

Parents do not cause eating disorders. What parents can do is become one of the most powerful influences in helping their child recover.

Eating disorders are serious illnesses

Eating disorders have one of the highest mortality rates of any mental illness. This is not shared to frighten families, but to highlight why early assessment and evidence-based treatment are so important.

Eating disorders affect the brain, heart, bones, hormones, muscles, gastrointestinal system and emotional wellbeing.

The sooner treatment begins, the better the opportunity for recovery.

Recovery is possible

Perhaps the most important message I can leave you with is this:

Recovery is possible.

Recovery is rarely a straight line. There will be difficult days, setbacks and moments when progress feels slow.

But with evidence-based treatment, compassionate support and persistence, many young people recover and return to school, friendships, sport, family life and the activities they love.

If you are worried about your child, please don’t wait. Reach out for help. The sooner support begins, the sooner recovery can begin.