Does My Child Have an Eating Disorder? Signs to Watch For and How FBT Can Help
Maybe your child has started skipping meals. Foods they once enjoyed now cause arguments. Exercise seems less like something they enjoy and more like something they cannot miss.
Or perhaps your child has always been a selective eater, but their list of accepted foods keeps shrinking.
You may find yourself wondering: “Does my child have an eating disorder, or is this a phase?”
An eating disorder may be present when eating patterns, food avoidance, or concerns about weight and shape begin affecting your child’s health or daily life. Your child does not have to look underweight to need help. A professional assessment can clarify what is happening and what support is appropriate (Hornberger & Lane, 2021; National Institute of Mental Health [NIMH], 2024).
You do not need to figure out the diagnosis before reaching out. You can start with what you have noticed—and the concern that something has changed.
What Are the Signs of an Eating Disorder in a Child or Teen?
Eating disorders do not all look the same. Some involve restriction, some involve binge eating or compensatory behaviors, and others involve difficulty eating enough because of sensory sensitivities, fear, or limited interest in food (NIMH, 2024).
Warning signs worth discussing with a healthcare professional include:
Increasing restriction or food rules. Your child skips meals, eliminates more foods, or becomes distressed when eating does not follow a particular plan.
Distress about weight, shape, or eating. Food and body concerns take up increasing attention, or your child expresses significant guilt after eating.
Exercise that feels compulsory. Your child becomes unusually upset about missing exercise or uses activity to compensate for eating.
Binge eating or compensatory behaviors. Your child describes feeling unable to stop eating, eats secretly with distress, or engages in vomiting or other behaviors intended to compensate for food.
Physical or developmental changes. Weight changes, slowed growth, persistent fatigue, dizziness, feeling unusually cold, or menstrual changes warrant medical attention.
These signs are reasons for assessment, not a checklist that can establish a diagnosis. Their context, severity, and effect on your child’s life matter (Hornberger & Lane, 2021; NIMH, 2024).
Rather than trying to decide whether your child is “sick enough,” consider asking: “Is eating becoming harder, more distressing, or more disruptive to their life?”
Can My Child Have an Eating Disorder Without Being Underweight?
Yes. Body size alone cannot tell you whether a child has an eating disorder or how medically serious it is.
Atypical anorexia nervosa involves the restrictive eating and psychological features of anorexia, but the person’s weight is not classified as significantly low despite significant weight loss. It can still involve serious medical complications (Society for Adolescent Health and Medicine [SAHM], 2022).
In research involving hospitalized adolescents and young adults with anorexia or atypical anorexia, weight-loss history was associated with markers of medical severity independently of admission weight. This supports looking beyond the number on the scale when assessing risk (Garber et al., 2019).
For growing children, a concern may also be not gaining weight or growing as expected, rather than obvious weight loss. Reviewing your child’s growth history is an important part of assessment (Hornberger & Lane, 2021).
Is It Picky Eating or Could It Be ARFID?
Not every selective eater has an eating disorder. However, food avoidance that substantially affects nutrition, growth, or everyday functioning deserves evaluation.
Avoidant/restrictive food intake disorder, or ARFID, can involve difficulty eating because of food textures or other sensory characteristics, fear of choking or vomiting, or low interest in food. Unlike anorexia nervosa, ARFID is not driven by a desire to change body weight or shape (Hornberger & Lane, 2021).
For example, a child may want to participate in a birthday party but feel unable to eat any available food. Another may become increasingly afraid to swallow after a frightening eating experience.
The important question is not simply how many foods your child accepts. It is whether their eating is meeting their needs and allowing them to participate in daily life. ARFID can affect both physical health and functioning (NIMH, 2024).
What Should I Do if I Think My Child Has an Eating Disorder?
Arrange a medical evaluation
Contact your child’s pediatrician or another medical professional experienced in eating disorders. Explain the eating changes and physical symptoms you have noticed.
An evaluation helps assess medical stability, review growth and nutrition, and consider other conditions that can affect eating or weight. The clinician can determine whether blood tests, an electrocardiogram, or other assessment is needed (SAHM, 2022).
Seek eating-disorder-specific treatment guidance
A medical evaluation and a therapy assessment serve different, complementary purposes. Eating disorder care may involve a therapist, medical provider, and registered dietitian, with responsibilities coordinated around your child’s needs. Psychotherapy does not replace medical monitoring (NIMH, 2024).
Start the conversation with observations, not accusations
You might say:
“I’ve noticed that eating seems stressful lately, and I’m concerned about how you’re feeling. You’re not in trouble. We’re going to get support so we can understand what’s happening.”
You do not need to win a debate about whether your child has an eating disorder before asking a professional for guidance.
When to seek urgent help: Fainting, chest pain, confusion, severe weakness, significant dehydration, or an inability to eat or drink warrant urgent medical assessment. Immediate safety concerns, including imminent suicide risk, require emergency help. In the United States, call 911 for a life-threatening emergency. Do not wait for a therapy appointment when urgent symptoms are present (SAHM, 2022; NIMH, 2024).
What Is Family-Based Treatment for Eating Disorders?
Family-Based Treatment, or FBT, is a structured eating disorder treatment that helps parents and caregivers take an active role in their child’s recovery. It is a first-line outpatient psychological treatment for adolescents with anorexia nervosa who can be safely treated outside the hospital (SAHM, 2022).
FBT is not simply general family counseling. Its early focus is directly addressing the eating disorder, including helping caregivers support adequate eating and weight restoration when needed. Responsibility then shifts back toward the young person as recovery progresses (Lock et al., 2010).
Importantly, FBT does not approach parents as the cause of the eating disorder. It involves them as a resource for recovery (Lock et al., 2010).
For a parent who feels overwhelmed, the goal is not to become a perfect caregiver. It is to develop a clearer understanding of what your child needs and how to respond with support, consistency, and compassion.
How Does FBT Work?
FBT for adolescent anorexia generally follows three phases. The pace depends on clinical progress rather than a fixed deadline for every family (Lock et al., 2010).
Phase 1: Support eating and nutritional recovery
Parents take a stronger role in helping their child eat adequately and restore weight. The therapist works with the family on supporting these changes.
Phase 2: Gradually return eating responsibility
As recovery progresses, eating responsibility returns to the young person in developmentally appropriate steps.
Phase 3: Support development and life beyond the eating disorder
Treatment addresses adolescent development, autonomy, and family relationships as the young person moves beyond the eating disorder (Lock et al., 2010).
These phases describe FBT for anorexia. Treatment adapted for another diagnosis may have different priorities.
Does FBT Work? What the Research Shows
Research supports FBT, but its evidence should be understood in relation to the specific eating disorder—not as a promise that one approach works for every child.
FBT for anorexia nervosa
In a randomized trial of 121 adolescents, FBT and adolescent-focused individual therapy both produced improvement. Full remission did not differ significantly at the end of treatment, but FBT produced higher full-remission rates at the six- and twelve-month follow-ups (Lock et al., 2010).
For families, this supports FBT as an important treatment option while also recognizing that recovery takes time and outcomes vary.
FBT for bulimia nervosa
An adapted approach, FBT-BN, has evidence for adolescent bulimia. In a randomized trial, it produced higher rates of abstinence from binge eating and purging than adolescent-adapted cognitive behavioral therapy at the end of treatment and six-month follow-up. The difference was not statistically significant at twelve months (Le Grange et al., 2015).
FBT for ARFID
Evidence for FBT-ARFID is growing. A 2026 randomized trial of 98 low-weight children ages 6–12 found greater weight improvement with telehealth FBT-ARFID than with individual psychoeducational motivational therapy. However, improvement in overall ARFID symptom severity did not differ between the groups (Lock et al., 2026).
That distinction matters: the study supports a benefit for nutritional recovery in this particular group, not a conclusion that FBT is best for every child with ARFID.
The right treatment begins with understanding your child’s diagnosis, health, developmental needs, and family circumstances.
Can Family-Based Treatment Be Done Online?
FBT can be delivered through telehealth, with attention to whether virtual outpatient care is appropriate for the child and family.
A 2025 study comparing telehealth and in-person FBT for 169 young people with restrictive eating disorders found no statistically significant differences in end-of-treatment weight restoration or hospitalization frequency. Early weight response was less common in the telehealth group. Because the study was retrospective rather than randomized, it does not prove that the two formats are equivalent for every patient (Drury et al., 2025).
Virtual FBT can bring therapy sessions into the home, but it is not an online-only substitute for comprehensive care. In the same study, young people also received medical follow-up and additional services as needed (Drury et al., 2025).
Questions Parents Often Ask About FBT
Will FBT blame me for my child’s eating disorder?
No. The FBT model explicitly moves away from blaming parents and toward involving them in recovery (Lock et al., 2010).
A useful question to bring to treatment is: “What support do we need as caregivers to help our child?”
Will my child’s feelings still matter?
They should. Supporting nutrition does not require dismissing fear, sadness, frustration, or distress. For example, a parent can acknowledge, “I know this feels frightening,” while continuing to follow the treatment team’s guidance.
At Ezer Psychotherapy, you are welcome to ask how your child’s perspective, emotional needs, and developmental stage will be incorporated into the treatment plan.
What happens if FBT is not the right fit?
Treatment should be reassessed when a child is not improving or needs more support. Other psychological treatments and higher levels of care may be appropriate, depending on the situation (SAHM, 2022).
A change in the plan is not a verdict on your parenting. The goal is to find the care your child needs—not to prove that your family can make one approach work at any cost.
Eating Disorder Therapy for Children, Teens, and Families at Ezer Psychotherapy
Ezer Psychotherapy provides virtual outpatient therapy for children, adolescents, and young adults in Minnesota, Wisconsin, North Dakota, and Florida. Services include individualized treatment planning, Family-Based Treatment when appropriate, parent coaching, and coordination with medical providers and other members of the treatment team.
Hallie Orton, MSW, LICSW, works with young people and families navigating eating disorders and related concerns. Treatment recommendations are based on assessment—not the assumption that every child needs the same approach.
Perhaps you are still unsure whether what you are seeing is an eating disorder. Perhaps you already have a diagnosis but feel lost about what to do at home.
Either way, you can begin with a conversation.
Contact Ezer Psychotherapy to ask about eating disorder treatment, whether FBT may be appropriate, and current availability. The practice offers a free 15-minute discovery call to explore treatment fit.
Phone: 612-662-1421
Email: hallieorton@ezerpsychotherapy.com.
You do not need to have every answer before asking for help.
This article provides general education and does not diagnose an eating disorder or replace individualized medical or mental health care.
References
Drury, C. R., Singh, S., Manzano, M., et al. (2025). Comparing outcomes for telehealth versus in-person family-based treatment: A retrospective chart review. International Journal of Eating Disorders, 58(11), 2090–2104. doi: 10.1002/eat.24511.
Garber, A. K., Cheng, J., Accurso, E. C., et al. (2019). Weight loss and illness severity in adolescents with atypical anorexia nervosa. Pediatrics, 144(6), e20192339. doi: 10.1542/peds.2019-2339.
Hornberger, L. L., Lane, M. A., & Committee on Adolescence. (2021). Identification and management of eating disorders in children and adolescents. Pediatrics, 147(1), e2020040279. doi: 10.1542/peds.2020-040279.
Le Grange, D., Lock, J., Agras, W. S., Bryson, S. W., & Jo, B. (2015). Randomized clinical trial of family-based treatment and cognitive-behavioral therapy for adolescent bulimia nervosa. Journal of the American Academy of Child & Adolescent Psychiatry, 54(11), 886–894.e2. doi: 10.1016/j.jaac.2015.08.008.
Lock, J., Le Grange, D., Agras, W. S., Moye, A., Bryson, S. W., & Jo, B. (2010). Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Archives of General Psychiatry, 67(10), 1025–1032. doi: 10.1001/archgenpsychiatry.2010.128.
Lock, J., Matheson, B., Jo, B., Bohon, C., Datta, N., Whyte, A., Boyce, H., Gurcan, H. Y., Cogburn, A. E., & Kim, B. (2026). Family vs individual treatment for children with avoidant/restrictive food intake disorder: A randomized clinical trial. Journal of the American Academy of Child & Adolescent Psychiatry. Advance online publication. doi: 10.1016/j.jaac.2026.04.007.
National Institute of Mental Health. (2024). Eating disorders: What you need to know (NIH Publication No. 24-MH-4901). National Institutes of Health.
Society for Adolescent Health and Medicine. (2022). Medical management of restrictive eating disorders in adolescents and young adults. Journal of Adolescent Health, 71(5), 648–654. doi: 10.1016/j.jadohealth.2022.08.006.
