Anorexia in Children and Teens

What are the signs and symptoms of anorexia? 

The symptoms of anorexia include significant weight loss as part of a drive to be thin, fear of weight gain and body image distortion (not perceiving appearance accurately, such as the belief that one is overweight, despite being very thin). Females may have a loss of menstruation.  

Trusted adults, friends and family members may not realize the severity of their child’s illness until the person with anorexia becomes dangerously underweight. By this time, the affected person has severely limited what they will eat. They may exercise for hours every day as they adhere to a rigorous schedule to burn even more calories.  

A person with anorexia usually denies they have an eating disorder and refuses to change their extreme diet, regardless of what those around them might caution or advise. Without professional intervention, the person will continue to lose weight, putting their health and life in serious danger. 

Young people often go to great lengths to deny and conceal their struggles with food and weight. Here are some signs that may help you recognize anorexia in someone you know: 

• Excessive weight loss. Anorexia is diagnosed when someone is significantly underweight, whether because of weight loss or failure to gain weight as they grow. 
• Unusual eating habits. These may include taking tiny bites to stretch out eating time or compulsively arranging food on the plate. 
• Avoiding family meals. The child might make excuses that they are too busy or eating elsewhere. 
• Secretive behavior around eating and bathroom use. A teenager who habitually runs water, plays music or flushes the toilet repeatedly while using the bathroom may be masking the sounds of vomiting. 
• Use of laxatives or diet pills. Taking any medication outside of recommended use can be dangerous to overall health. 
• Excessive, and often obsessive, exercise. The child may attempt to burn calories consumed. 
• Physical signs of malnutrition. These can include dull or thinning hair, hair loss, splitting or softening nails, extreme sensitivity to cold, dental cavities and gum disease. 
• Absence of menstrual periods. This is related to loss of body fat. 
• Appearance of fine body hair on arms and legs. This is a result of the body’s attempt to keep warm. 
• Low self-esteem and/or mood changes. These may include irritability, depression, or talk of suicide. 
• Distorted body image. No matter how thin the child becomes, they believe they are overweight. 
• Drug or alcohol abuse. Teenagers with eating disorders may turn to substance abuse to relieve feelings of fear, shame, and depression. 

How is anorexia treated?  

Our approach to treatment gives families the support and education they need to manage anorexia and help their child work toward recovery, while minimizing time out of school and away from home.   

For patients with significant medical concerns, an inpatient medical stabilization stay may be necessary before the family-based treatments below can safely begin.   

We provide support to hundreds of children and teens, ages 6 to 18, each year. We offer customized treatment plans to meet each patient's unique needs.  

We offer two program options:  

• Day Treatment Program: Also known as Partial Hospitalization Program, this is designed for children and teens who need intensive support through eating disorder recovery but do not require 24-hour care. This typically is between 5 and 7 days, with some or all meals eaten in the program. A specialized care team guides families and children in developing healthy coping skills and supporting nutrition needs in their recovery process. Learn more about the Day Treatment Program.  
• Outpatient Clinic: Includes individual, family and group therapy, as well as psychiatric medication management, as needed. If you’re not sure if outpatient services are right for your child, call us at 720-777-6200 to speak with our team. Learn more about the Outpatient Clinic. 

The role of patents in meal planning and meal support 

Much of our treatment approach is grounded in family-based treatment (FBT), an evidence-based treatment that helps parents identify and interrupt their child’s unhealthy behaviors and redirect them toward healthy habits. We equip parents with the skills they need to successfully support their children by managing meals, routines and emotions, all of which actively support their child’s recovery.  

Parents learn how to plan balanced, nutrient-rich meals that support weight goals for their child. Mealtime becomes a focal point for working through challenges as parents develop strategies for addressing resistance, difficult emotions and disordered behaviors. By the time families transition out of the program and into outpatient support, parents will feel confident in continuing progress at home. By prioritizing family involvement, our program creates a sustainable and supportive path toward recovery together.

Helpful resources 

If you think someone in your family may be struggling with an eating disorder, speak with your child's physician or call an eating disorders program that specializes in the treatment of children, young adultsand teenagers. Children, teens and young adults have different problems and pressures than adults, and treatment approaches should address these special concerns. 

For more information about the Children's Colorado Eating Disorders Treatment Program, please call 720-777-6200. 

The Family Health Library 

Children's Hospital Colorado's Anschutz Medical Campus location offers a Family Health Library with information on parenting, child development, medical diagnosis in children, and more. Families are welcome to visit and use this resource at any time. 

Recommended books 

• “Survive FBT: Skills Manual for Parents Undertaking Family Based Treatment (FBT) for Child and Adolescent Anorexia Nervosa” by Maria Ganci. (2016) 
• "What Causes Eating Disorders - And What Do They Cause?" by Guido Frank, MD (2016) 
• “When Your Teen Has an Eating Disorder” by Lauren Muhlheim, PsyD (2018) 
• “Brave Girl Eating: A Family’s Struggle with Anorexia” by Harriet Brown (2010) 
• "Off the C.U.F.F. (Calm, Unwavering, Firm and Funny)" by Nancy Zucker, Ph.D., a parent skills manual that provides the curriculum taught to parents in group programs. Duke University Eating Disorders Program. (2008) 
• "Skills-Based Learning for Caring for a Loved One with an Eating Disorder. The New Maudsley Method" by Janet Treasure, Grainne Smith and Anna Crane. Routledge Taylor and Francis Group, London and New York (2007) 
• "Help your Teenager Beat an Eating Disorder" by Jim Lock, MD, PhD, and Daniel LeGrange, PhD (2015) 

Organizations and recommended websites 

• National Association of Anorexia Nervosa & Associated Disorders 
• National Eating Disorders Association (NEDA) 
• The Academy of Eating Disorders 

What can I do? 

As a parent: 

• Be a good role model. Set a family standard of eating meals together regularly and encouraging balanced eating and activity. 
• Avoid negative comments about appearances and be aware of comments you make about yourself and family members. Stay positive and emphasize the whole person, not just how someone looks. Don't criticize or tease your child about minor weight gain and avoid power struggles over food. 
• Help your child build healthy self-esteem. Give them opportunities to explore different interests and build confidence. 
• Remember that no one is to blame when a child develops an eating disorder. Discuss your concerns openly, then seek professional help. A pediatrician or primary care provider is who most families start with when they become concerned. 

As a friend: 

• Don't comment on your friend's eating behavior or size. If your friend has had anorexia nervosa and gains weight, don't praise them for it.  
• Remember that you can't solve the problem. You aren't responsible for saving your friend – you can be supportive and concerned, but encourage your friend to talk to a parent, teacher or counselor. If they don't, tell an adult close to your friend about your concerns. 

As a school nurse, counselor, teacher or coach: 

• Discuss your concerns with the child or adolescent first and suggest that he or she talks with their parents or caregivers. 
• Expect denial of any problem. You may have to talk with the parents or caregivers but always let the adolescent know that you will be doing this and why.