How can parents best support a child with anorexia nervosa?

How to Help Parents Understand Their Child's Anorexia

Parents must understand that they are not to blame for their child's anorexia nervosa, but they are vital to therapeutic success and are responsible for weight restoration. 1

Core Principles Parents Need to Understand

Parents Are the Solution, Not the Problem

• Parents are not to blame for the eating disorder—this is the first and most critical message to convey 1
• Parents are vital to therapeutic success and serve as critical change agents in the recovery process 1, 2
• Parents are responsible for weight restoration, taking a central role in managing and disrupting eating disorder symptoms 1, 2

Separate the Child from the Illness

• Parents must learn to separate their child from the illness—the eating disorder is not their child's identity 1
• Treatment requires a nonauthoritarian approach where parents take control of refeeding without blame or punishment 1
• The goal is to create a climate of respect between the adolescent and parents while parents firmly manage the eating disorder 3

Understanding the Medical Seriousness

This Is a Life-Threatening Condition

• Mortality rates for eating disorders are among the highest for any psychiatric disorder 1, 4
• Cardiac complications are responsible for at least one-third of all deaths 4
• More than half of adolescents with eating disorders have normal laboratory results despite being medically unstable—normal tests do not mean safety 1, 4

Critical Warning Signs Parents Must Monitor

• Bradycardia (heart rate <50 beats/minute during the day) 1
• Hypotension (<90/45 mm Hg) 1
• Hypothermia (body temperature <96°F) 1
• Orthostatic changes (pulse increase >20 beats/min or blood pressure drop >20 mm Hg systolic on standing) 1

The Three-Phase Treatment Framework

Phase 1: Parents Restore Patient's Weight

• Parents take full control of all eating decisions and meal planning 1
• This phase focuses on medical stabilization and nutritional rehabilitation, which are the most crucial determinants of short- and intermediate-term outcomes 1
• Parents must understand that rapid and aggressive treatment provides the best prognosis 1

Phase 2: Control Transferred Back to the Adolescent

• As weight restoration progresses, control gradually returns to the child or adolescent 1
• This transition occurs only after medical stability is achieved 1

Phase 3: Focus on Adolescent Development

• Treatment addresses broader adolescent developmental issues 1
• This phase prepares for termination of formal treatment 1

What Parents Must Avoid

Stop All Weight Talk Immediately

• Parents must avoid all comments about body weight—even well-intended comments are perceived as hurtful 1
• Parental weight talk (encouraging dieting or discussing their own dieting) is linked to higher rates of overweight and eating disorders 5 years later 1
• Never tease or allow family members to tease about weight—family weight teasing predicts development of overweight status, binge eating, and extreme weight-control behaviors 1

Focus Only on Healthful Eating Behaviors

• If conversations about eating must occur, focus exclusively on healthful eating behaviors, not weight loss 1
• When the focus is only on healthful eating, adolescents are less likely to diet and use unhealthy weight-control behaviors 1

The Role of Multidisciplinary Education and Support

Parents Need Structured Education

• Multidisciplinary education programs significantly improve parents' knowledge about the treatment course of eating disorders 5
• Parents who receive structured education feel less excluded from their child's care and more prepared to care for their child at home 5
• Parent support groups complement health professionals' interventions and help parents discover new aspects of the parent-child relationship 3

Evidence-Based Treatment Approach

• Family-based treatment (FBT) is the only form of family therapy with a substantive evidence base for adolescent anorexia nervosa 6
• Seventy-five percent of adolescents with anorexia nervosa studied in randomized clinical trials used manualized FBT 6
• Parent-focused treatment (where therapists meet with parents only while a nurse monitors the patient) may be even more efficacious than conjoint family sessions at end of treatment 7

The Pediatrician's Critical Role

Parents Should Expect Their Pediatrician To:

• Act as a consultant to the parents and therapist 1
• Explain the medical seriousness of the eating disorder 1
• Monitor and manage the medical status of the adolescent 1
• Empower parents in decision-making 1
• Communicate regularly with the patient, family, and therapist 1

Common Pitfalls to Avoid

• Do not wait for laboratory abnormalities to take action—most patients with eating disorders have normal test results despite serious illness 1, 4
• Do not assume the child will "grow out of it"—early diagnosis and intervention are associated with improved outcomes 1
• Do not allow parental denial or differences in treatment approach to delay care—these reactions can exacerbate the illness 1
• Do not attempt to manage this alone—eating disorders require a multidisciplinary health care team 1