Eating Disorders in Children and Teenagers: Signs and Support

Other specified feeding or eating disorder

Other specified feeding or eating disorder, or OSFED, describes clinically significant symptoms that cause distress or impairment but do not meet every criterion for another eating disorder. One example is atypical anorexia nervosa, where the features of anorexia nervosa are present but the person’s weight is not below the expected range. OSFED is not a mild or less important diagnosis. Medical and psychological risks can be serious.

Avoidant/restrictive food intake disorder

ARFID involves avoiding or restricting food in a way that leads to significant nutritional, growth or psychosocial consequences. It is not driven by body-image concerns. Read more in our guide to ARFID in children.

Other feeding and eating disorders

Pica involves repeatedly eating substances that are not food and is developmentally inappropriate. Rumination disorder involves repeated regurgitation of food that is not better explained by another medical condition. Both require professional assessment. Unspecified feeding or eating disorder may be used when significant symptoms are present but there is not enough information, or a clinician does not specify another diagnosis.

The former term “eating disorder not otherwise specified”, or EDNOS, is no longer used in current diagnostic classification. It was replaced by OSFED and unspecified feeding or eating disorder.

Warning Signs in Children and Teenagers

No single sign proves that a child has an eating disorder. Look for patterns, changes from the young person’s usual behaviour and effects on health or functioning. Signs can include:

Changes around food and eating

• skipping meals, eating very little or avoiding an increasing number of foods
• new rigid food rules, rituals or distress when a routine changes
• frequent checking of ingredients, energy content or portion size
• episodes of eating unusually large amounts with a sense of losing control
• going to the bathroom during or soon after meals
• hiding, discarding or storing food
• avoiding eating with others or giving repeated reasons for having already eaten
• vomiting, using laxatives or other attempts to compensate for eating.

Changes in body image, movement or behaviour

• increasing preoccupation with weight, shape, appearance or perceived flaws
• frequent body checking, weighing or reassurance seeking
• compulsive, secretive or distress-driven exercise, or exercising despite illness or injury
• withdrawal from friends, family activities or situations involving food
• irritability, anxiety, low mood, shame, secrecy or difficulty concentrating
• marked perfectionism or distress when unable to follow rules.

Body dissatisfaction can increase vulnerability but is not the same as an eating disorder. Our guide to positive body image and social media offers broader prevention-focused information.

Physical and developmental changes

• unexpected weight loss, rapid weight change or not following the child’s expected growth pattern
• dizziness, fainting, weakness, fatigue or feeling unusually cold
• gastrointestinal symptoms, dehydration or repeated vomiting
• changes in sleep, concentration, school participation or sport performance
• menstrual changes in young people who menstruate
• delayed puberty or other changes in growth and development.

These signs can have several causes. They should be assessed rather than attributed to an eating disorder without evidence. Equally, families should not wait for a child to become visibly underweight. A 2023 systematic review and meta-analysis found that medical instability can occur across a range of weights in adolescents with restrictive eating disorders. The review included nine studies, so its estimates should be interpreted with that limitation, but it supports assessing the rate and extent of weight loss as well as current weight.

How Eating Disorders Are Assessed

Start with a GP or other appropriately qualified health professional. Children and teenagers can deteriorate more quickly than adults, so a lower threshold for medical assessment is appropriate. Tell the clinician about changes in eating, growth, weight trajectory, exercise, vomiting or other compensatory behaviours, physical symptoms, mood, self-harm risk and the effect on school and daily life.

A comprehensive assessment may include:

• medical history, physical observations and tests when clinically indicated
• growth and weight history interpreted in developmental context
• eating patterns, food restriction, binge eating, compensatory behaviours and exercise
• body-image concerns, sensory needs, fear of choking or vomiting and appetite or interest in food
• mental health, suicide and self-harm risk
• developmental, family, school, cultural and social factors
• other medical or psychological explanations for the symptoms.

Screening questionnaires can help identify concerns, but they do not establish a diagnosis on their own. Children may minimise or have difficulty describing symptoms. Information from parents or carers can therefore be important and should be taken seriously.

How to Raise a Concern With Your Child

Choose a private, calm time and describe what you have noticed without commenting on appearance. For example: “I’ve noticed you are skipping lunch, feeling dizzy and avoiding dinner with us. I’m concerned about your health and I want us to get support.”

• Listen and remain curious, even if the child denies a problem or becomes upset.
• Avoid debating whether they look unwell or praising weight loss.
• Do not blame the child, yourself or another family member.
• Do not promise to keep serious health or safety concerns secret.
• Arrange medical assessment promptly and write down the changes you have observed.
• Keep the focus on health, development, energy, mood and participation rather than numbers or appearance.

General family language around food can also matter. Avoid labelling foods or bodies as morally “good” or “bad”. For non-clinical guidance, see improving your child’s relationship with food. If an eating disorder is suspected, general healthy-eating advice is not a substitute for specialist assessment.

Treatment and Recovery

Treatment should be matched to the diagnosis, medical risk, age, development, circumstances and preferences of the young person and family. It commonly brings together medical monitoring, nutritional rehabilitation and psychological treatment. Coordination between clinicians is important, and practitioners should have suitable eating-disorder training and supervision.

Family involvement is often central for children and teenagers and should not be framed as blame. Eating-disorder-focused family therapy is a recommended first-line option for many adolescents with anorexia nervosa and bulimia nervosa. A 2025 meta-analysis of 18 randomised trials found greater weight gain with eating-disorder-focused family therapy than individual therapy for adolescent anorexia nervosa, but did not find a significant advantage on the other outcomes examined. Measures and comparisons varied, so treatment decisions should not be reduced to one finding.

Other approaches may be appropriate when family therapy is unsuitable, ineffective or not preferred, and treatment differs across anorexia nervosa, bulimia nervosa, binge-eating disorder, OSFED and ARFID. Medication should not be presented as a sole treatment for anorexia nervosa or bulimia nervosa. Families should receive a clear care plan, information about risks and options, and support to participate in decisions.

Schools and sporting organisations can support recovery through a confidential, coordinated plan. This may include adjustments to attendance, workload, meal support or exercise, based on advice from the treating team. Adults should avoid public discussion of the diagnosis, weight or food intake.

When to Seek Urgent Help

Seek urgent medical help if a child or teenager has fainted, has chest pain, is confused, is severely weak or dehydrated, cannot keep fluids down, has blood in vomit, is deteriorating rapidly or may be at immediate risk of self-harm or suicide. Call 000 or go to the nearest emergency department when there is immediate danger or a medical emergency.

If the situation is not an emergency, book an urgent GP appointment and explain that you are concerned about a possible eating disorder. Do not delay assessment while trying to manage refeeding, purging or rapid deterioration without clinical guidance.

Finding Support in Australia

• A GP can assess immediate medical risk, coordinate referrals and determine whether a child meets the criteria for a Medicare Eating Disorder Treatment and Management Plan.
• Butterfly’s National Helpline provides eating-disorder information, counselling and referral support on 1800 ED HOPE (1800 33 4673), 8 am to midnight AEST/AEDT, seven days a week. It is not a crisis service.
• Lifeline is available on 13 11 14 and Kids Helpline on 1800 55 1800. Call 000 for immediate danger.

How Quirky Kid Can Help

A Quirky Kid psychologist can help assess psychological and developmental concerns, discuss the most suitable care pathway and collaborate with other professionals where the service is an appropriate fit. Eating-disorder care may require a specialist multidisciplinary team. Contact us before booking if you are unsure whether Quirky Kid is the right service for your child’s current needs.

Learn about child psychology consultations or contact Quirky Kid to discuss next steps.

Key Points for Families

• Eating disorders are serious conditions, not choices or phases.
• They can affect children of any gender, body size or background.
• Not every eating disorder involves weight or body-image concerns.
• Rapid weight loss and restricted nutrition can be dangerous even when a child is not underweight.
• Parents should act on patterns of change and seek assessment rather than trying to diagnose from appearance.
• Early, coordinated and diagnosis-specific care can support recovery.

Clinical disclaimer: This resource provides general educational information and is not a diagnosis or individual treatment plan. Seek advice from a qualified health professional. Call 000 or attend an emergency department if a child is in immediate danger or has signs of a medical emergency.