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How to support your child returning to school after eating disorder treatment

Eating disorder treatment often requires that your child take time away from school in order to get the intensive help they need to recover from their eating disorder. The structure and routine of an inpatient or residential program can be beneficial in providing your child with the time and space to focus solely on their recovery—and in a safe, structured environment at that. But once they finish their program, it’s time to transition back into their everyday life, where there are many more triggers, stressors, and challenges. While returning to school can be an exciting time for your child, it can also be an overwhelming and anxiety-inducing time as well. What your child needs during this time is support, honest communication, a nonjudgmental attitude, and positive role models.

Last updated on 
August 29, 2022
In this article

Is my child ready to return to school?

Once your child returns home after eating disorder treatment, you may be wondering if they’re ready to return to school yet, and this is a valid question. School is an extremely unpredictable environment, rife with conflict and pressure. Plus, you won’t be able to monitor what they’re eating while they’re at school all day, which can understandably be very stressful for you. Here are some indicators that your child is ready to return to school:

  • They are able to tolerate changes in food options, scheduling, and other unexpected changes
  • They are able to concentrate on various tasks at hand, as opposed to obsessing over eating disorder-related thoughts
  • They are communicating openly about their disordered eating symptoms and urges
  • They regularly use coping skills to avoid engaging in disordered eating behaviors, such as binging, purging, or excessive exercise
  • They eat appropriate meals regularly with little to no support
  • They reach out to you or other members of your support system if they need help
  • They are able to challenge cognitive distortions related to food and exercise beliefs

Supporting your child is a collaborative effort. If you aren’t sure whether they are ready to go back to school or not, you can consult their therapist to get their thoughts on the matter. Together, you two can decide when it is appropriate to send them back to school.

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Possible triggers at school

No matter how much you wish for a trigger-free environment for your child, they’re going to inevitably encounter triggers. It’s unavoidable, but what you can do is prepare your child for possible situations that may arise. You will also want to be aware of these challenges so that you can have a plan in place for how to support your child. It can also be important to communicate regularly with specific faculty members at school to stay in touch about your child’s recovery. 

Bullying

Unfortunately, bullying is very prevalent across schools in the United States, with over 20% of students reporting being bullied. (1) While students are bullied for many different reasons, a major one is related to physical appearance, especially weight or body size. And bullying can influence the development of an eating disorder or contribute to a relapse to disordered eating. 

If your child is being bullied, they may internalize the stigmatizing and shameful language they hear. Make sure you cultivate a safe space where your child feels comfortable coming home and telling you about bullying so that you can communicate with the school and intervene, as well as get your child the additional support they need, such as increased therapy frequency or outpatient care.

Academic pressures

School can be extremely stressful. From homework and exams to group projects and standardized testing, the pressure can be intense. Academic pressures may trigger disordered eating behaviors or contribute to relapses. 

Additionally, there is a link between eating disorders and perfectionism—statistically, those with eating disorders exhibit elevated perfectionism compared to those without. (2) And while your child’s treatment program may have challenged some of the beliefs your child has related to flawlessness, self-criticism, and control, school can be a triggering environment since teachers and principals often reward perfectionism, whether they realize it or not. If your child has struggled with perfectionism, you may want to contact your child’s teachers and discuss ways to support and encourage mindfulness and acceptance.

Athletic pressures

Sports can help children in many ways, including: (3)

  • Improving self-esteem
  • Teaching collaboration and teamwork
  • Building social skills
  • Engaging in joyful movement
  • Controlling negative emotions
  • Creating a sense of belonging
  • Improving mental health
  • Fostering cooperation and leadership 
  • Improving sleep

However, participation in sports can trigger an eating disorder relapse, especially sports that often emphasize body weight, size, or shape. Educate your child about the risks of these sports and meet with their coach, regardless of sport, to discuss ways to demonstrate body positive language while coaching. Many coaches may not even realize the harmful ways in which they speak about athletes’ bodies (e.g. who is stronger, who is bigger, who is “puny” or getting pushed around, etc.)

Lunchtime

Mealtime can be one of the most stressful and triggering times for people of all ages recovering from an eating disorder. This may be compounded for children at school by having to eat in public in the cafeteria. Because of the extreme anxiety this induces in many people, they may choose to isolate, eat in secret (such as in the bathroom), or avoid eating altogether.

Plus, depending on your child’s lunch offerings, they may feel extra anxious about all of the food options. For this reason, it may be smart for you and your child to pack their lunch together. Give them agency in deciding what to bring for lunch. You can also collaborate on a meal plan and encourage your child to stick with it. Before school, you can also talk to your child to prepare them for lunch that day. Having a conversation about it may ease some of their worries.

Social comparison

The school environment is primed for social comparison. It can be easy for your child to fall back into a pattern of comparing themselves and their body to those of their peers, but this is dangerous and can trigger disordered eating impulses as well as increased body dissatisfaction. 

Following fellow students as well as influencers, on social media platforms like TikTok and Instagram can exacerbate social comparison, especially because so many people edit and brush up their photos before posting them. It’s important to communicate with your child about how social media creates a distorted view of the world in which everyone has the “ideal” body and everyone is living their best life. Encourage them to follow diverse and body positive accounts.

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How to support your child’s recovery

While you can’t fix or heal your child’s eating disorder on your own, you can play a major role in their recovery. Your child needs a strong support system to encourage, empower, and uplift them, people who won’t shame or blame them for their condition or impulses.

Use body positive language

Supporting your child’s eating disorder recovery starts with how you talk about yourself and others. Embrace and demonstrate body positivity or body neutrality. Avoid talking about dieting, your weight, or your clothing sizes. Show your child that you love, accept, and are grateful for the body you live in. And avoid commenting on other people’s weight or body size, whether they are strangers, celebrities, athletes, or otherwise. 

Practice and teach mindful eating

Mindful eating involves using your five senses to promote awareness while you eat. It means that you are giving your full attention to your meal. It can also involve gratitude for where your food came from, the opportunity to enjoy such delicious food, and for the company you keep. Teach and foster mindful eating for the whole family and make mealtimes about truly experiencing and enjoying the food. 

As an added bonus, if you have the means and space, you may want to work on a garden with your child. Then they can see where their food came from and feel pride and accomplishment in helping their food grow.

Practice a compassionate and nonjudgmental approach

It can be easy to stay positive when things are going well, but it can be more difficult to practice compassion and avoid judgment when your child is stressed or triggered or experiencing negative emotions. No matter what, your support must come from a place of empathy and compassion. Listen first, and allow yourself to fully process before responding. 

Ask your child how they would best like to be supported—sometimes people just want to vent while other times they may be looking for advice. Never blame your child for what they are experiencing. Instead, use “I feel” statements when talking to them about their eating disorder symptoms or behaviors. Assure them that they can always come to you, no matter what they are struggling with.

Organize family activities that don’t center food

Make a point to organize family activities that don’t center food, such as going to the park, planning a game night, shooting hoops, watching live music, going for a nature walk, and more. Activities that don’t involve food can take some of the pressure off of your child, especially in early recovery. It also gives you a chance to connect through joy and appreciation.

Prioritize regular therapy sessions

Just because your child has completed an eating disorder treatment program, that doesn’t mean that the work is done. Recovery is a lifelong process, and everyone’s journey looks a little different. It’s important for your child to receive ongoing professional care, such as therapy, so they can build upon the skills they learned in treatment and have a resource for dealing with issues that may arise. Start out with two or three therapy sessions per week and overtime, you may be able to reduce the frequency.

Know the signs of eating disorder relapse

Lastly, it’s important to educate yourself on the signs of an eating disorder relapse so that you can get your child help sooner rather than later. Generally, a relapse means that your child has returned to a pattern of disordered eating behaviors. Beyond observable behaviors, your child may be struggling emotionally and mentally, which can be difficult to detect if they are good at hiding their distress.

Some signs of an eating disorder relapse may include:

  • Checking their weight regularly
  • Avoiding social activities
  • Sleeping way less or more than usual
  • Hiding information from you
  • Checking their appearance in the mirror
  • Isolating themself from family and friends
  • Appearing guilty or ashamed after eating
  • Exercising excessively
  • Eating alone on a regular basis
  • Wearing loose-fitting clothing
  • Taking frequent trips to the bathroom after meals
  • Expressing eating disorder beliefs, like needing to burn off calories

If you are worried that your child has relapsed, don’t panic. Approach them from a caring place and gently ask how they are feeling and if there’s anything they’d like to talk about. Use “I feel” statements and make sure that your child understands you are approaching them because you are concerned and want to find the best way to support them. While some children or adolescents may be able to get back on track with a few therapy sessions, others may require the additional support of re-entering a treatment program. Make sure to talk to your child’s provider about which option makes the most sense for your child.

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Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. PACER’s National Bullying Prevention Center. (2020). Bullying Statistics: By the numbers.
  2. Bardone-Cone, A. M., Sturm, K., Lawson, M. A., Robinson, D. P., & Smith, R. (2010). Perfectionism across stages of recovery from eating disorders. The International journal of eating disorders, 43(2), 139–148. 
  3. Victoria State Government Department of Health. (2015). Sport and children. Better Health Channel.

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