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Although most common in teens and adults, bulimia nervosa can also affect kids of all ages. Thankfully, through treatment, kids can make a full recovery from this disorder and move on with their lives unburdened by disordered thoughts and behaviors. But to do so effectively, they need their parents’ love, support, and participation in the treatment process. 

Treatment centers focused on resolving bulimia nervosa in adolescence offer many ways for parents to participate in the care process. Through their parents’ participation, kids receive the support they need to become recovered and avoid relapse during stressful times. Here’s a look at just some of the ways parents can play an important role in bulimia treatment.  

Learn About the Level System

To provide the ultimate in support to their kids, parents need to understand the level system used by the treatment center. With this system, the care team can gauge the child’s progress in becoming recovered.

As they complete their given activities and collaborate with the care team, kids move through the treatment process one level at a time. With each level they gain, children are given increased responsibility in managing their thoughts and behaviors. They still have the treatment team’s support, however, ensuring they can stay on track and have someone to fall back on during tough times.

This system has four levels:


At this initial level, the treatment team takes time to learn about the child’s needs and helps them adjust to the program. Children undergo many different assessments during this time, including medical, nutritional, and psychosocial evaluations. The family will also play a part, sharing their familial needs and hopes for the child’s progress in recovery.

Level 1

Level one centers around the stabilization of the child’s mental, physical, and emotional wellness. Kids are encouraged to engage in treatment and follow their care plan exactly as written, including 100% meal and snack completion. Exercise is limited at this level to help dismantle disordered thoughts and actions that otherwise contribute to the progression of their eating disorder.

Level 2

At the second level, kids start to focus on improving their motivation to get well while following the treatment plan. The treatment team promotes flexibility in choosing snacks and other foods plus presents portioning challenges as appropriate for each kid’s progress. Children may start to receive passes for outings with their family if their progress in treatment supports that next step.

Level 3

Level three grants even more independence and pushes kids toward becoming fully recovered from bulimia nervosa. They are given full control of portioning for all snacks and meals, for example, plus have a chance to complete some light exercise. They may be able to go on walks, perform yoga, or complete strengthening exercises as appropriate for their needs.

Level 4

By the fourth level, kids have explored their eating disorder in full, understanding its causes and warning signs. They have a wide range of coping skills to use during tough moments, keeping them from engaging in disordered thoughts and behaviors instead. They will also continue to complete many on and off-site challenges that revolve around their triggers, showing their progress in healing from bulimia nervosa. At this point, kids are often ready to start to transition to a lower level of care or even return home from the eating disorder treatment center.

In following this system, all kids start at the entry-level and slowly make their way to level four as they meet key milestones in treatment. Their progress is gauged through weekly contracts that are reviewed and revised with help from the care team. Throughout this process, parents are invited to review their progress and provide appropriate support with the activities introduced through all the levels.

Understand the Family Roadmap

Bulimia nervosa treatment centers that serve adolescents provide a roadmap of sorts for families to follow. They are given these insights through the initial meeting with the treatment team and by learning about what the care process entails.

Through this process, family members can learn what they can do to participate in the program and help their child become recovered. The roadmap might show how therapy can assist in unraveling difficult family dynamics, for example, helping the whole family unit heal and grow.

Every step of the way, this process empowers family members and informs them of all the different aspects of eating disorders. They will learn everything from the underlying causes of bulimia nervosa in adolescence to ways to keep relapse from occurring.

Communicate with the Treatment Team

Parents are encouraged to communicate with the treatment team regularly and receive updates on their child’s progress. With open communication, they can stay informed about their child’s level of care and ways to remain involved in their recovery.

Eating disorder treatment professionals even encourage parents to ask as many questions as they can to better understand the care process. By improving their understanding, the family can become partners in the care process and better support their child in becoming and remaining recovered. They can also better prepare for their kid’s transition out of treatment after reaching level four.

Embrace the Power of Therapy

While in treatment for bulimia nervosa, kids attend regular individual, group, and family therapy sessions. Bulimia treatment centers often require that parents participate in weekly family therapy as well. Parents can also attend sessions without their child, speaking freely with other parents faced with similar challenges.  

Through their participation, they can gain insights and tools that help them rectify many of their kid’s barriers to recovery. It is also possible to resolve difficult family dynamics and help everyone gain a better understanding of each other. Children can share their challenges and inner thoughts with help from their therapist as a mediator, showing their family where they need help most.

By attending the parent-only groups, parents can also receive therapy for their distress, opening the doors for true family-wide healing to begin. Bulimia nervosa in adolescence can put a lot of stress on the family as a whole, after all. By sorting out their issues and relieving that stress, parents can remain calm and clear-headed while supporting their child through treatment.

Listen Without Judgment

Whenever parents interact with their children, they need to listen without judgment. As kids work on becoming recovered from eating disorders, they need to feel like they are not alone — and parental involvement goes a long way to send that message. But only if parents can listen to their child without casting judgment or trying to make the situation better with a few insightful words.

Many of the problems kids are going through are not instantly resolvable and can feel quite embarrassing to talk about with other people, even their parents. By lending a calm, judgment-free listening ear, parents can show that they are there for their child and love them unconditionally. With that loving support, kids are more likely to feel motivated to get well and have hope about their future.

Go to the Parent Education Program 

Every other weekend, families can attend the parent education program onsite at the treatment center. This program informs parents about their child’s eating disorder and the necessary treatment steps needed to help them recover. They may learn about:

  • Eating disorder symptoms
  • Relapse warning signs
  • Nutritional planning
  • Meal prep and portioning tips
  • Behavior management techniques

Through this educational program, parents can also attend psychoeducational seminars, which explore co-occurring conditions and other complicating factors. There is also a parent-only support group held at that time, giving family members a chance to sort out their issues and gain steady footing.

By talking with other parents, they can navigate their shared struggles with more confidence and much less guilt. This can renew their strength in helping their child move through treatment and become recovered.

Participate in Exposure Activities

As children move into higher levels of treatment, they gain opportunities to participate in treatment challenges or exposure exercises. These challenges center around helping kids face their triggers and choose adaptive coping skills to handle the tough feelings that arise. They typically begin these exercises in the treatment center, but soon need to go on outings to face situations that may arise in daily life.

Whether working on exposure exercises in the treatment center or on outings, kids greatly benefit from their parents’ participation. If kids are working on eating sit down meals with others, for example, their parents’ presence bridges the gap and readies them for a return home. With that support, they can learn how to best approach the coping process with an aim at rejoining the family at mealtimes after discharge.

Check-in with the Family Resource Library

For additional support during their child’s treatment, and beyond, parents can check into the family resource library. This important resource provides access to informational webinars and articles, helping educate families on how to best participate in their loved one’s care.

By digging through the available resources, parents can learn about:

  • Medical complications caused by eating disorders
  • Impact of social media on recovery
  • Challenges presented by returning to school after becoming recovered
  • Therapy models and how they can help promote sustained recovery

The resources are designed to act as a guide through the treatment process and the transition home. By checking in regularly, parents can improve their understanding of how to help their child become recovered. They can also gain the insights needed to heal alongside their child and cast away beliefs that are not helpful to anyone involved.

Assist in the Transition Out of Treatment

Before kids recovered from bulimia nervosa can return home, they must be prepared to make this transition, as should their parents. To facilitate that process, treatment centers slowly ramp up family involvement as kids make it through each stage of recovery and move toward level four.

In addition to continuing to attend all therapy sessions, parents may start to accompany their child on more outings to practice their treatment challenges. This helps them become a leading source of support for their child, helping leave the treatment team behind when it comes time to transition home.

Parents also need to help establish connections with the outside providers who will be taking over their child’s care after this transition. As treatment is handed off to the outpatient team, parents must still play an important role in their child’s care, helping them remain recovered through the years.

Understand When to Reach Out for Help

Even after completing treatment, many kids still need bulimia counseling to keep disordered thoughts and behaviors from returning during difficult times. As stress arises, kids need to have a support system in place to help them cope using appropriate methods that support their long-term wellness goals.

Parents will need to maintain close connections with outside care providers and the treatment team to alert the support system when trouble is on the horizon. They also need to understand the relapse warning signs and report any, and all, problems to the care team upon noticing their child having difficulty remaining recovered.

Warning signs they need to watch for include:

  • Skipping family meals
  • Eating in secret
  • Ignoring the eating plan
  • Withdrawal from social activities
  • Avoidance of food they previously enjoyed
  • Binging and purging behaviors
  • Obsessing about weight or body shape

Prompt care can help kids avoid slipping back into using disordered thoughts and behaviors to cope, so it is always important for parents to report those warning signs to the care team.

To get their child the care they need, all parents have to do is call 855-900-2221. Admissions specialists are always available to assess the child’s need for care and find them the appropriate level of support.


Areas We Serve:

Houston, TX | South Miami, FL | Malibu Lake, CA | Naperville, IL | Portland, OR | Briarcliff Manor, NY | Twin Lakes, VA


Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.