First, remain calm. Approaching a child with an eating disorder can be tricky. Naturally, it is very upsetting to discover that your son or daughter might have an eating disorder. If you are panicked, talk to your pediatrician, your partner, or a trustworthy family member or friend. Avoid letting your child overhear you or see you distraught.

Find resources. Before approaching your child, you need to find out what resources are available for her and for your family, so you can suggest a helpful strategy. Ask your pediatrician, internist, and school counselor or nurse for information and referrals. You might want to talk to another parent who has been in a similar situation for support and leads to available resources. Learn as much about eating disorders as you need to feel like an informed parent and advocate.

Meet with a referred therapist initially - without your child, but with your partner - to ascertain how the therapist practices and to discuss the best strategy for approaching your child. If you are experiencing strong emotions such as anger toward your child, you might want to work with a therapist on your own before approaching her.

Be prepared. Choose a safe, and private place to talk. Plan ahead for enough time so that you will not be interrupted.

Remember that an eating disorder is a desperate attempt to cope with underlying problems. Even though you can see how unhealthy and unproductive your child's disordered eating is, she may perceive it as her only way to deal with life. That is why it is common for individuals with eating disorders to be upset or mad if a parent tries to help them. They may fear that you are going to take away their only coping mechanism. Your child may deny the problem, be furious that you discovered her secret, or perceive your caring to be a threat. Raise your concerns, then give her time and space to think about them.

Begin by telling her how much you love her. Explain that you are not angry; rather, that you are worried and concerned about her. Gently offer some specific observations about her emotional well-being or lack thereof. For example: "You seem unhappy / withdrawn / preoccupied / anxious / fidgety / distant / jumpy / angry, and I'm worried about you." Speak from your heart, using "I" statements. Avoid naming other people who are also worried about her, such as, "Your aunts, uncles, and grandparents are all worried too." That can feel like an overwhelming gang-up.

Make a few observations about your child's behavior to convey why you think she might have an eating disorder. For example: "I see you skip meals / I watch you run to the bathroom / I hear you talk all the time about being afraid you are fat, what you ate, how many pounds you want to lose, how much you're going to exercise, etc." Again, your child may feel threatened by your discovery or observations. Give her space to respond; listen to her and ask her to listen to you.

If your child gets upset, mad, or denies having a problem, stay calm. Do not panic or get angry. Avoid getting into a "Yes, you do / No, I don't" power struggle. Remind her that parents tell children when they are worried about them.

If she insists that she does not have a problem, that she will and can stop on her own, or that she stopped recently, you can say something like, "You know how it is with alcoholism and denial. The addiction makes it so hard to see you have a serious problem and that you need help. I'm worried that you're trapped in a similar kind of situation. Even though I hear what you're saying, I think you are really struggling, and you need help stopping. I believe in you, and I know you deserve to get help and get better."

Even if your child knows she has an eating disorder, she still may be afraid and resistant to getting help. The illness can lead sufferers to perceive treatment as very threatening. You may need to approach your loved one many times before she agrees to accept professional assistance.

Point out to her that you are her parent, not an expert on eating disorders, and that you will stand by her and help her get the care she needs. It is important to realize that children generally feel safer with their parents in situations like this if they do not think that Mom and Dad are talking to everyone about their family crisis.

Try to avoid being the adult who tells your child about aspects of his treatment plan that he does not want to hear. Let the pediatrician be the bearer of hard news, so you can be the supportive parent, such as: Doctor: "Yes, you have a serious eating disorder, and you might not be able to play sports." Parent: "I see how upsetting it is for you to hear this. I'm so sorry you have to go through this. But we need to do what Dr. Smith says."

Sometimes it is better not to overwhelm your child with details about a treatment plan until she has had time to absorb the knowledge that you are aware of her eating disorder. On the other hand, some children feel relieved to learn that their parents have found a good person to help them. Trust your judgment about your loved one. If she refuses treatment, gently and firmly tell her that you see how upset or mad she is. Add that you understand how she wishes that you'd leave her alone (or whatever matches her response to your initial approach), but that you are not going to stop being concerned. Do not get caught up in fighting about what she is or isn't eating.

Find a therapist, preferably one with experience treating eating disorders, and strategize how to get your loved one the help she needs. If your child is no longer living at home and you have less leverage and she refuses to seek treatment, you might want to say something like, "Even if I can't convince you to get help now, I can't stop caring." That gives you a foot in the door without being too threatening and allows you time to strategize further. Stay calm and avoid sounding as if your mission is to rescue or cure her. If your child is an adult, remember that she ultimately is the one responsible for getting help; you can't force her.

Eating disorders and disordered eating can be serious physical and psychological problems, but are usually not emergencies. However, if your child is rapidly losing weight, not eating at all, fainting, depressed, suicidal, or otherwise in serious danger, get professional help immediately, and say something like, "I don't care if you're mad at me. Parents don't let their children suffer in danger and isolation."

For policies on athletic participation in eating disorders, please view the following:
National Athletic Trainers' Association position statement: preventing, detecting, and managing disordered eating in athletes
Bonci, C.M., Bonci, L.J., Granger, L.R., Johnson, C.L., Malina, R.M., Milne, L.W., Ryan, R.R., Vanderbunt, E.M. National Athletic Trainers' Association position statement: preventing, detecting, and managing disordered eating in athletes. Journal of Athletic Training. 2008; 43: 80–108.

Position stand on the female athlete triad
IOC Medical Commission Working Group Women in Sport. Position stand on the female athlete triad. Medical Commission of the International Olympic Committee. 2005. Accessed November 2, 2012.

Coach and Athletic Trainer Toolkit
National Eating Disorders Association, 2010. Accessed November 2, 2012.

American College of Sports Medicine position stand. The female athlete triad
Nattiv, A., Loucks, A.B., Manore, M.M., Sanborn, C.F., Sundgot-Borgen, J., Warren, M.P; American College of Sports Medicine. American College of Sports Medicine position stand. The female athlete triad. Medicine and Science in Sports and Exercise. 2007; 39: 1867-82.

Eating Disorders in Sport
Thompson, R.A., Sherman, R.T. Eating Disorders in Sport. New York: Routledge; 2010.

Managing the female athlete triad
Sherman, R., Thompson, R. Managing the female athlete triad. NCAA Coaches Handbook. Indianapolis: National Collegiate Athletic Association; 2005.