In-Person & Virtual Eating Disorder Treatment for Kids & Teenagers

What is family-based treatment for adolescent eating disorder recovery?

Family-based treatment (FBT), also known as the Maudsley method, is an evidence-based approach to the treatment of eating disorders, particularly for adolescents and young adults. FBT aims to empower parents or caregivers to play an active role in supporting their child’s recovery. There are three phases of FBT.

Frequently Asked Questions

What are the signs of an eating disorder in kids and teens?

Eating disorders aren’t always obvious from the outside. Just because someone hasn’t lost a bunch of weight doesn’t mean there’s a problem. Some behavioral symptoms to look out for are skipping meals, eating very small portions, avoiding certain foods or food groups, frequent comments about weight or body size, eating in secret or hiding food, or sudden changes in growth, mood, or energy levels.

You might also notice increased anxiety around meals, rigid food rules, or a pattern of eating very little during the day and more at night. If something feels off with your child’s eating or relationship with food, it’s worth getting support early.

Do you need a diagnosis to start working with a dietitian?

Nope! At Ruby Oak Nutrition, you don’t need a formal diagnosis to get started. Many kids and teens we work with are in the early stages of disordered eating, or their symptoms don’t fit neatly into a specific diagnosis. While we often receive referrals from pediatricians, a referral isn’t required.

If you’re concerned about your child’s eating, growth, or relationship with food, that’s enough reason to reach out and start nutrition counseling.

What does nutrition counseling look like for kids and teens?

Nutrition counseling is tailored to your child’s age, needs, and level of support. For younger kids, sessions often focus more on working with parents or caregivers. For teens, we typically work with both the teen and caregiver in a way that supports increasing independence while still keeping parents involved.

At Ruby Oak, sessions focus on restoring consistent eating, expanding food variety when needed, and reducing anxiety around food. We also make sure your child is getting enough nutrition to support growth, development, and overall health.

Will I, the caregiver, be involved in my child’s eating disorder treatment?

Yes. Caregivers play a massive role in eating disorder treatment, since they’re responsible for providing food and setting boundaries around disordered behaviors. In our appointments, our eating disorder dietitians will guide you on how to structure meals and snacks, respond to your child’s “eating disorder voice“, and be supportive and firm without escalating conflict.

Parenting a child with an eating disorder can be challenging, confusing, and frustrating, even when parents mean well and do everything they can to help. Your dietitian is there to make the process a bit easier.

What if my child refuses to eat and I can’t do anything about it?

While outpatient nutrition counseling (which is what we offer at Ruby Oak Nutrition) works well for some adolescents, it doesn’t work for everyone. Sometimes, even when parents have good intentions and follow eating disorder treatment guidelines, an adolescent isn’t able to make progress at home. If you worry that this is the case for your child, we recommend booking an appointment with one of our dietitians anyway. In the initial assessment and first few appointments, we’ll get to know you and your child, and we’ll learn more about their eating disorder. From there, we’ll be able to make a tailored recommendation for a higher level of care if needed. We have relationships with several residential treatment centers and intensive outpatient programs, and our team can connect you to the right people and places for the next step in treatment.

How do you support teens who want more independence with food?

This really depends on what phase of recovery a teenager is in. If they’re undernourished (which often, but not always, means that they need to regain weight), their desire for autonomy is probably their eating disorder trying to stay in control and keep them sick. In this first phase of treatment, we strongly recommend that caregivers be in charge of what, when, and how much a teenager eats. This can feel confrontational and uncomfortable, but research shows that the sooner a teenager can restore weight and nutrition status, the more likely it is that their eating disorder recovery will stick.

Once a teenager is fully nourished and in a later stage of recovery, they’ll work with their dietitian to slowly regain autonomy and independence with food. We use the principles of intuitive eating to help teens create healthy, flexible food habits that they can continue to practice for life. There are typically some backslides and moments of uncertainty along the way, but regular nutrition counseling and a strong relationship with a dietitian are two things that can keep a teenager grounded in their recovery even when things feel hard.

Can you help with ARFID or picky eating?

Absolutely. Our dietitians have experience working with ARFID and more extreme forms of selective eating. We take a gradual, individualized approach that focuses on increasing comfort and variety over time, rather than pushing rapid change. We know that forcing someone to eat something doesn’t work, and can actually create more resistance (and sometimes trauma) down the line. Instead, we take a sensory approach to increasing food variety. We might incorporate food play therapy into treatment with younger kids (think painting with tomato sauce, or building piles with rice), and we often walk our clients through experiencing a fear food with all of their senses except taste before recommending they take a bite.

We also help caregivers understand how to support their child without increasing pressure or anxiety around food. Our dietitians can also help you set realistic expectations for your child and their eating behaviors. Picky eating can take years to work through, but your child can be fully nourished and enjoy various foods in the meantime.

How do you support growth and weight restoration if needed?

If your child needs to restore weight or support growth, we’ll guide you through that process in a clear, compassionate way. This includes helping you understand portioning, meal structure, and what adequate nutrition looks like for your child’s stage of development. We determine estimated body weights (AKA, the weight that your child “should” be at) by looking at their growth charts to see what percentile for height and weight they’ve historically been in. Then, we set goals that will bring them back onto their natural growth curve.

We also help you navigate the emotional side of this, since changes in eating and body size can feel challenging for both kids and caregivers.

Do you work with my child’s therapist or pediatrician?

Yes. With your permission, we collaborate closely with therapists, pediatricians, and other providers. Eating disorder recovery is most effective when everyone is working together, and we make sure nutrition care is aligned with the rest of your child’s treatment team. Dietitians are often the bridge that connects other parts of the treatment team to each other.

Do you offer virtual sessions for kids and teens?

Yes. We offer both in-person sessions in Raleigh and virtual sessions across North Carolina and beyond. Many families find virtual sessions to be more flexible and easier to fit into busy schedules. We’re also happy to write notes to your child’s school, or make recommendations for medical 504 plans, if they need to miss class in order to make it to their nutrition counseling appointments. Often, the adolescents we work with will get permission to use a private room at school for a midday virtual appointment.

How long does treatment usually last?

The length of treatment for an eating disorder varies pretty significantly from person to person. We recommend booking weekly appointments for at least the first three months, which gives your dietitian time to understand your family, your child, and your child’s eating disorder and create a flexible treatment plan that works with your family’s routine. Many of our adolescent clients and their families work with us for several months or years, depending on the type and severity of their eating disorder, and their recovery goals.

What if my child doesn’t want help?

This is very common. Kids and teens don’t always recognize that there’s a problem, or they may feel scared about change. We’ll help you navigate that dynamic in a way that’s the most supportive of your child’s long-term well-being. Sometimes this creates some conflict, but we like to remind parents that it’s better if the treatment recommendations are coming from a dietitian (or another member of the treatment team) and not only from the parent. We’re OK with you saying, “I know you don’t want to eat this meal, and I understand you’re uncomfortable. We’re eating it because it’s what your dietitian recommended.” (In other words: It’s OK that you make us the bad guy.) Even if your child is hesitant, getting guidance as a caregiver can make a meaningful difference.

Is picky eating the same as an eating disorder?

Not always. Picky eating is common in kids, especially in early childhood, and often improves over time. But in some cases, more extreme or persistent selective eating may be a sign of something more, like Avoidant/Restrictive Food Intake Disorder (ARFID) or another eating disorder.

A few signs that it may be more than typical picky eating include a very limited range of accepted foods, strong fear or anxiety around trying new foods, difficulty eating with others, or impacts on growth, nutrition, or daily life.

At Ruby Oak Nutrition, we help families understand what’s within the range of typical development and what may need more support. If your child’s eating feels stressful, restrictive, or isn’t improving over time, it’s worth getting guidance so you’re not navigating it on your own.