Returning to School After an Eating Disorder

At times, the need for eating disorder treatment necessitates that young people and their families make the difficult decision to take time away from the school setting.

The truth is: intensive eating disorder treatment often requires young people to take time away from school to focus on getting the help that they need.

Removing a child or adolescent from the school setting can be a painful decision, particularly when the child is excelling in academics or it seems that social relationships are sustaining the child.

Parents sometimes ask me: “What will my child have to work for?”

I tell them, just as with any other medical illness or condition, it is sometimes important to step away temporarily from the rigors of school. And, I tell them:

We can fully heal when we focus all of our attention and energy on recovery.

And sometimes, when we take a closer look, we may even find that the child isn’t functioning especially well in the school environment. We may even notice one or more of the following issues:

• He is having trouble concentrating
• She is putting incredible pressure on herself to perform
• He is hiding out in the bathroom at lunchtime

But what about the child who has made a great deal of progress in treatment and appears to be ready to return to the school setting? This can be a challenging and confusing time for families and students as they evaluate when and how to return to school after eating disorder treatment.

Families can consider a number of the following questions and strategies when making the decision to return to school.

Is my child ready to return to school?

This is one of the most important questions — and the first question that families might ask themselves and their treatment team. Some of the important signs that a child or adolescent may be ready to return to school include the following:

• She is completing meals regularly with minimal or no prompting or support
• She has demonstrated the ability to use skills to avoid engaging in behaviors like purging or compulsive exercise
• He’s demonstrating increased honesty and openness about eating disorder behaviors and urges
• Her ability to concentrate has returned, and she’s not consumed with eating disorder-related thoughts most of the time
• His ability to tolerate changes in schedule, available food options, and other unexpected events allows him to make flexible adjustments when needed

Who will support my child when she returns to school?

It’s important to connect with the student’s school counselor and other support staff to ensure that they are aware of your child’s specific challenges. It can be helpful for your student to know that at least one adult at school will be a helpful resource should challenges arise.

Before your child returns to school, discuss the best way to approach the counselors and support staff. You’ll also want to decide if, and how, you want your child to contact you during the day, if needed.

Who will oversee my child’s nutrition at school?

The transition back to the school environment can be challenging. New situations, relationships, and food choices abound.

Let's say your child has been in treatment for anorexia or another eating disorder. It can be helpful, well ahead of the transition, to decide how nutrition will be managed. This can help your child prevent challenges from escalating. Some possible strategies include:

• Eating with a school staff member, perhaps having meals in a counselor or nurse’s office with supervision
• Sharing meals with a parent during the early days of reintegration
• Eating with peers and using other strategies to assist in accountability, like looking for signs of anorexia behaviors in the school setting (these can be identified with help from the treatment team and family members)

The type of support that is best for your child will depend on a combination of their individual challenges and the available options.

Is it possible for my child to return to school slowly?

Whenever possible, I recommend that parents help their children acclimate slowly to the school environment.

Many of our patients begin this process by attending a few hours of school in the morning and then going to treatment. This allows the students the opportunity to get their feet wet in readjusting to the (many) stressors of school, without needing to get nutrition there initially.

Next, we might have the student attend the school day through lunch and then return to treatment. In this manner, we can gradually increase exposure to the various challenges the school day provides with an ample amount of support, structure, and monitoring. 

Can my child participate in extra-curricular activities?

Reintegration into school doesn’t necessarily mean that your child is ready to be back, full throttle, in the pace of an average student’s life. Families need to carefully consider if their child will be participating in activities outside of school. If you are facing this decision, consider the following:

• How well is your child balancing his/her nutritional and psychological needs with the adjustment to school?
• Is your child able to complete their school work without becoming overwhelmed?
• Is your child physically ready to engage in activities?

When it comes to participation in sports or other more physically engaging activities, families need to even more carefully consider readiness and are encouraged to consult with their child’s treatment team. Prerequisites for engagement in physical activities include a period of stability in weight, vitals, and other physical markers of well-being (e.g. if menses has returned).

Learn more about how we treat compulsive and excessive exercise at ERC.

It is understandable that school reintegration can feel like an overwhelming process to all involved. But, with thoughtful consideration and regular consultation with your child’s treatment team, it can be a rewarding opportunity for your child to build back a life worth living.

Ashley Solomon, PsyD, CEDS is the Executive Director at Eating Recovery Center, Ohio.