How do you get your child to eat in spite of anorexia or a restricting eating disorder?

This is a section from Chapter 7 of ‘Anorexia and other eating disorders – how to help your child eat well and be well’

 

It can seem impossible to get your son or daughter to eat when they’re suffering from anorexia or another restrictive eating disorder. Yet refeeding is essential in the early days of treatment. In this chapter I give you all the tips I’ve learned from experience, from our therapists and from other parents. I’ll use a bungee-jumping analogy to illustrate the principles. Later, I’ll offer some examples using practical scenarios of refeeding and of exposure to scary (fear) foods.

In the early days, most of us find it impossible to get our children to eat. We desperately hunt for treatment, and when we find it we’re brought round full circle: we, the parents, are the people at the centre of our child’s recovery. We need to learn how to get our kids to eat.

The tools I’m about to offer you got my child from eating practically nothing, to eating what she needed. They saw her through a whole list of foods she couldn’t previously eat, and freed her up to enjoy other people’s cooking and meals in cafés. These tools deal with fear and irrationality, so they’re relevant to many of the challenges of anorexia and related eating disorders, including the drive to exercise, or to engage in obsessive-compulsive behaviours.

Some of what I suggest may not be for you, and that’s fine. We’re all different. Different situations, different resources.

And now, prepare yourself. I’m going to invite you on a bungee jump. I hope you are suitably terrified!

Actually I have no intention of raising your stress levels and I’m going to take very good care of you. The aim of this thought experiment is to help you empathise with your child, so that when you’re in the middle of a meal the tools come to you instinctively and you don’t have to go and consult a book.

The great bungee-jump: a thought experiment

Your child’s resistance is driven by fear

One day I realised that just about every mealtime obstacle my daughter threw at us was driven by fear. This changed everything. Her behaviour might have looked like contempt, or stupidity, or rudeness, or defiance, but the eating-disorders specialist coaching us suggested that the underlying emotion was fear. How can food be frightening? It’s not of course, but if you have a brain disorder, you don’t think the way others do.

“Before, we knew she was having rages and tantrums, however, on the multi-family therapy week we have all learned together that it is fear and anxiety.”[1]

When we presented our daughter with a plate of pasta, she refused because she was scared. When we asked her to drink a glass of milk in a café or at home, she refused, despite having been able to drink milk in the hospital, because in this new situation she was scared. When we asked her to sit for a car journey, she was in turmoil because she was scared.

Knowing this meant that none of her abuse pushed my buttons any more. I stopped telling myself that she wasn’t trying enough, or that she was being awkward or inconsistent. Instead I felt deep compassion. My only concern became wanting to know how I could ease her fear enough for her to manage the next step. And I recognised the parallels with my own challenges to support my daughter even when I was scared.

My new understanding also meant that there was no point in lecturing her about her rudeness while she was in this state. She was a kind and considerate person normally, and I trusted that her unwelcome behaviours would disappear along with her fear. Which they did.

Fear is a horrible emotion. So horrible that often we fear fear, and will do anything to avoid situations we know induce fear. When we feel fear, we assume that we are in danger. Think of public speaking. Many people fear it more than anything, and yet where is the danger? Even the fear we feel as we prepare to give our speech is not dangerous. Feel the fear and do it anyway, as Susan Jeffers says in her best-selling self-help book.[2] Eat.

Ready for the bungee jump?

The bungee jump analogy - help your anorexic son or daughter to eat
Photo credit, and a very relevant description: Thank you to www.roamingaroundtheworld.com

To help us support our children to eat even though they are frightened, let’s think what it would be like to take a bungee jump. I don’t know about you, but I have never even considered taking a bungee jump. Way too scary. Are you telling me I have to take a jump? Arghhh!

And to take the analogy further, let’s say that I’m supposed to jump not just once but several times a day for the rest of my life.

Perhaps that’s what eating feels like to our kids right now.

So, how could a friend support me to jump?

[End of the extract]


More in this chapter of the book:

  • Planning the challenge
  • Logic doesn’t work
  • Education: the dinner table is not a lecture hall
  • Conversation topics: pick with care
  • Distraction: a firm favourite
  • Reassurance: suprisingly not reassuring
  • Trust me, I’m an expert
  • Shock tactics: short-lived gains, high costs
  • Shouting, intimidating, blaming: counterproductive
  • Threats, punishment, and ‘consequences’: unnecessary
  • Rewards and bribes: handle with care
  • Incentives: a nudge in the right direction
  • Visualisation: access to inner resources
  • Praise: complex and risky
  • ‘It’s your medicine’: worth a go
  • Damage limitation: blame something other than your kid
  • Make a graceful exit
  • Containment: stay close
  • Humour: the best relaxant
  • Feelings: a good start
  • Empathy: powerful when focused on the task
  • Selective hearing, body-swerving and translation skills
  • Mirroring: model calm confidence
  • Defusing fear: remove the fear of fear
  • Notice indicators of progress
  • Wait a few minutes
  • How long should you persist?
  • Focus on the current step in the present moment
  • Let your kid save face and maintain some dignity
  • All singing from the same hymn sheet
  • Teamwork: relay each other
  • Giving uncritical acceptance
  • Putting it all together
  • Video and audio resources

More on how to get your child to eat, or what your options are if your child isn’t eating everything required, on this page, listing all video and audio resources.

Buy

 

* Go to Table of contents *

Next  chapter: See the tools in action: mealtime scenarios

 

15 Replies to “How do you get your child to eat in spite of anorexia or a restricting eating disorder?”

  1. Our daughter is in a residential programme at the moment but is continuing to lose weight and we are seriously wondering if they are doing anything that we couldn’t do at home. We have talked about her coming home but she has said that although she wants to come home she knows it won’t work. Are we living in cloud cuckoo land thinking we can manage this? Also any advice on how you get them to stay sitting at the table when they just get up and leave? I’d love to hear your thoughts – everything you said made a lot of sense!

  2. You sound like you’re up for taking an active role at home, and you’d like to know that’s a realistic plan and that you could make it work? What I can tell you is that many other parents have done this, so it’s definitely not cloud cuckoo land. It doesn’t matter whether your daughter thinks it will work or not: either way she’s bound to put up resistance because that’s the nature of the illness. But it’s a pleasant start that she’d like to come home (we didn’t have that luxury). Ideally you’d want to be ready, well supported, and continue to have some kind of medical set up, as this will see you through the ups and downs. Note this article by Harriet Brown on following an FBT approach with a non-FBT team: http://maudsleyparents.org/workingwithanonmaudsleyteam.html

    On the other hand, is there a chance that her residential unit could work for her if, I don’t know, communication was improved, something was changed? Either way you’ll still have work to do when she’s discharged – we certainly did – so it’s useful that you’re getting yourself psyched up and ready.

    What would you think of asking the same question on the Around the Dinner Table forum? http://www.aroundthedinnertable.org/
    Then you could give more detail, and you’d receive support from not just me but lots of other wonderful parents. I’ll go on and look out for you there in case you decide to do that.

    Thanks for asking about how to get your daughter to stay at the table when she gets up to leave. That was a tough one for us too, and I ought to add this to the book. Rather than answer any old how, I’d like to write it up properly and add it to this website. That might take me a few days. Would that be OK for you?

    Meanwhile, thanks for getting in touch, and for giving me the feedback that what I write makes sense – that’s really encouraging – and I’m crossing my fingers for you at this possible time of transition.

  3. I love your use of humour and I think the analogue with the bungy jump is very powerful. This makes it easy for parents to remember waht to do and what not to do during a stressful time. Thank you Eva

  4. Lia, that’s most encouraging feedback, thank you. I like to know the humour is OK even though eating disorders aren’t funny, and that the bungee jump analogy will help concepts stick in a parent’s mind.

  5. Hi Eva,
    you referred me to your site on ARDT forum
    This is EXCELLENT advice, so wise and well worded
    Thank you again
    SnP

  6. Thank you.
    My daughter is only eating oranges and aiming for a weight of 32kilos. Your word have given me some hope to work thru this

  7. Sounds like you have hope as well as resources to help you shift things. I dearly hope that by now you’ve experienced some kind of success, even if it’s just a tiny step in your daughter’s ability to take a bite of something else, or in your ability to be by her side, no matter what. I would love to know and send you warm wishes.

  8. My daughter (13 years old) is in the early stages of the refeeding.
    She said that the last two weeks were the worst of her life..
    Sometimes she simply close her mouth and stop eating saying that she cant eat.
    What is the best approach to this situation?
    Thanks

    1. Jorge, you’re at the most horrible stage, and it’s so hard for all of you.
      My best ideas and suggestions are in the book, so I’m wondering what more to suggest for your particular situation.

      Something that is positive is you say she stops eating.
      So I’m guessing that means you managed to get her at the table, you’ve made it OK for her to sit down, and she has managed to eat something before stopping. Apart from the stopping, these are real successes. Notice what you’ve done that might have supported her to do all that, and keep doing it. Seriously. In the early days there were times I couldn’t get my own daughter to even begin a meal.

      It’s great she’s telling you she “can’t eat”, as she is probably telling you 100% her truth. I mean, it’s more direct than “I don’t need to eat” or “This will make me fat” (which can be expected too). You can tell her you believe her. That you really hear that to her, eating seems totally impossible, and at the same time you know that eating is safe and is exactly what she needs, and you are there to help her, one bite at a time. That way she feels heard and understood and it helps build trust so she can accept your support, meal after meal.

      What may help you, as you support her, is to ask her to have one more bite than she thinks she can manage. I know from your email to me that she is under clinical supervision, so at least she is safe, which means you can try and not panic when she doesn’t manage enough food right now. You can only do what is possible, and you are busy learning as fast as you can. I am guessing that although you want her to eat 100% as soon as possible, it may take this one-bite-at-a-time process for a few meals before she really manages to eat quite a bit more and you can breathe more easily.

      She’s also telling you these last 2 weeks are the worst of her life. Whether she’s screaming it at you or crying (you don’t say), hear how she relies on you to be helped, to be understood. Pretend you’re an expert already (you will be soon) and tell her this illness is treatable, that you know what to do, and that you will support her all the way through.

      I hope this gets you going for now and send you all my best wishes.
      Eva

  9. Am so glad i stumbled over this site. My daughter was addmitted to hospital with eating problem we felt so alone. We have no idea how to help but reading the comments has made me feel a bit better will try to download uour book.

  10. As somebody with an eating disorder I can just encourage all parents don’t force your children too eat food or try food
    Try asking them too help you cook or they can choose what’s for dinner. Make them feel supported and undeestand not forced and pushed
    Eating disorders are horrible!

  11. Tia, I am so with you about how horrible eating disorders are, and the need for people to feel supported and understood. I imagine that this is something you dearly long for for yourself, and I am sending you warm wishes.

    I dearly hope that my book shows how our children can receive so much loving support and understanding and a whole range of possible strategies to help parents find a way to help their child regain weight, so as to get the best chance of recovery. The strategy you are suggesting will be useful for many people much later on in treatment, when they are increasingly able to take care of themselves and to practice doing so.

    On the other hand it can often be unhelpful in the acute stages, when the person is unable to eat enough for weight gain when they have a lot of choice. Parents often find that when they give choices, their son or daughter is anxiously trying to reduce their intake and the trend tends to be downwards. When parents take charge, their child also goes through anxiety, but after a while the anxiety is reduced because there’s less internal conflict – plus, at least we know the person is on the path to freedom thanks to the better nutrition and weight gain.

    Parents who use my book or videos tell me they really get how scary and horrible it is for their child. If you read my book, I hope you will warm to it and see how much care and love we parents put into giving our children their life back.

    As you write that you have an eating disorder yourself, I wish you lots of good things, and in particular, lots of understanding and support.

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