What gets someone with anorexia to manage meals?
I'm delighted to share a mother's thoughts about what got her girl to start eating the meals served to her, after weeks of restriction. What made it possible for this young person? What did the parents do differently? They already had been trying to use all the best feeding advice that's out there. So what, for them, was the key?
You'll know how difficult that meals can be, when a child or teen has anorexia (or the ridiculously-termed 'atypical anorexia'). In the early days of treatment, our children may eat a little, but not enough to get on the path to recovery.
May these early steps in a mother's journey give you ideas, courage and hope.
Weeks of restriction, hospital, and then a breakthrough
The mother — I'll call her M – wrote to me:
"Good news! My daughter started gaining weight on week 4 of FBT treatment. We have made progress steadily since that breakthrough."
So I asked her, "Do you have an idea what made it work at last?"
Here's her reply. And further down I'll add a few comments of my own.
"What made it work? Who knows, but I can make some guesses"
1) on her second stay in the hospital, the staff made it clear that they hope NOT to see D again. She needed to hear that. She loves the hospital.
2) on her second stay in the hospital, we got one-on-one meal support coaching: that gave me some new 'D-approved' ideas.
3) your workshop was great because I realized there is no silver bullet. I was already doing everything pretty good. So I stopped feeling helpless waiting for a magical formula.
4) I listened to your YouTube "Connect before you Direct" over and over. It seemed to be a skill I could grow into more. I practiced saying nothing when I didn't have something empathetic to say. Instead just a "mmm" with a really kind tone.
5) I started asking D questions, and eventually she felt heard. The hospital staff taught me a lot by example. I started talking really softly, just audible.
6) I take mental note of what foods are especially tempting. I have noticed that a bad day always starts with skipping breakfast completely. So I focus on breakfast being amazing. This is hard. I'm not a morning person.
7) I tried rewards over and over until something worked. Right now, if she meets a whole day's intake goal, she gets a prize. Maybe trying on school clothes at one store in the mall. For each meal completed she gets time on her phone.
8) I turn off the TED-Ed video if she stops eating.
9) I realized where in the escalation she stops wanting to be touched. I realized that letting her go cool off doesn't mean I've lost an argument. I stopped following her into her room with food. I wait calmly at the table.
10) I got some help, lots of help. It's a lot to coordinate but it has to happen.
11) I have a bazillion friends praying for us.
Back to Eva:
I am a huge fan of coaching and I'm well impressed how the hospital staff supplied it — we too had a turnaround through coaching, when professionals spent a few mealtimes at our home. While many succeed with meals thanks to books and support groups, it makes a huge difference when professionals get practical.
It looks like loving connection with her daughter, with extra-skilled communication, played a major part. Our children have felt so confused and scared before, they've never felt quite so isolated and misunderstood and judged, so we parents really need those skills.
It's so common that breakthroughs happen when a parent drops into acceptance of 'what is'. Far from leading to resignation or helplessness, it energizes us to do what we can do. I too had a major turnaround with a similar 'aha' moment.
M is keen for me to tell you her daughter is 11 and that other ages may respond differently. I have spoken to parents of older teens who succeeded with similar insights. I think it's more important for you to experiment and see what works, rather than dismiss anything on the basis of age.
It's fascinating that at first, rewards did not work — and then M found the right kind of reward, which really did help. When parents go down the road of removing a phone they are — lets' face it — punishing. M flipped the concept around to make time on the phone a reward. Take care. A carrot (and stick) system may work for you, or it may backfire terribly. I say more in Chapter 14 of my book.
M found it better not to follow her daughter into her room with food. This is the beauty of having parents at the centre of treatment — they are the expert on their child. Some parents have found they can make a meal work by waiting a little and then bringing the meal to their child, wherever they are.
This beautiful woman has supportive connections with other adults. I keep seeing how that really strengthens parents and allows them to be kind to their suffering child. Personally I spent far too long over-valuing self-sufficiency.
M really did work at getting good help. I remember how when she came to my workshop, there were at least four other members of her extended family, and D's father who was in the middle of work. The beauty of Zoom workshops is anyone can join from anywhere.
What help do YOU need to get your child to eat?
The keys to a breakthrough may be different for you. Though I suspect that you can never go wrong with good communication skills, good connections for yourself, and meal coaching.
Tell your treatment team what you've been trying to do, what works and does not work, and ask them for more support. If your child is not progressing, it's nobody's fault — eating disorders hit people in different ways — it's a sign that you need more expert help.
There's lots from me to help you. This website has lots of immediate help for you: head over to my "Start here" page. For more reading with loads of practical and emotional tools, there's my book. If you're more into listening on-the-go, there's my Bitesize audio collection. And for accelerated learning, hop onto one of my workshops. I really hope that like M, you will enjoy a turnaround very soon.