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Practical meal scenarios - refeeding anorexia

Practical mealtime scenarios: see the tools in action and treat your child’s eating disorder

In this chapter I give you examples of things to say and not to say at mealtimes. This will help you keep calm and make it easier for your child to pick up that fork and eat. Further down, I offer a scenario where parents support their child to eat for the first time. This chapter uses many of the practical and emotional tools described throughout the book.

Excerpts from Chapter 8 of 'Anorexia and other eating disorders – how to help your child eat well and be well'


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How can you 'make' your child eat? We're getting very practical here.

Let’s assume you’re doing everything pretty damn well. You’re non-critical, accepting, determined, empathic and at times you even have a sense of humour. Even then, it would be a miracle not to encounter resistance. In this chapter, you’ll find tips for responding in common challenging situations.

First, I’m going to offer you a very, very dull list of responses you can give to the many arguments your child may raise during a meal. It’s supposed to be dull and a bit of a broken record, because you don’t want to get caught up in long discussions. Once you’ve got the gist of it, feel free to skip to the following section, where I invite you to be a fly on the wall during a fictional lunchtime session. This example pulls together many of the practical and emotional tools I talk about in this book.

What to say, and what not to say when you are supporting your child to eat

Thanks to some meal coaching at home, my husband and I learned to avoid getting drawn into unproductive discussions. It is not our normal style to deflect questions or to refuse to discuss things, so we had to be vigilant. We saved eating-disorder-related discussions for outside mealtimes.

As we saw in our bungee-jumping analogy, the idea is to keep the focus on the task of eating and to use direct eating prompts. This usually helps meals along better than giving information or choices. The message is that yes, your child has some anxiety right now, and (not ‘but’) he also needs to eat, and he can eat while feeling awful. ‘Compassionate persistence’ is your motto. You’re communicating a quiet certainty that he is safe, that the food is what he needs and that he can trust you to be kind and competent. Think of how you’d help your child to tolerate a medical procedure or how you dealt with his first day at school.

If your child reacts with distress or aggression, this does not mean you’re doing anything wrong. Remember that for him, eating is presently a horrendous experience.

Add empathy to the examples in this chapter

Keep your humanity: whenever you ask for something difficult, whenever you use a phrase from this chapter, start with a statement or gesture of empathy (such as a hug). For example (lots more in Chapter 13):

  • Say ‘Yes’, or ‘OK’ or nod (to save you from contradicting), and repeat some of your child’s words in a loving and concerned tone (so they know they’ve been heard, and are not being judged). So if they say, ‘I’m not hungry’, you could say, ‘Ah, you’re not hungry…’)
  • Then show their reaction is understandable and normal, or make a guess about their feelings (‘I can imagine that makes it extra hard. Nobody likes to eat when they’re not hungry.’ or ‘You’re looking very upset. Is that right?’)
  • Express your sorrow (‘I’m so sorry’)
  • Express your support (‘I’m by your side, darling, ‘I hear you’, ‘I’ve got you’, ‘You deserve this’’)
  • Now that you have connected, you can direct with a request (‘I’m so sorry, it’s hard to eat when you’re not hungry. And at the same time [avoid using ‘but’], I’d like you to get started on the egg.’)

With time, you’ll find what comes to you naturally and from the heart… and what works best with your child.

Eating examples anorexia
Eating in spite of the fear

Setting the scene

‘Whatever you’ve made, I’m not having it.’
Please get off the computer, sweetheart. I want you sitting at the table before I serve lunch. It’s ready.

‘Put it on the table, then, and I’ll see if I want it.’
This is not up for discussion, sweetie. Please come and sit down now.

‘I don’t want to.’
I’m turning the internet off and you need to come and sit down now. Right now please.

[Staring silently at screen.]
Darling, I’m going to stand right here next to you and I’m going to keep asking you to come and sit at the table.

‘I’m not hungry. I’ll eat later, I promise.’
This is the time to eat. Come and sit down. I’m going to sit with you and support you.

‘Leave me alone!’
You need to eat your snack. Let’s get on with it. Come to the table now.

‘But I need to text Carla. You’re always stopping me from doing what I want to do. We’re making plans to meet up at the park.’
That sounds fun! You need your lunch first. Come and eat, and then we can talk about your plans and you can text then.

‘It’s boring at the table. Why can’t we watch telly?’
That’s a good idea. Go put the telly on and I’ll bring your plate over.

‘I want Dad to help me with dinner, not you.’
Yes, that’s fine. Dad can do it tonight.

‘I want Dad to help me with dinner, not you. You’re rubbish’
Dad’s not going to be in for another hour. Right now you’ll have to have your dinner with me. Is there a way I can make it easier for you?

‘Dad makes me laugh. You’re boring and you’re always staring at me like this.’ [Crosses her eyes.]
OK, laughing helps you. How about we watch funny cat YouTubes while we eat?

[Jumping to further in the chapter:]

Be a fly on the wall: a lunchtime scenario

Ever wishes you could be a fly on the wall during a mealtime? Just to see how parents manage to bring their child to the table—and actually get them to eat—even when resistance is high? Here’s a scenario I’ve put together to weave in as many helpful principles as I can . The characters are fictional and don’t screw up as much as real-life parents (like me) would. I will show you that you don’t need to succeed at every step. You can help your child just by doing ‘well enough’.

For the sake of the demo, I’m making the young person put up a lot of resistance. This may be excessive for you: happily, some children eat without much protest when parents are clear that the food must be eaten, offer plenty of love and use distraction.

On the other hand, some of you have been trying to feed your child for a very, very long time. You may be weary. My tips may seem impossible or ridiculous. If meals are not working, do insist on more support from professionals. You haven’t failed, and neither has your child – you just need more help.

My intention, in what follows, is to give you ideas – to expand your toolbox. You’ll see that sometimes I lead with words of empathy before requesting an action (‘Connect before you direct’). Other times I go straight to the instruction. With time and experience, parents get a sense of what might work – and what might not – with their child. As always, take what serves you and leave the rest.

[A little further down in my fictional example:]

Getting her to the table: first attempt

At 12.30 on the dot, my husband, bless him, announces that lunch is served.

My daughter makes a few steps towards the table and hovers at the door. ‘Where’s the food?’

My husband says, ‘Take a seat and I’ll serve.’ (When the food is already on the table, D panics and turns away, so it’s easier to bring the food once she’s seated. But let’s make life hard for ourselves and say that she’s panicking anyway.)

D clings to the doorframe. ‘I don’t want lunch. I’m not hungry.’ I notice that she hasn’t actually backed off, and she’s looking at the table. That’s a positive sign.

H says, ‘It’s understandable you don’t want it. Take a seat anyway.’

‘But I’m full! I’m going to be sick if I eat.’

H says, ‘Take a seat. We’re going to help you and make it as easy as possible.’

‘Tell me what it is and then I’ll come.’

‘I’m serving it right away. On you go, sweetie.’ He gestures encouragingly. I’m already sitting, smiling kindly at D. I’m letting my husband do the talking so that D doesn’t have too much thrown at her at once, but my body language says we’re on the same page.

At this stage, she might well sit down, but I can hear you saying, ‘What if she doesn’t?’ so I’ll make life hard for myself and address this now.

Getting her to the table: empathy

She marches back into the sitting room, mumbling, ‘I’m not having lunch.’ I notice that she hasn’t run upstairs to her room, and she hasn’t bolted out of the front door. That’s a sign that there’s hope.

I come close to her and speak very gently. ‘Sweetie, I’m guessing that this is quite scary for you. Is that right?’ Here I’m giving voice to what I guess she’s feeling. Feeling felt is part of empathy, and my guess is she needs empathy before I ask her to go back to the table.

She shrugs. Her eyes are welling up.

‘I’m wondering if you’d like to know this is going to be OK for you?’ I could have said ‘safe’ too. I’m showing her that I care about what matters to her.

The vulnerable look she gives me makes my heart melt. When empathy hits the mark, the whole atmosphere shifts. It’s now possible to move on.

I say, ‘We’re going to help you. We’ll make it as easy as it is humanly possible. May I give you a hug?’ She scowls, and I say, ‘That’s OK, I’m glad I checked.’

She sniffles, then tenses up again. ‘You’re just going to shout at me. You’re always screaming at me.’

I try and respond to what’s going on for her, not to her actual words. Whenever you hear ‘always’ or ‘never’, avoid getting hooked in an argument. When someone is exaggerating they probably need to be heard at a deeper level.

I say, ‘Screaming at you would be awful. Would you like to be sure you’ll get a lot of kindness?’

She nods miserably. Much of the fight has gone out of her, and I sense that she now feels understood. I can now safely move the focus from her to me and offer the assurances I guess she needs.

I say, ‘Ughh! I hate it that I shouted at you the last few meals. I am quite determined to do my very best to be kind and make things calm and easy for you. I know it makes it harder when I shout. Dad and I have learned so much in the last few days, we are now the best experts you could possibly have. Especially as we love you so much. Come on, come to the table.’ Here I’m trying to make us trustworthy in her eyes, so she can lean on us, and then I’m returning to a direct prompt.

Can we say she now comes to the table? I think she would. But you want to make things harder for me. OK, let’s see what would happen if that didn’t work?

[End of extracts from the chapter]

In this chapter:

What to say, and what not to say when you are supporting your child to eat

  • Add empathy to the examples below
  • Setting the scene
  • I’m not hungry
  • Quantities and ingredients
  • Calories
  • Calculations
  • The hospital/Mum/Dad don’t do it like you
  • You’ve changed my meals
  • Hiding food
  • My weight
  • Got to go
  • Hygiene
  • Self-hate
  • Lashing out
  • Emotions that distract from the task
  • Suffering and despair

Be a fly on the wall: a lunchtime scenario

  • Principles
  • The set-up
  • Preparation
  • During meal preparation
  • Getting her to the table: first attempt
  • Getting her to the table: empathy
  • Getting her to the table: escape
  • * Pause for self-connection *
  • Onwards
  • ‘I hate my life!’
  • Howling in the bedroom
  • Calling it a day … for this meal
  • Failure?
  • Sitting at the table
  • ‘I’m not eating this!’
  • Flying food
  • ‘Do I have to eat this?’
  • Eating successfully
  • Butter, hygiene, and ‘you gave me more’
  • Feeling too full
  • The last crumbs
  • A gift
  • Sticking by her
  • Finishing
  • After the meal
  • Debrief
  • How typical was that?

* Go to: Table of contents *

* Next: Chapter 9 : How to free your child of fears: exposure therapy *

Bitesize audio collection - help for parents of a child with an eating disorder
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