Last updated on June 23rd, 2020
You've been told to feed your child, but how?!
If you knew how to get your child to eat, you'd have done it by now. I know how distressing it is to be told you can do it, when so far it hasn't worked.
On this page I give you simple tips to use right away because you are in a HURRY! There's lots more from me, which I list at the bottom of the page. Everything here is in line with principles of family-based treatment (FBT or variants).
Refeeding or 'nutritional rehabilitation'
With most eating disorders, people are compelled to restrict and they can't fix that by themselves. They need intensive help with nutrition and weight gain: ‘refeeding’.
One eating disorder that requires a different approach is ARFID: it comes in many forms and some of the tips here will not be suitable.
Put yourself in your child's shoes
To succeed, meal after meal, you need to understand that your child finds eating extremely distressing. It's not that they won’t eat – they can’t. Not without your help.
How would you feel if someone told you that for your own wellbeing, you have to take a bungee jump 6 times a day. Or jump in a pit of snakes. Or deal with a hijacker who is holding a gun to your head, screaming, 'If you eat, I will shoot you. I will shoot those you love.' Would you not fight, manipulate, bargain, and cry?
Because eating is easy and lovely for us, it's hard to appreciate how much courage it takes for our children to eat. Their anxiety, in the early days, spikes before, during and after eating. When your child restricts it's because they desperately want to feel calmer (though part of them is also hungry, scared and wishes they could eat).
But my child is so aggressive!
Many of our children have outbursts that are not at all like them. It's because the spike in fear around food places their nervous system in a state of fight, flight or freeze. Your compassion and confidence helps move them a little bit out of that state.
Imagine trying to bandage the leg of a terrified animal you rescued from a trap. You'd expect to be snapped at. You would make your tone of voice and body language soothing and competent.
You’re in charge
While eating is so hard for your child, put yourself in charge. Most of our children later say what a relief that was.
- You decide what to serve, plate it up, and expect it to all be eaten. Don’t negotiate or consult your child. This protects them from their internal bully.
- Do the food shopping without your child
- You do the cooking – not your child
- Keep your child out of the kitchen
- Put your own activities on hold to fully support your child at each meal
This is demanding and emotional work for you. You're not a robot. You will need some lovely things in your life to top up your wellness and resilience levels. Emotional support for parents is something I give a lot of attention to in my resources.
How to use compassionate persistence
It is possible to be both compassionate and persistent. Both firm and kind. Strong back, soft front. Like when you used to take your child for an injection.
Make all your responses genuinely compassionate and make firm requests (‘I’m so sorry [that you are __ [horrible feeling]. And at the same time I want you to __ [action]')
Your compassion will make your child a little more connected, a little less resistant, a little less fearful. Your persistence will give your child an ally against the eating disorder bully who tells them they must not eat, even though they may be terribly hungry.
Your four main tools are:
- Direct prompts: clear instructions to clear through your child's ambivalence
- Distraction: to quieten the bullying mind and change the mood
- Silence: when you sense your child is psyching themselves up to eat
- Compassion: listen and talk in ways that make your child feel understood and loved
You also need to know how long to keep going: I guide you through this in 'How long should I persist with a meal?'.
Use direct prompts every few minutes
You will find your style, words that work, words that don't. Either way, keep the focus on eating. Give direct prompts. So if your child has stalled for the last minute or two, or is trying to draw you into some kind of bargaining, use a clear instruction. For instance:
- Sweetie, get started on the omelette.
- Yes, go ahead
- Pick up your spoon
- Keep going, darling
- Have another bite
- And now, another bite, honey
- I'd like you to eat the potatoes now
- Yes, that's right. Keep going.
- Take a spoonful of yoghurt now. A whole spoonful, yes.
Your gestures are prompts too: sit by your child, move the plate towards them. You can do the whole meal with your arm around them, and there are times spoon-feeding them breaks an impasse.
Words that show compassion during a meal
The idea is to get your child a little bit out of fight-flight-freeze by making them feel accepted, understood and loved. Your body language and tone of voice matter enormously. Humans are also wired to be calmed by touch. If your child usually pushes you away, you can still ask, 'May I give you a hug?'.
Here are some words that often seem to help: examples of a short piece of empathy, which may be followed by a direct prompt.
- Trust me, sweetie. This is right for you. Yes, it is what you need. It's safe.
- I'm going to keep helping you. I'm on your side. I'm with you.
- You can do it — I know you can.
- That last potato and then we're done!
- As soon as this meal is done I'm so looking forward to our shopping trip.
- I'm so sorry, this is so hard for you, is it?
- You haven't had cheese for several months, so no wonder it's difficult. Keep going, sweetheart.
- Yes I can imagine how you'd be feeling uncomfortably full. That's so unpleasant. It's safe as well. Let's have a couple of minutes break and breathe. (Then keep going).
- I can well imagine how this is hard — you’ve not had it for a while. Have another bite.
- I can see how this might freak you out. One step at a time. The next bite now, honey.
And these might work too
All you can do is try, and see what helps your child. For instance some parents swear by "Food is your medicine" whereas I was sure my daughter would find that terribly unsympathetic. Here are some more tips that may or may not be good for you:
- As soon as you've finished your plate, we'll get back to doing nail art
- You need the energy to return to your choir
- This will get you ready for your school trip — let's make it happen!
- Let's do our very best so you don't need to go to hospital. Keep going darling.
- I'm sorry, leaving out the cheese is not an option.
- I'm so sorry you're freaked out / so sad. You're in good company. So many other young people have also found it hard, and then it passed and life got good. I'm with you every step of the way. Have another bite.
Avoid these– it could make things harder
Most of us have tried and tried to use logic to convince our sons and daughter to eat, and it just doesn't work!
And here's another counter-intuitive lesson: many of our kids can't bear to receive a 'Well done!' at the end of a meal. Here are more things that tend not to work (though of course if any of this has been working, continue doing it!)
- Don't offer reassurance on ingredients, calories, having weighed the food, 'it's the same as yesterday' or 'you're not fat': this usually only leads to more anxious questions (I cover the 'Am I fat?' issue in detail in my book and in my Bitesize audios)
- Don't give choices for quite a while: 'What do you want for lunch? Want some more?' For some, though, a choice between A or B does work.
- Don't say 'but' when you're giving empathy : 'I'm sorry you don't want the cheese but it's part of your meal. Better to say, 'and at the same time it's part of your meal.'
- Avoid 'if … then' threats. Replace with 'as soon as… then'.
- Don't paint disaster scenarios. Your child needs you to be the bearer of hope, not someone who increases their state of fight, flight or freeze.
- Get away before showing aggression (fight) or blatantly giving up (flight)
- Never disagree with your partner in front of your son or daughter. That's what parents' bedtime is for.
- Even if you've been told to 'externalise' the illness, don't use it to bash your child. When parents shout, 'I am sick of ED!' the young person hears, 'I am sick of you'.
Distraction is your friend
Distraction is great because it interrupts thoughts that increase the nervous system's sense of threat — the critical, fearful and catastrophising ruminations that, for our children, can seem like an eating disorder voice.
So make meals pleasant or fun, using TV, games, conversation, jokes. Don't talk about ingredients, health, body shape, food, whales, pigs and the myriad other things that fuel eating disorder anxieties. But do give a direct prompt ('Keep going with the toast'), if your child hasn't taken a mouthful for a minute or two. If they ignore you and continue staring at the TV, pause the movie, ask for a mouthful, and then press Play again while they're chewing.
In the early days, be punctual with meals and encourage your son or daughter to distract themselves while you're in the kitchen. This reduces some of the pre-meal anxiety.
What, and how much?
- Serve normal family meals without calorie-counting or measuring. The extra nutrition can come from bigger servings, the use of high calorie ingredients, or adding high-calorie drinks.
- Three meals and 3 snacks a day is usual
- Maximum 3-4 hours between food intake. Bigger gaps activate the restricting or bingeing mindset.
- Feed for rapid weight recovery (min 5 kg in the first 3 weeks and min 0.5-1 kg/week average till weight-restored (but first check for refeeding syndrome)
- Don’t be scared of what your child is scared of. Serve plenty of carbs, proteins, dairy, fat.
- No more low-fat/low-sugar/diet versions of foods (you’re aiming for balanced and ‘normal’)
- On the other hand there is normally no rush to serve particularly hard foods in the early days while your top priority is weight gain
- Very rough guides for weight gain: 1000 Kcal/day extra is needed for a gain of 1kg/week; whatever the adults need, the child may need 1.5-2 times more. Some need 2-3 times their baseline amounts.
- Increase calories if weight gain is not rapid enough (children's needs differ)
- Serve full portions right away or build up quickly over a few days
- Favour energy-dense foods (high nutrition in a small volume). See great tips on FEAST.
- Favour variety in foods, serving sizes and crockery (to promote flexibility)
- Don’t be bullied into counting calories or weighing food (‘Trust me, I know what you need’)
- Favour home cooking, where your child cannot know calories. Consider obscuring nutrition labels.
What if my child doesn’t eat it all?
- Whatever you serve must be eaten. If your child is stuck, aim for them to manage one more mouthful. And then another…
- Set yourself a reasonable time limit, after which you make up for any deficit with a supplement drink.
- If your child resists the supplement, assess whether to keep working on the meal or to call a halt while remaining ‘in charge’ (see YouTube ‘Stuck, not eating’ or read 'How long should I persist with a meal?')
- Some parents use leverage, removing phone, internet, TV etc. Others, like myself, find that rewards or sanctions increase resistance and that compassionate persistence works better.
Don’t let your child miss out
- Make it impossible for your child to cheat: supervise closely and non-judgementally
- Interrupt any vomiting habit: toilet to be used before a meal and no access for 1 hr after
- Refeeding raises our children’s misery at first, yet they long for permission to eat. After physical restoration, carefully move on to the next phase of treatment.
Will it get easier?
Usually, refeeding gets easier after a few days or a few weeks. Your child will get used to 'having' to eat, and will be secretly relieved that they can now eat, and that they are not so hungry and weak any more. Within a generally positive trend there may still be ups and downs, so don't panic. The odd meal may fail. Keep your cool.
What if I can't feed my child?
Steady, rapid weight gain matters. Don't let your child stayed under-nourished or underweight. If refeeding isn't working, insist on the professionals giving you more help. And keep reading. This page only brushes the surface of what can help you. There's loads more, listed below.
Lots more in my Bitesize audio collection and in my book:
- Chapter 7 of my book has tips and examples: 'How do you get your child to eat in spite of the eating disorder?'
- Chapter 8: 'See the tools in action: mealtime scenarios'
- Chapter 9 : 'How to free your child of fears: exposure therapy'
- My Bitesize audio collection contains lots of mealtime help and demonstrations
- YouTube videos including my popular 'bungee jump' one
- Lisa's Tarzan leap for her daughter: facing anorexia fear
And there's more:
- This article of mine says more: 'Getting your child with an eating disorder to eat'. It's in Mirror-Mirror.
- I also wrote 'Tips for helping your child to eat' for FEAST.
- In this podcast, Tabitha Farrar interviews me on 'Seven Tips for Getting a Person with an Eating Disorder to Eat'.
- Get experienced parents to cheer you on using online groups.
Much of this page is also in my free helpsheet 'Refeeding tips' (which you can download here).