Steps to independence

Last updated on March 11th, 2020

How to guide your child towards age-appropriate autonomy

This is close to my heart as I talk to too many parents who have not been guided through this phase, have missed it out altogether, and then see their child unwell again.

Read this to learn how to really complete the whole treatment.

This page outlines what needs to be done once the refeeding and weight-restoration is done. Your child might be in 'Phase 2' of FBT, or they might be 'almost' recovered in the sense that all is well and they are in a 'maintenance phase'. The following also applies to those who are discharged from treatment before they are ready to fully take care of themselves wisely.

The following shows the content of my free helpsheet 'Steps to independence', which you can also download here.


Once your child is weight-restored and eating a reasonable range of foods without resistance, you may ease into the second phase of treatment, towards normal, age-appropriate independence.

Baby steps to autonomy

You don’t expect someone with a broken leg to run as soon as the cast had gone. Both body and brain require rehabilitation work and healing time.

You continue to be the parent in charge, but now you are experimenting with giving back small amounts of independence to your child. Their needs, capabilities and emotional age matter more than their real age.

You may ask your child to choose between two foods, decide on a snack, help themselves to some of the dinner on the table.

Keep your authority to guide and correct. Pull back and retry later if the outcome is negative, or else your child may ‘relapse’ before the treatment is even completed.

Some children need parents to stay in charge of some areas a long time after weight-restoration. If they’re young, there’s no rush. If they’re close to college age, you may speed up their autonomy using ‘exposure’.

Monitor closely

Early on your child needs to know they cannot misuse their freedom because others are monitoring for you (e.g. school staff in dining hall).

Later, you can take more risks (e.g. allow a meal out with friends) while monitoring that weight, behaviours, beliefs and mood are improving.

Vigilance

Even with weight-restoration the body caloric needs may continue to be high while the body heals. Your child’s fullness signals may be unreliable for many months, so don’t aim for intuitive eating yet. Your child should:

  • Eat every 3 to 4 hours, even if not hungry
  • Eyeball your usual amounts (e.g. always a full glass of milk)
  • It’s OK to consult the calorie label on a ready-meal to check it is enough (never to restrict)

Back to normal eating

List what constitutes age-appropriate autonomy, such as:

  • Enjoys all previously-loved foods
  • Can choose normal quantities just by eyeballing
  • Relaxed about variations in quantities and ingredients
  • Enjoys eating out with friends
  • Can eat independently in school
  • Enjoys celebration meals without pre/post restriction
  • Can eat in restaurants
  • Can shop and cook (age-appropriately)
  • Eats freely when senses hunger signals

Start with items your child is most likely to handle well or that provide the greatest benefits to life.

Back to normal exercise

If your child can exercise without risk to health, check their motivation. Does it give the eating disorder a boost?

  • If it’s to change body shape and weight, redirect them towards activities that are sociable and enjoyable.
  • If your child’s only way to combat anxiety is to exercise, help them use other strategies.
  • Re-introduce normal exercise slowly. Monitor.
  • Check that exercise routines are not increasing, that your child can cope with unexpected cancellations and enjoys several non-exercise days a week.

Psychotherapy

Mood and wellbeing are often vastly better now and there is no need for psychotherapy. If your child is still suffering from anxiety, depression, OCD etc (especially if this pre-dates the eating disorder), explore getting them therapy now – as long as the therapist respects the parents’ ongoing ED-recovery work.

Ongoing support

Resist giving independence too fast, or the illness will regain ground. Recovery means normalization of attitudes and behaviours. Transformation happens with time, the repetition of normal behaviours, and the pull of an enjoyable, normal life. Once your child has age-appropriate independence, continue supporting them to consolidate and maintain their wellbeing as new life challenges come up.


Relevance to Family-Based Treatment (FBT)

These tips help parents treat their child/teen for a restrictive eating disorder (e.g. anorexia) using Family-Based Treatment (FBT) or similar. Some tips are relevant to bulimia, binge eating disorder and OSFED. May not all be suitable to ARFID sufferers. This is not a substitute for professional advice. Please check with your child’s clinicians as your child’s needs may be different.

Other help sheets

Onwards

  • Chapter 9 on exposure therapy
  • Chapter 10 on the road to full recovery
  • My Bitesize audio collection guides you through this phase too.

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