Last updated on September 14th, 2023
Parents need help to get their teen to eat in spite of the eating disorder
If your child has anorexia or a similar restrictive eating disorder, at first it seems impossible to get them to eat what they need. Yet rapid refeeding is crucial and so is weight regain. I'll share tips that empower parents to make meals work and that help a child with anorexia manage to eat.
Refeeding 3 meals, 3 snacks a day: the first phase of recovery
The eating disorder makes it almost impossible for our child to choose to eat what they need. So for teens and younger, recommended treatments make parents responsible for 'refeeding'. We're told, "Go home and give your teen 3 meals and 3 snacks daily". We're told, "Get your child to eat." But how?!
This page shows you how parents get their son or daughter to eat, in spite of the eating disorder.
The way to recovery starts with renourishment and weight recovery. Getting our children to eat is crucial, because both nutrition and the formation of new habits enable their brain to function normally again.
Everything here is in line with principles of family-based treatment (FBT or variants).
Make it possible for your child to eat in spite of the eating disorder
When our daughter was struck by anorexia and couldn’t eat, she couldn't even drink water. Like so many parents we were desperate for answers to our repeated question, “How can we get our anorexic child to eat?” The hospital rescued her, but we had to find out for ourselves how to finally make meals work.
In spite of all the know-how people like myself make available, most parents still don't receive any guidance on how to actually get their child to eat. So here goes.
As with everything, take what works, make adaptations to suit your situation, and leave the rest. Check with your treatment team. And for lots more help, I have loads more resources for you: my book, my searchable Bitesize audio collection (especially if you're fed up with reading), my workshops and my individual support.
Be bold: your child needs lots of food
We've all started too cautiously. Understandably, given our terror of making things worse. If our teen has an apple and a yoghurt for breakfast, we fear that by insisting for more, they'll drop the yoghurt. We say, 'At least they're eating something'. The eating disorder worsens.
We parents need help to be bold, and we need the skills to get our child to eat.
It’s not that our children won’t eat, it’s that they can’t
With anorexia and similar eating disorders, our children find it near-impossible to eat. That's because eating – even just the thought of eating – doesn’t ‘just’ create a feeling of disgust, it doesn’t ‘just’ create discomfort in the belly, it actually triggers fear.
Their brain responds to food with a rush of anxiety-producing chemicals. The sensations and thoughts are horrible, so of course they avoid food.
And with anorexia, our children also seek the momentary relief, the reassurance — sometimes even the 'high' — that arises when they resist a meal, when they exercise or purge. Possibly like an addict getting their fix.
So it makes sense that our children avoid eating with all their might. Even though they are scared, weak, sore, and often ravenous. Even if for some it means fighting us, lying, and giving up on everything they used to value. They need compassion and help, not blame.
What parents are tasked with
- 3 meals and 3 snacks a day
- full nutrition (carbs, fats, proteins; no diet products)
- generous, rich food to support rapid catch-up on weight (the usual advice for home is to aim at a minimum of 0.5 to 1 kg weight gain per week)
- interrupt purging behaviours, including excessive/compulsive exercise
So parents are micromanaging — but it's not for ever. Treatment will evolve (see my book's Chapter 4, which is all reproduced here). It's realistic to expect rapid progress, leading to full recovery.
Collaboration is not enough: parents make the decisions
When our teen develops an eating disorder, our instinct is to get them motivated. To offer collaboration. We want to be gentle guides, assisting, nudging. You'll see that in much of adult treatment.
But it doesn't work very well. (But there is hope for adult treatment).
With children and teens, modern treatment is a lot more effective. Parents are required to be hands-on with refeeding. That means that for almost all children and teens, in a first phase, parents take charge rather than collaborate. (Chapter 6 for more on that 'almost': how can you know if collaboration might work?).
Rescue your child from their inner bully
When you require your child to eat, you make it possible for them to eat. Removing choices means that your child can give themselves permission to eat. It's a bit of a rescue operation at this stage.
After a meal, they don't feel quite so guilty. They don't torture themselves with plans on how to step up the restriction, because they know you won't let them do it.
You're giving them ammunition against their inner critic, the internal bully who punishes eating and who rewards restriction and exercise. For some it's like a hijacker holding a gun to their head, a mean voice that threatens: 'Restrict… or else!!!'.
Many youngsters later reveal what a relief it was that their parents took the decision to eat (and rest) away from them.
“I was desperate for my parents to feed me”
Listen to this short clip from my Bitesize audio collection. I quote 40-year old Helen explaining how she was desperate for her parents to feed her.
Individualise for your child
My aim is to expand your box of tools, to help you experiment with the most likely successful strategies. Beware of anyone telling you that their way is the only way. All that matters is, what works for your child?
While the strategies I describe tend to help the huge majority of youngsters, some parents find meals work better when they do some things (not everything) very differently. You'll find some of their ideas and variation on my page on autism.
Note that if your child has ARFID, it comes in many forms and some of the tips here will not be suitable.
So let's get started with what will get your child to eat, in spite of the eating disorder.
Be a wise coach, not a lecturer
How would you like to be supported if you had to take a terrifying bungee jump? I bet you'll want someone you feel you can trust. Someone who can assure you you are safe. Logical, rational, scientific information only multiplies your anxious questions.
Tips to set the scene for your child's successful eating
- Remove wiggle-room and indecision, by making eating a non-negotiable requirement .
- Parents make all the food-related decisions: you plan, shop and cook without your child. Insist your child stays out of the kitchen while you're cooking.
- You plate up the required quantity of food. Generous amounts for rapid weight gain (except briefly if doctors warn you of refeeding syndrome). And all food macros (you can't renourish without carbs or fats).
- Make the time to sit by your child to support (and monitor) every mouthful.
- Set up close support in school, as your child is (hmmm) not yet able to tell you the truth.
- Some of us find it helps our children to know in advance what will be served, and some of us find the exact opposite.
- Our children's anxiety is usually less when we keep precise times for each of the 3 meals and 3 snacks.
- It's OK to put normal life on hold e.g. to let go of family meals with the other children; to eat in front of the TV… It's more important to renourish.
And some additional thoughts:
- Does your child eat 'extra' in between the 3 meals/3 snacks that you serve? Great! Encourage it! Hunger is driving rapid catchup. It may indicate your set meals need to be bigger. Either way, the rule is that the meals you serve also must be eaten. Otherwise soon you'll see those 'extras' become their only food.
Tips to keep the meal going, bite by bite
- Give direct eating prompts: “Next bite”, or “Please eat the potatoes now”: to read or hear loads of prompts, Chapters 7 & 8, and many Bitesize audios
- Use a direct prompt when a minute or two has passed without a bite.
- While your child is successfully taking bites, use distraction, or a companionable silence if that works better.
- Distract your child from anxious thoughts with games, movies, non-food-related chat, and friends.
- Track subtle signs in order to steer each moment as skillfully as you can: this will help you guess when it’s useful to keep encouraging, to wait, to comment on progress, or be silent.
- Many of us give up too early: if your child is still glancing at their plate, if they haven't stormed off, it's a sign they secretly long to eat more.
- Expect your child to eat everything you've served. Wondering when to give up? Should you set a time limit, like they do in treatment units? You have many options, described here:
- Options also in my YouTube 'Stuck, not eating':
- Are they very anxious and fidgety? Are meals very slow, with long gaps between bites? Is your child leaving the table? All easily searchable on my Bitesize audio collection)
Tips to manage your child's resistance during the meal
- Your child needs to eat even though it's raising their anxiety. Your compassion will make it bearable for them.
- 'Connect before you Direct' is a handy framework I guide you with in all my resources, for being both kind and effective.
- Use words like "trust", "I'm on your side", "this is safe".
- 'Connect before you Direct' is a handy framework I guide you with in all my resources, for being both kind and effective.
- Lots of tools to show empathy, reduce your child's anxiety, give them ammunition against their inner bully and persist with each bite, in Chapters 7 & 8, and many Bitesize audios
- Address your child’s resistance (hostility, tears, shut-down) with compassionate communication and with calming skills. Silent empathy can also work wonders. Then back to a direct prompt for the next bite.
- Any hysterics, meltdowns, panic attacks? Get skilled with calming and de-escalation tools.
- When your child asks if they're fat, and complains you are making them fat, and what the weight target is, there are pros and cons to various answers. More here and lots more in my book and Bitesize audios.
- Any violence? Each parent decides where they set the limit of what they'll accept and where they will intervene. And for prevention, 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.
- Many parents and therapists recommend that when all food isn't eaten, we give incentives through the use of punishments ('consequences' is the polite word). E.g. they remove access to the phone or internet. Both carrot and stick backfired hugely for us, and it was skills of compassionate persistence that eventually worked. To help you think carefully about punishments, rewards and incentives, see my book, Chapter 14.
Your stance: 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.
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 weak and hungry.
- Show calm confidence, compassion, patience, non-judgement (fake it till you make it).
- Exude competence and know-how so that your child trusts you.
- Be unrelentingly persistent, determined and focused.
- Put across hope and a vision of good things to come: your child will recover their smiles, they will have a rich life. If the illness hasn't removed all their goals and aspirations, talk about those.
- Expect complete recovery. It's irrelevant that for a long time, beating an eating disorder is of no interest to your child.
- You and your partner must show you’re united, e.g. on what and how much your child must eat. (If not, get help, or this will be a major block to recovery.)
- If you've been taught to 'externalise' the eating disorder (I list pros and cons in my resources), take care not to display aggression against it.
- See my self-compassion resources to help you get in a better mental space ahead of a meal.
Post-meal support matters too
- Plan after-meal distraction. During the meal, your child needs to know that they will cope with any post-meal self-hate. e.g. many go for a post-meal drive or watch a TV series.
- While there's any risk of purging, keep your child with you for an hour or so after a meal.
- If a meal fails, it's common to cancel school or outings, so your child can rest. Clarify that this is not a punishment but wise action, due to the lack of fuel.
- What support do you need to keep going, meal after meal? Reflect. Do you need more help to keep your head above water? Do you want to get other supporting adults skilled up to support meals? This is a time in your life to be assertive and problem-solve.
Use words and body language that show compassion during a meal
Get your child a little bit out of fight-flight-freeze by making them feel accepted, understood and loved. Words (and body language) like:
- 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.
I provide loads of 'scripts' in my book and Bitesize audios. Some parents are amazed to find that a sentence just 'works'. Others find they must first make it their own, so it sounds natural and therefore, genuine.
When you're struggling with what to say, a useful framework is 'Connect before you Direct'. It's in all my resources and this short YouTube is an introduction:
To be clear: while our kindness helps, our children need to eat, and can eat, even when they are very anxious.
Avoid these– they could make things harder
I will never ever be dogmatic, but…
There are things most parents have learned to be avoid. If it's the opposite for your child, then keep doing what works.
- Most of us find that while food is on the plate it’s best to avoid using logical arguments or lecturing on nutrition. We refuse to discuss calories, quantities, weights.
- We avoid giving choices or agreeing to alternative foods until experience shows our children are capable of making good choices. And that substitutions don't lead to endless negotiations.
- We avoid creating doubt, with 'Try to eat', 'See if you can eat just half'.
- We avoid making deals that we’ll have to backtrack on next time.
- We avoid saying 'Well done' if we've found our child then feels guilty.
- We avoid shouting and blaming. We leave the room before we lose control. We can make an excuse, or be transparent about everyone's need for a break.
- We avoid 'if … then' threats. Replace with 'as soon as… then'.
- We avoid wailing about how bad things are: inducing more fear in our children often shuts them down more. (Tough sometimes a dose of reality does wake them up)
- When we think our child can’t eat any more, we don't give up too soon: we try one more thing.
- We don’t let our fear, or our child’s fear, stop us from supporting our child to eat.
- We don't try and try for weeks with no weight gain: we alert the professionals that we need more support.
What if meals regularly fail?
It's normal that some meals will fail, in spite of our very best efforts. With six occasions a day, it's not the end of the world. Keep up your stance as a competent, wise coach.
If resistance and anxiety are so high that meals are regularly failing, you need more help. Such as:
- meal coaching from your treatment team
- meal coaching from myself, in my one-on-one calls and my workshops
- find out if your treatment team can provide home meal support — enough to get the eating habit back on track — either themselves or through a private company.
- your child might need a higher level of care: day unit, partial hospitalization, inpatient unit etc. Make sure your treatment team has a safety net planned for you so that meanwhile you can boldly do your best with meals at home.
- your professionals may alter or add to the treatment approach (e.g. changing the focus with regard to psychotherapy, treatment for OCD, autism).
- insist on a psychiatric appointment: psychiatrist may prescribe medicine that will reduce your child's higher-than average mealtime anxiety.
And take heart, if your child needs a spell as an inpatient, you will soon be back in a position to be supporting your child with meals at home.
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.
To learn more
Lots more in my Bitesize audio collection and in my book:
- Chapter 6 for 'Practical steps in a first phase of treatment'
- Chapter 7 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 for fear foods: '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
If you're already familiar with the above and want to expand your learning:
- On my website, a parent contributed: "A mother's story: what got my girl with anorexia eating again"
- Another mother wrote 'Lisa's Tarzan leap for her daughter: facing anorexia fear'
- An adult wrote these great insights here: 'I'm not a tortured soul. I just needed to eat!'
- For a bigger range of strategies to get your child to eat, parents of autistic youngsters have provided me with many of their own successful experiences, here.
- Obviously, your clinicians should be your main source of expertise and support. If you're worried they're following evidence-based treatment, check out my page here and Chapter 12. If you don't have my book, not worries, the whole of Chapter 12 is on my site.