School support: a checklist for parents of a child with an eating disorder

Teamwork between parents and teachers helps children with eating disorders benefit from school

I imagine that staff in schools all over the world have a desire to contribute to a child and a family’s wellbeing. If this is not what you’re seeing, the key to removing obstacles is communication. Engage key teachers in understanding the issues and priorities for your child. Discuss how they can support him or her with study, friends and eating.

Note that in the UK, educational psychologists are assigned to schools and they can be helpful in coordinating efforts to help your child.

Of course, it might not be right for your child to be in school at all, and I discuss this in Chapter 6 of my book. But let's assume your child is reasonably well, and would benefit from being in school if the right support was in place. It's time for an in-depth discussion with the Head, the relevant teachers and support teachers.

A checklist of points you might like to raise

(Parents of boys, on this page I use the feminine – I try and switch around between pages so you are just as included)

  • You can make a huge difference to my child: you can enable her to engage with normal life, friends and studies. With your support, we can keep sending her to school and you will be a proud part of her recovery.
  • This is an illness which she has not chosen and for which nobody is to blame. Her brain presently makes food and weight gain so terrifying that she’s spending much of her day in a state of high anxiety.
  • Our best chances of lasting recovery is if we can get her to eat what we give her, if we remove all opportunities for her to hide or bin food or lie, and if she regains weight as quickly as possible. If she feels hunger or if she finds she can avoid food, she will remain ill. So your collaboration during school hours can make the difference between recovery or a long drawn-out illness and hospitalisation.
  • If my child fails to eat breakfast, I may keep her at home. I may also ask you to keep her away from sports. This will all depend on her health at the time and what doctors advise. I don’t want you to end up with a medical emergency on your hands and I will keep you informed, so that you know what the situation is at any time.
  • Let’s keep flexible about homework and exams for now. When she’s at home our priority is to get through dinner and snacks, when anxiety levels may be high. Conversely, if we let her get anxious about exams, then this will slow down her recovery because at present, not eating is how she reduces stress.
  • There are issues with classmates (e.g. bullying). Let’s discuss what can be done to help my child feel secure.

Depending your child’s age and circumstances, you might also raise the following:

  • The most precious thing you can do for my child is support her snack and lunchtime. I’ll describe what’s involved so you can consider how it could work at your end.
  • I’ll hand over my child’s lunchbox in the morning so that she has no temptation to remove things from it.
  • A member of staff should bring the lunchbox to a quiet room and sit with her in a relaxed manner while she eats: staff can chat or read a magazine, or play a game, whatever comes naturally.
  • Allow her to bring a friend or two if she wishes.
  • Let her run off and rejoin her friends as soon as everything is eaten, or when she indicates she won’t eat any more (if she can’t eat everything we might set a minimum amount of time before she’s allowed to leave).
  • If any food is uneaten, it should go back in the lunchbox. My child will know that you will then get in touch with me so that I know what was eaten or not.
  • Your supervision should be friendly and relaxed, but I will describe to you the most obvious ways in which my child might try to hide or bin food.
  • Your role is not to encourage my child to eat, just to observe and report back. If she can’t eat with simple supervision we’ll seek other solutions e.g. a parent coming in, or a school nurse or counsellor getting more specialised training.
  • Please don’t comment about the food, the quantities, and do not engage with food or weight questions (‘Sorry dear but I’ve been given strict instructions not to talk about these things.’) Do not talk about your own eating or weight issues, or about anorexia, and don’t attempt to talk my child out of her illness: supervising her meal is the very best thing you can do to help cure her.
  • If you see that food is hidden or uneaten, your role is not to comment, encourage or chide: just to notice and then inform me. My child will know that you will do this.
  • As my child gets better, we can discuss how to transition to her eating in the dining room, or in the playground with her friends.
  • This is how you could make a huge contribution to us. Let’s discuss it. Thank you.

A template

* How to tell the school of your child's eating-disorder needs: template for a 504 plan * I offer parents an example of things to say or write when discussing their child's needs. The '504 plan' is for the US but the template would be valid anywhere.

Our story: how we set up meal support in school

My daughter reluctantly endured various levels of meal support in school, both in primary and in secondary school. At age 11 she hated being supervised one-on-one by a staff member. She wanted to be in the playground with her friends. Eventually we assessed she was probably capable of handling that degree of freedom. It was nerve-racking: we judged that if she missed one meal a day, she’d soon be spiralling down. Happily, we had a major safety net in place in the form of the chief dinner lady. This amazing woman had never met us and had not been included in the training delivered by our clinicians, yet she had taken it upon herself to keep a discreet eye on our daughter. If she noticed the slightest sign that my daughter was leaving food, she told the Head. I’m glad I managed to thank her properly on my daughter’s final day in primary school.

As time went on and our daughter's eating became pretty reliable, there was less and less supervision. These factors may have helped:

  • She knew she was being watched at some distance by some of the teachers.
  • She knew her friends would raise eyebrows if they saw her throw away food, and she had a strong motivation to stop being considered anorexic.
  • She knew that if she missed meals, it would show up in her regular weigh-ins, and that we’d reinstate the supervision.
  • Finally, we asked her to be honest with us. Asking for honest feedback is of course a weak measure, as our children may not yet be able to tell us the truth. At that stage we assessed there were more benefits than risks, as she was well and wanted to never sink back down again.

Our story: other ways in which both schools helped us

When my daughter was first ill, age ten, we hit some pretty poor attitudes in her primary school. There was one incident where a teacher wanted to exclude her from an outing for fear she would ‘contaminate’ the others. The problem was sorted before I got fatally apoplectic, in no small part thanks to our specialists who educated key school staff. There were great improvements with the arrival of a new Head who took pride in supporting our daughter.

We each have our styles. Mine was to hug everybody. When any of these stern-looking teachers showed the slightest sign of melting, I’d burst with gratitude and give them tearful hugs. It wasn’t manipulation – I really meant it, and hey, it freed them up to act human. Soon, we were doing exemplary teamwork and hugging on a regular basis.

Here are some of the ways in which the school eventually helped my daughter, age 10-11:

  • They allocated a support teacher to our case. She set up meetings and ensured information flowed.
  • The educational psychologist associated with the school stayed discreet (my child did not need one more therapist) but he coordinated, among other things, the transition from primary school to high school. He was also ready to provide a listening ear for my husband or me. Another educational psychologist gave my daughter some one-to-one EMDR therapy at my request. Although this was unsuccessful, I was glad to have this rare resource, and it was free.
  • There were regular meetings with us parents, the school, the clinicians and the educational psychologist. We worked out how best to supervise my daughter’s meals. We discussed various opportunities for her to be given roles and responsibilities that would boost her self-confidence. We tried out various ideas to help her feel secure with girls whose jeers had, more than a year earlier, caused her to start dieting, and who at times continued to trigger huge distress in her. We were quite torn about whether it would be better to change schools, and the school’s willingness to try various measures made a huge difference.
  • Together we planned every detail of how to make it possible and safe for my daughter to go on a week-long school trip.
  • As my daughter and her friends prepared to move to the same high school, new teachers came on board to support the transition. When they allocated pupils to classes, they discreetly took account of our guesses about which girls my daughter would be happiest with and which would perpetuate her insecurities. As a result, nothing but good things came from her move to high school.
  • My daughter was increasingly well and wanted to get on with her life, so most of this work went on behind the scenes.

Later, when my daughter had a setback in secondary school, the school kept an eye on her in the dining hall, never made a fuss about her coming in late, and when she got stressed about a new maths teacher, they discreetly changed her to one she found more supportive.

There were some negatives, such as when teachers didn’t realise that for my daughter, the drive to get top grades was unhealthy. On one occasion I had a hard time fielding off a school nurse who insisted my daughter should have one-to-one chats with her. I judged this nurse was not specialised enough, and I didn’t want too many cooks.

I’m full of gratitude for the actions of many individuals who together made a whole system work so very well. I believe key ingredients are good information and a strong lead from the Head. My guess is that every single person who helped us along got pride, satisfaction and joy from their input. There was no shortage of hugs and tears on my daughter’s last day of primary school. If you ever hesitate to ask for the support you need, remember that what may initially seem like a burden to someone can become an opportunity for them to make a meaningful contribution.

Preparing for a school trip or summer camp

I address this in more detail here.

Resources for schools

I am hearing more and more from parents of schools being truly helpful. If you would like your school to become better informed about eating disorders, you can point them to a whole lot of resources I have produced here:

Schools: main page / portal to eating, exercise and body issues

If the school is resistant

Most schools are keen to help and proud of their contribution to a child's wonderful life. But… some are not. In this case you can remind or inform them that their collaboration is a legal requirement. See my other pages:

* How to tell the school of your child's eating-disorder needs: template for a 504 plan *

* Is your school supporting lunch? For pupils with an eating disorder, it must *

6 Replies to “School support: a checklist for parents of a child with an eating disorder”

  1. EXACTLY what I need. Thank you so much. My daughter going back to full time school next month for the first time this year and I’m nervous about it.

    1. I'm glad you want to use it! To edit or print any of those school pages, the best is to select the whole page (Ctrl-A), copy, and paste onto a Word document. There may be some fiddling to do with images or footers, but at least you'll have the latest version that way. I'm very happy for schools to change what I've written, so it suits their own needs. I would appreciate they write something like "Adapted from Eva Musby's resources on https://anorexiafamily.com/eating-disorder-policy-guidance-school/" That way I stay accountable for what is my stuff, and not for anything I might not wholly approve of.
      Cheers, Eva

  2. This is a godsend – meeting with school this week for the first time in over a year – invaluable advice. THANK YOU

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