By Kali, Around the Dinner Table (ATDT) Forum Moderator
We all know that our children who have eating disorders need to eat well. That means three nutritious and balanced meals a day plus snacks when restoring weight if a child has Anorexia Nervosa, three meals and snacks with supervision afterwards if a child has Bulimia or Anorexia Nervosa Binge/Purge, and oversight with meals when a child has Binge Eating Disorder. But the million dollar question for each family is how to achieve this. This topic is frequently discussed on the Around the Dinner Table Forum.
When the parent of someone new to a diagnosis arrives on the forum, they are distressed, frightened, and anxious. They wish someone could say to them: This is how you get your child to eat. They show up at the therapist’s or dietitian’s office and are told to go home and feed their child. They register on ATDT and are told to feed their child 3 meals a day and two snacks.
If we were able to get our children to eat we would not be making appointments with professionals or reaching out to other parents on the ATDT forum. Yet there seem to be many families who have figured out how to feed their ill children.
So how does that happen?
I see it as a process. You understand that your child is deathly ill and that eating disorders have a very high mortality rate. Yet it takes some time and knowledge to figure out how to support your particular child to eat. Sometimes you might struggle through trial and error for months before finding that way to make it happen.
There is no recovery or remission from Anorexia Nervosa without full nourishment. And there are many ways to start the process of refeeding. It can happen at home, in the hospital, in a residential or day program, with a fork or a tube or a supplement or with the help of an FBT therapist. The ultimate goal is to get the food and nourishment in on a consistent basis so that there can be adequate weight gain and eventually, normalization of eating. However that happens for your child is the right way for your family.
Some parents have used LSUYE, or Life Stops Until You Eat, or Magic Plate, so called because the ill person needs to make all the food disappear off the plate. Our foray into magic plate, however, after getting advice on the forum, was a many hour standoff over a forkful of shredded cabbage. So I wondered: what are these parents talking about? Magic plate, to me at that moment, seemed to require that a parent also have magical powers to get their child to eat!
In the end, we did figure out how to get our daughter to start eating again, after she became so ill that she completely crashed out of her life, with the help of a small army of highly trained and competent professionals and an excellent residential program which placed emphasis on both weight restoration and therapy. I read every book available on the subject of anorexia. And when she returned home, magic plate became an every day occurrence as I sat with our daughter while we ate. But in between point A (Panic: What do I do!) and point B (Yay! she is eating at home!) it took an agonizing 13 months. While at the beginning of that time I was not hip to the eating disorder tricks, by the end I was, and was much better able to deflect them when they arose. And even after she did start eating again we had many steps forward and backward, and I put 3 meals on the table plus snacks each day and stepped in when necessary to help make sure that the eating was happening and an adequate weight was being maintained. The division of labor in the recovery process between the team became clear to me. My role was like a project manager: I was in charge of food at home and keeping an eye on the overall picture, how the different team members were doing, and how my daughter was progressing while meeting with them. The outpatient therapist (after my d. was weight restored) was in charge of talking to my daughter about her feelings and challenges. The dietitian was in charge of reinforcing instructions about portion sizes, correct nutritional choices and meal planning. The psychiatrist was in charge of medication. My daughter’s job was to show up at her appointments and continue to eat and try to engage in her life outside of the eating disorder again, and to work on making that leap towards independent eating along the way. Which took considerable effort and tenacity on her part because she didn’t always feel like doing these things or actually listening to any her team, due to the illness.
I’ve heard many lived experiences from other parents. Some relied on life saving hospital admissions because their child could not eat at home. One family refed a dangerously underweight child mainly on soup at home but with strong professional medical backup. Some added Benecalorie to food to increase the calories in a small footprint of food. Some were able to use distractions such as game playing or eating in front of the TV to successfully refeed. Some had long residential treatment stays. Some went through hellish experiences of trying to get their child to eat at home, including plates smashed and food thrown accompanied by screaming but persevered and eventually their child started eating again. And unfortunately there are also families faced with a very strong version of the illness and despite them trying everything they could, struggling for years.
My own tips from eating with my daughter would be:
Keep the mealtimes as low stress as possible. Don’t bring up difficult subjects because stress can add to the difficulty of eating for your child. Play some calm music in the background. Our kids can sense our stress as well; I found that when I was able to be calm at mealtimes it went better overall than when I was super stressed with the fear that she wouldn’t eat.
Model taking adequate portions of food by taking the same portions as your child on your plate.
I upped my cooking game and tried hard to make visually attractive as well as good tasting food. Show excitement about cooking and eating and using recipes.
Engage your child in conversation that has nothing to do with food, and listen to what they have to say.
I kept the recipes she was able to successfully complete and made some of them over and over again. The requirements were that they had to have enough balanced nutrition and calories. I then tried to broaden the variety by adding a new recipe once a week or so.
Be patient! There may be times when it takes an hour to eat breakfast. Stay the course and sit at the table until the meal is finished. Unfortunately we can’t assume that any food we don’t see eaten has actually been eaten.
You will need to have firm boundaries on many occasions. For example it may be better if your child does not drink water with meals while in recovery, but drinks a caloric beverage. Learn how to say no effectively and calmly and with authority and offer the alternative (for example, juice) as nonnegotiable; then change the subject. Remember that you are the parent.
Try to keep to a meal schedule which is roughly the same every day. However, if life intervenes, it is ok to change it up a little by staggering the meal times as long as 3 meals are eaten.
Fear foods: There are different ways of handling them. We found that a laddered approach seemed to work well. For example: if you want your child to be able to eat strawberry pie. First you serve strawberries, just fruit. Then strawberries on a small piece of baked tart. Then add some whipped cream to the strawberries on the tart. Repeat as many times as you need to. There may be some resistance, and a step back to just strawberries is okay. Eventually you work up to the berry pie. Eva Musby has a good description of laddering in her book.
I want to end by giving you some links so that you can think more about your family’s personal journey to effectively getting your child to eat and weight restore, and what you can try on a daily basis to get to that place. The FEAST website has a dedicated page with meal support links that you might want to look into:
And there is also a high calorie thread on ATDT which has ideas for meals while refeeding:
Becoming an effective meal support is a skill, and like most skills, takes time to learn and master. I hope that you will be able to learn how to help your child to eat.