by parent and educator, Eva Musby
It’s not that they won’t eat, they can’t
An eating disorder* can make eating genuinely awful. Your child isn’t being stubborn: they are filled with terrifying thoughts and sensations when faced with food. They may have an internal tyrant holding a gun to their head, bullying them to restrict. Not eating buys them a short respite from the panic and dread they are feeling.
As their loving parent, you can make it possible for them to eat in spite of their terror.
If you are judgemental, panicky or aggressive, their nervous system will throw them further into fight, flight or freeze, making it harder for them to eat.
Your skill lies in putting yourself in charge and coaching them with calm, loving confidence. You have years of love and trust in the bank. Even while your child fights you, there is a part of them that is desperately hungry and weak, that longs for the food, that is scared of the state they’re in, that is confused, and that yearns for wellbeing.
That is why meals are usually more successful when parents take charge (read the principles of ‘Magic Plate’ here).
If your child has ARFID or Autistic Spectrum Disorder (ASD), not everything on this page will be applicable. Discuss with your specialists.
Your child’s mind is a mass of screaming contradictions. Cut through the confusion by giving clear, direct prompts such as:
- Get started on the pasta, darling
- Now pick up your fork
- Go ahead
- [Move plate towards your child, offer a hug, spoon-feed, sit close]
- Honey, keep going with the pasta
- Have another bite, sweetheart
- And another
- Yes, I do want you to have it
- Make the bites bigger now
- I see you’re squishing the food. Please don’t. Keep eating now, honey.
You should also offer distraction, and may need to use silence and empathy, but return to a direct prompt every few minutes if your child is not eating.
What else can you say?
Until you find your own style, here are further suggestions of words that often help:
- Trust me
- I’m with you, I’m on your side. I’m going to keep helping you.
- It’s OK. It’s safe. It’s perfectly fine. You can do it.
- Yes, it’s what you need.
- Last few mouthfuls to finish your plate and then we can go and [fun activity]
- I’m guessing/sensing/imagining that this is very hard for you. I’m so sorry. Have another bite now.
- I can well imagine how this is hard — you’ve not had it for a while. Have another bite.
- I’m really sorry your tummy hurts. Let’s relax/breathe for 2 minutes [and then resume]
- Let’s focus on one bite at a time (when they want to negotiate)
The following work for some, and not for others. Experiment!
- You need this to have the energy to do the things you love
- As soon as you’ve eaten we’ll do [fun activity]
- Think how much you want to manage the trip next month
- Not-eating is not an option. Let’s keep going.
- I’m guessing/sensing/imagining that you’re [guess a feeling]. Is that right? I’m so sorry. At this stage, this often happens for many people. It will pass. Emotions pass. This will become easy and natural. Now keep going with the pasta, pet.
- Food is your medicine (can sound preachy and unsympathetic)
The following are not usually helpful to talk about during a meal. Don’t blame yourself if you’ve used these, none of us knew this until we had to learn.
- What do you want to eat?
- Just eat what you can / just eat half
- Do you want some more? (if they haven’t had enough, give them more)
- It’s hard but you have to eat it (more supportive: ‘It’s hard and at the same time, sadly, you have to eat it’)
- Try to eat it (‘try’ doesn’t show enough confidence)
- There’s only x calories in this and your body uses y calories just sleeping
- It’s exactly the same as last time
- I weighed it/I checked the calories/No I didn’t add butter
- Let me explain why carbohydrates are essential
- But you’re not fat!
- You need to put on weight
- Your tummy hurts because you’re not eating enough
- People get fat because […] and that’s not going to happen to you
- If you don’t eat then (change to ‘When you’ve eaten…’)
- If you don’t eat then [doom and gloom scenarios that increase fight-flight-freeze)]
- You’re ruining our lives / you’re selfish / you’re not even trying
- Just eat!!!
- It’s up to you, I can’t make you eat! It’s got to come from you.
- See if I care, I give up on you!
- I hate ED! I don’t talk to the eating disorder! (they don’t see the Eating Disorder as separate)
- Well done! (Praise, during a meal, can produce conflicting emotions and regret in your child)
In between your direct prompts, chat about fun things, watch TV, play games. Pause the distraction if your child has stopped eating, then resume.
Distraction works because it interrupts your child’s fearful or self-bullying thoughts.
If your child seems busy psyching themselves up for the next bite, a minute or two of silence may help. If it doesn’t give a direct prompt.
Plan some distraction before and after a meal too, if your child is full of dread (before) or of self-reproach (after).
Kindness is your main tool for signaling to your child’s nervous system that there is no threat, that they can move out of their state of fight, flight or freeze. It makes it a little bit easier for them to eat (though your job is to help them eat even when they’re terrified).
The nervous system responds to touch, tone of voice, body language. If your child will let you, put an arm around them (you may need to check: ‘May I hold your hand, sweetheart?’).
Make your voice and body language loving. Try to appear calm and confident (fake it till you make it). Say kind things that show you are on your child’s side, not blaming them.
You can be kind and persistent. It’s not kind to let your child go without the nourishment they so need. It is not supportive to leave your child in hell because you’re both scared of walking through it and out of it.
Don’t stop just because your child fights you, or because they cry and tremble. Keep using all the tools, aiming at one more bite. Then another. An eating disorder is overcome one (painful) bite at a time, in spite of fear.
Recovered people have revealed that at the time, in spite of their show of resistance, they were secretly relieved to be made to eat, because they were so weak, hungry and scared.
Don’t use logic
In their state of fear and avoidance, your child will ask many questions and put up many arguments. It’s natural to get drawn in and start imparting lots of information and logical reasons why they must eat. If logic worked, our intelligent children would not have an eating disorder! Logic rarely makes any impact on a brain that is in a state of fear.
This video makes that point:
Should I start with easy meals?
If your child lost weight, your priority is rapid weight gain. If you’ve started slow, build up calories rapidly. Aim to cover nutritional needs by swiftly including all food groups, even if your child is scared of fats or carbohydrates. Read ‘High calorie meals: big impact, small footprint’. As soon as you have a decent handle on feeding, your priorities will shift to continuing the weight gain and to increasing the variety of foods.
If it doesn’t work
Refeeding is usually hardest at the start, or when you introduce a fear food. With some young people, after a few days or weeks there is a resignation, even a hidden pleasure, in eating. They moan, ‘Do I have to eat this?’ and you just say ‘Yes’ and they eat without any more complaint.
If within a couple of weeks you can’t get your child to eat enough for weight gain (if they lost weight), then you need more professional input without delay. It’s not your failing: you haven’t yet been given the right support for the way your child is affected by the eating disorder. Be open to a short hospitalisation to get your child eating again. Then take over again as soon as possible.
Eva Musby is an educator and author in the UK. She can be reached at https://anorexiafamily.com/contact
NOTE *All eating disorders involve some sort of restrictive eating, even binge eating disorder. This article’s advice is particularly focused on the “re-feeding” element of treatment and especially of the parent responsibilities during Family-Based Treatment for anorexia and bulimia and OSFED.