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.
Direct prompts
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)
Distraction
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
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.
Compassionate persistence
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.
My 15 year old daughter does not refuse to eat but doesn’t eat what she should like the fear foods. She has lost some weight and I almost think she might want to go back to the hospital. I just don’t see how we can make her eat the fear foods all the time. She will have them but not nearly as much as she should. I feel like the long conversations and this is why we need to eat this and this is the way out of this knightmare but it just doesn’t click in her head which I understand. I feel like if she was consistent with these all the time we could put this all behind us. Whenever you bring up words like ED or Therapy she puts up the wall and screams and yells and it’s especially hard because we have 2 other kids In the house that this has affected as well and aside taking her phone there is no other way to get her to listen and the phone thing doesn’t even work.
Hi Ryan,
What you are describing with regards to the resistance to fear foods, or at least eating the quantity necessary, is not uncommon for kids with an ED. The inability of your daughter to understand what is happening, or to logically process conversations around food is also to be expected. The impact on your other kids and family life, in general, is immense. Getting support for yourself, and asking questions of other parents who really ‘get’ how challenging it is to deal with an ED can be very helpful, and you’ll get the benefit of others’ experiences, which may help you decide on what might work best for your own family. The Around the Dinner Table Forum (www.aroundthedinnertable.org) is free to read without logging in and easy to join anonymously. You will find plenty of support from caregivers who are willing to share their own experiences.
F.E.A.S.T. also has an active peer support group on Facebook, which is member-only:
https://www.facebook.com/groups/ATDTCarerSupportGroup
Warmly,
Daryl
F.E.A.S.T. Parent Volunteer
We’re only 3 days into this but it has proven difficult. She eats between 1,000 and 3,000 calories each day.
I’m having difficulty coming up with new recipes she will enjoy.
Our dietician suggested many things my daughter is not going to eat because she’s a vegetarian,
She wants to gain weight purely on ice cream and baked beans.
They are high in calories but I know that’s not the right thing.
Have any of you dealt with with a AD who’s vegetarian? They want me to get her back on fish at the very least but I don’t know how to!
Hi April – I see your email is dated Aug 14. Has it been answered or are you still struggling to find additional food items your daughter will eat?
Our 16 year old refuses snacks – there is no cajoling her into having them. Her mealtimes take 3 hours and we can’t get enough calories into her as she is so anxious about eating she spends a long time building up to eat… we are at a loss. What can we do – we’ve read Eva Musby’s book, we’ve taken everything off her (phone, kindle etc) we offer the daily snacks and she tells us I’m not having them- we keep offering them… how do we break this stand-off??
As I review this piece I wrote a while back, I’m moved to add some extra tips, partly based on Vanessa’s question above.
It’s common that snacks, or one particular meal, is just impossible. And that meals take too long. So some extra tips:
1. Taking every nice thing off your child (phone etc): some say this really works, others (like me) learned to steer clear of both carrot and stick. Because it didn’t work (we shouldn’t be guided by dogma but by what works!). I think it added to the fight, and that distracted from the connection, which is such a powerful tool.
2. If a meal is taking hours, it’s understandable that it’s hard to then be faced by a snack right afterwards. Mood is still low, stress is still high… Check with the clinicians — I think most advise to keep the meals shorter if eating has almost stopped. So many options, each with pros and cons, which I outlined in a YouTube.
3. A tip I learned recently from a professional (Sophia Vieira), to keep up the speed and momentum of a meal: request your child keeps the fork in their hand (because it’s hard to pick up each time). Prompt them, as soon as they’ve swallowed, to reload their fork, then count down 5,4,3,2,1 and take the bite.
4. To break the impasse of never having a snack, make empathy guesses: how it might be extra-hard because they’ve not had one for so long, and because maybe it feels like a ‘rule’ will be broken if they start, and because perhaps it feels so soon after a meal… Make those guesses and check and see if your child will say more about what’s blocking them. Then empathise with that and move to problem-solving (collaboratively, or YOU might have to make the decision). E.g. it might be easier to start off the new habit with snack A rather than snack B, to eat it while strolling through a shopping centre, etc etc) and then do the usual persistent kind coaching.
5. If your child is explaining that they can’t have a snack because it’s “extra”, way too much, will make them fat… all that talk-talk-talk, another tip I recently learned from professional Sophia Vieira is to take the guilt and confusion away with statements like, “I’m taking that decision away from you. I’m telling you, you need to have it. Forget what your head is telling you, listen to me, not your head. I’m telling you, you can do this. This is what you need.“
6. Recently I’ve been learning more about how some of our children need the very opposite of the strategies that help others. For instance, if you search for tips for autistic youngsters with an eating disorder, you may find that a few youngsters DO need logical, scientific talk, and a few do better with collaboration, rather than the parent making the decisions.
Can I ask why does my daughter need to eat so much? We just received an email meal time guide after seeing a dietitian last week for the first time (she is part of our team supporting FBT). However when we had the appointment she said we were doing really well. The guide has so many snacks, my husband and I both would not eat that much.
Hi Madeleine,
Another thing to consider is that often kids with eating disorders have a hyper metabolism, and in return they require a lot of calories. It might be helpful to read about this or talk to your treatment team about it. There is so much to learn and it can be overwhelming. You’re doing great. Food is medicine. Food heals the body and the brain.
Dear Madeleine, you’re concerned that the dietitian has prescribed more food than you or your husband eat, and I’m guessing this means you can’t imagine how or why your daughter would eat it. Maybe it feels wrong to you, or even cruel. I remember a family member pointing out that with so much food, it was normal that my own daughter should feel food and therefore resist food.
Eating disorder treatment requires we parents learn so much!
Have these conversations with your treatment team. One way of learning fast is to subscribe to FEAST 30-days program. The treatment for this strange illness will all start making sense to you and you can then position yourself as your daughter’s reliable coach.
A quick response for now:
Growing youngsters usually need more food than their (middle-aged) parents, and the same for anyone who has been malnourished. So personally I learned to let go of that as a yardstick.
I hope this helps you and empowers you at the start of this journey.
Edit to the above: “that my own daughter should feel FULL”, not “should feel food”
Hello,
I am new to this and have just recently realized my daughter needs help. Luckily this is in the early stages. I recently found my daughter is not eating her snack that I give to her in her room. She refuses to eat snacks at the table and will only do so in her room behind a closed door. Today I saw days worth of snacks hidden at the bottom of her trash can. What do I do??? Do I confront her? Do I make her eat snacks at the dining room table? She refuses and I’m afraid to create a huge fight and power struggle making the problem even worse. Please help.
Hi–in my experience, eating behind a closed door=not eating. We supervised all meals and snacks for a very long time. If we didn’t actually see my daughter eating, we assumed that she didn’t eat. I don’t think you have to confront her per se I just think you have to let her know that from now on, she needs to eat all meals and snacks at the kitchen table, or on the couch while watching TV or wherever works best–and someone will be sitting with her to help her eat. Unfortunately, resistance is common. Usually, once kids know that you are serious and that they are more or less cornered, they do comply. But gird yourself up for a fight and don’t be distressed by it. It’s totally par for the course.
It is great to have an article with SPECIFIC wording to say. We are new to this (diagnosed 2 months ago- released from in-patient about one month ago). Our daughter has been taking in VERY little solid food and frankly is alive only due to Boost supplement. Our clinicians keep saying that “Nutrition is Nutrition” and that more boost and less food is okay. But, I can’t imagine that a sustenance of nearly 100% Boost is okay. The one tip from the above (in the comments) that we had not thought of was the one about not letting her put down the silverware- to keep the spoon in her hand to keep up the momentum. We will try that at the next meal.
But would love any insights on the issue of food to boost ration and other tips on exactly what to say..
Bit late for your specific question, but I understand that Soylent is somewhat healthier than Boost, and that five Soylent a day is specifically designed to be full nutrition. If the physical act of eating is a significant part of the struggle and a quick drink for a meal is easier, I see no reason a person couldn’t be on Soylent for 100% of their intake for at least a month, and one guy said he’s been at it for a couple years now (though I didn’t read his results).
I don’t myself have an ED (I’m researching for a story I’m writing), but I find the taste quite palatable, especially the mint-chocolate one, and there’s an “original” flavor that might be easier for those resisting food in general. They even have some caffeinated ones (which I can’t drink ‘cuz caffeine gives me headaches, but the flavors sound nice).
I think a bit of research into nutrition would uncover any gaps in Soylent’s set of nutrients, and then a little side dish (of fruit or nuts or greens or whatever) should be able to cover the holes — if indeed there are any, as it’s meant to be pretty complete, so I hear.
We had great success with refeeding but we cannot beat the disease. There is no way my 16 almost 17 year old can eat by herself. We brought in the rule that if you don’t finish the meal you don’t go back to school. This just means finishing the milk in her cereal. Today I enforced this for the first time and she jumped the fence and disappeared. Her turn to behaviour when everything is too hard. We are just worried if we don’t stop negotiating we will never beat the disease but is this consequence worth it? Our professional team agree that the constant negotiating is keeping her fed but is it beating the disease.
I can’t offer much but the thought that there *are* times when making progress has to take a break while you just try to tread water and survive. Look up the book “Simple Rules,” which I found quite informative for a lot of reasons, but which also taught me the Dragonfly Principle: “On windy days, stay put.” I stopped judging myself for those days when circumstances made it impossible to progress, and just let myself relax and wait it out until I had the energy to do more. (Note: My mental health conditions aren’t about an ED, but the principle transfers.)
There are various examples that could work with this. Surviving a rip current, for example: You literally cannot swim into the current, you just have to let it carry you away from shore while you swim sideways and just try to stay afloat until you’re outside the current and can then start trying to make progress toward the shore. Or kiting an enemy in a game: Instead of standing there and duking it out (taking a lot of hits), you strike once and move, strike again and move, keeping on the run and wearing the enemy out little by little. Heck, primitive hunters used this strategy on real-life animals, just following slowly to wear it out until they could move in for the kill.
I hope your struggle bears fruit eventually, but in the meantime, remember that sometimes you just have to survive one windy day at a time.