How to Survive Difficult Meals When My Child has an Eating Disorder
Creating a Meal Time Help Sheet
Today I am going to give you a worksheet to complete with your child with an eating disorder that will make meal times during eating disorder treatment less stressful, less chaotic, more predictable and more successful! It takes time, commitment to trial and error, talking about the eating disorder as a family, and ideally, support from your eating disorder treatment team.
If your child or family is struggling with meal times and they have become something everyone dreads, this post is for you.
Adolescent eating disorders are one of the most stressful and challenging mental health diagnoses a family can face.
They come with not only stress and worry for your child’s health and future, but often a huge disruption to what your daily family life looked like before. These changes are often intense and treatment can last from 6 months, to years. That means, we often have to find a way to quickly adjust and make the recommended changes work for your family, or you will be at risk of burning out and quitting the changes all together.
One of the main changes I’m talking about are family meals. Often times in adolescent eating disorder treatment for anorexia nervosa, it is recommended, especially in Family Based Treatment or FBT, but in most treatments, that their be some form of parental supervision and support during meals.
This means that parents are expected to eat meals at the table with their child who is struggling with an eating disorder- and if you have experienced this, you know it is easier said than done.
Often times, especially in the beginning of eating disorder treatment, this request is not simple or easily done. Dinner when your child has an eating disorder, anorexia nervosa, can include yelling, screaming, escaping, refusal to sit, throwing food, name calling, food refusal, food smearing and much more. Not the dinner times you were used to before the eating disorder.
While there are many things about this recommendation that we can’t change- Eating at a table, all together, presenting appropriate amounts of food and providing support through meal coaching- there are a few supports we can provide and a few choices we can give to your child with an eating disorder. During adolescent or children’s eating disorder treatment, there are so many things that are out of the child’s control (all those mentioned above). It can feel really challenging for children and adolescents of all ages to lose their sense of autonomy and control over choices in their life- but we know that it is necessary for their mental and physical health. So when we can, we want to give them autonomy and choices back when appropriate.
The way we can give choice and control back at meal times is to involve our adolescent with an eating disorder in creating this meal time tip sheet.
They can make choices about what they do before the meal, what coping skills they use during the meal, what distractions they want to engage in, and how parents can support them during meals.
Things I can do before meals-
We know that before and after meal times can be a time of high anxiety and loud eating disorder thoughts for adolescents struggling with disordered eating. Engaging in a helpful distraction can assist adolescents in coping with that anxiety and quieting the eating disorder voice so they can come to the table feeling more calm and prepared. If they are in the kitchen watching you prepare meals or just sitting around letting their mind wander, or using something triggering like social media, they are going to come to the table anxious and stressed. We want them to choose activities that produce positive emotions and aren’t stress inducing- so if Math homework is really stressful, save math for the evening when meals are done.
Coping skills I can use during meals-
While we can’t change that meals are challenging right now for your child, we can help them to identify skills they can use to help them get through meals. They have coping skills and have likely used them to get through difficult situations before (think anxiety before a test/performance, a disagreement with a friend, an awkward situation). Help them identify what coping skills they have in their toolbag that would be appropriate and helpful to use at meals. All of them won’t work all of them time, that why it’s important to list multiple so they can use another one if the first one isn’t helping. Their therapist can help them in identifying these. You can also find many lists of coping skills online!
Distractions-
We know that long-term distractions are not a permanent solution for anxiety, but they are an awesome tool to help us get through a difficult situation until we are more prepared and skilled to deal with that situation. This is true for eating in eating disorder treatment- it is REALLY difficult in the beginning and using distractions is OK! Eventually, eating will get easier for your child and they will rely less and less on distractions during meals, but at the beginning they are encouraged. We want to make sure the distractions are helping to distract their mind from eating disorder thoughts, but not distracting them from eating or completing their meal. So we want them to be that perfect level of distracting. This is a great area to help your child see they have a choice in what you do at meals- whether that’s play a word game, talk about life, play cards, listen to calming music, or trivia. There is no shortage of options out there- get creative! It’s best to list these on the plan, then check with your child before each meal to see what they are in the mood for- and if the answer is “nothing”, then you can pick for them from the list.
What parents can say-
Often times, children or adolescents with eating disorders, specifically anorexia nervosa, they will resist meal coaching or encouragement from parents during meals to help them eat. We know through research that meal coaching is proven to be effective, so treatment professionals are going to recommend and encourage you to provide it. What your child can have a say in however, is what phrases they find helpful. This is the place for them to let you know! Some kids don’t like “good job” or “you’re doing great” and respond better to “I know this is hard, I’m proud of you”. Some kids respond better to having you remind them of their motivations and goals, “this bite is getting you one step closer to soccer in the spring!”. This is another section your adolescent eating disorder therapist can help you with.
Below is an example Meal Time Tip Sheet filled out with inspiration and ideas. After that there is a blank sheet for you and your family to fill out together! Let me know how this works for you!
Meal Time Tip Sheet
Things I can do before meals to help:
1. Draw in my sketchbook
2. Do homework
3. Play video games with my sibling
4. Listen to my favorite playlist
5. Work on crafts
Coping skills I can use during meals to help:
1. Box breathing
2. Fidget toy
3. Reminding myself of my goal (playing soccer)
4. Visualizing success (having completed the meal without incident)
5. Grounding skills (keep my feet on the floor, notice the things around me on the walls)
Distractions I can use during meals:
1. Playing “Would you rather?”
2. Playing cards
3. Everyone sharing their “rose & thorn” of their day
4. Talking about what I’m looking forward to this weekend
5. Playing riddle word games
Things parents can do or say to help:
1. Give me instructions on what to do next (“take a bite of your roll”)
2. Remain calm, with neutral tone
3. “You are working so hard”
4. “I know this isn’t easy, I’m proud of you”
5. “You can do this”
Meal Time Tip Sheet
Things I can do before meals to help:
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Coping skills I can use during meals to help:
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Distractions I can use during meals:
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Things parents can do or say to help:
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I specialize in working with adolescents and teenagers with eating disorders in Ohio and Utah. I provide eating disorder assessments and eating disorder treatment for children and teens. This post is not meant to be treatment advice, but information and education. If you have questions or need help, please reach out.
If you have more questions about eating disorders or eating disorder treatment in Ohio, eating disorder treatment in Utah, please reach out here.
Navigating eating disorder treatment can be daunting. If you need help along your journey, please reach out to schedule a free consultation call.
DISCLAIMER: The advice on this blog is for entertainment purposes only and is not indented to be medical or therapeutic advice.