3 Steps to Refeeding your child with Anorexia Nervosa or ARFID
Today we are talking about the refeeding process that comes along with most cases of Anorexia Nervosa or Avoidant-Restrictive Food Intake Disorder, otherwise known as ARFID.
The steps for refeeding these illness are similar so the blog will apply to both. These steps can sometimes also be applicable to bulimia nervosa or binge eating disorder, but not always. Step one will be applicable to all types of eating disorders. If you have questions about what steps will work for your child, Schedule a free consultation call.
In the case of anorexia nervosa or ARFID, there is limited food variety, weight loss, and insufficient caloric intake. We want to correct all of these behaviors to ensure a healthy, happy child who is free from the eating disorder. Though eating disorders are brain based, the first step of treatment is physical and behavioral in the form of nutrition rehabilitation. This is because often times with AN (Anorexia Nervosa) or ARFID, the child has been restricting and not getting enough nutrition in. This impacts their entire body, including their brain. Not only are their muscles and organs malnourished, so is their brain. Even if they are performing well in school and maintaining their grades, it is possible their brain is malnourished and not functioning at full capacity. This could look like delayed processing or difficulty focusing. Changes to the brain have been shown to resolve with renourishment and appropriate refeeding and there has not been shown to be a loss in IQ.
In addition to brain malnourishment, we know the eating disorder impacts the brain by impairing rational thinking. You may be aware your child is struggling with logic and reason since the eating disorder. The eating disorder and malnourishment combined make insight oriented therapy a non-productive approach in the treatment of eating disorders initially. Research has not shown talk therapy to be effective in treating adolescent eating disorder. Therefore, we focus on nutritional rehabilitation or refeeding, and behavior change to stop the eating disorder behaviors from occurring.
Today in this post, we will explain what refeeding looks like and how you can implement it in your home.
If your child has lost weight, failed to gain weight, or engaged in restrictive behaviors without weight loss, it will be important for you to help refeed them. Weight loss is always an indicator of the need to refeed, but it is not the only one. We are restoring their body, but also their brain. IF they have engaged in skipping meals, eliminating foods, eating small portions or other “dieting” behaviors, we also need to refeed. It may be that we caught it early enough before there was significant weight loss, or that their body is protecting them from these dangerous behaviors for now. Either way, the best time to intervene is as soon as possible.
Step 1: Establish a Regular Pattern of Eating
With today’s busy world, including demanding jobs, intense homework loads, sports and extra curriculars, many families have gotten away from having meals together as often as they used to. Many families I talk to don’t have meals together at all during a typical week, due to conflicting schedules, especially as children get older. Though this has become the new normal, it has made it easier for the eating disorder to hide from parents for much longer. Without knowing when or what your child eats ,the eating disorder can encourage your child to lie to you or bend the truth. Phrases like, “I just ate”. “I’m full”, “I will eat after practice” are common ways the eating disorder takes a cornel of truth and uses it to avoid eating in front of others or eating more than desired. When your child was younger, you likely had a scheduled pattern of eating 3 meals and 2-3 snacks per day. In order to help them renourish, you will need to set up a similar pattern. This means figuring out times each day when a caregiver or both caregivers can be with the child to eat a meal. There may be times when you are picking and preparing meals and times when your child is preparing, depending on what you decide with your treatment team. Either way, it will be important for your child to have the support and supervision of a trusted adult to ensure they are eating. At first, this will likely be more meals and snacks than your child is used to consuming, and it is what they need. Our bodies function best with fuel every 3-4 hours, and in your child’s case, their metabolism could be sped up from restricting, so this schedule of fueling is extremely important. It is best if these meals happen seated at a table where you can provide your full focus and support of encouraging words for this hard task, while also monitoring to make sure your child isn’t hiding food or sneaking it to the dog (all behaviors that are common with eating disorders).
As a teenager, your child may have gotten away from having snacks. There is all kinds of false information in the media portraying snacks are unnecessary or fattening, but that is not the case at all. They can be helpful to regulate blood sugar and hunger cues and help your child to get consistent nutrition throughout the day. Sometimes, your child will want you to eat with them and eat the same thing. If you chose to do this, you may sometimes find it helpful to support them in the beginning. Know that it is not necessary to eat the same meals in the same quantities each time that they are eating, because you are not suffering from an eating disorder. IF you are, it is imperative that you get the help you need with your own eating issues in order to help your child.
Step 2: Increase the quantity of food your child is eating
The goal with the beginning of refeeding is to have your child take one more bite than the eating disorder wants them to. IF you can do this, you have succeeded. Every day, you will work to have them consume one more bite than they did the day before. This may seem like an overwhelming or impossible tasks. I have heard from parents, “Well I can’t make her eat” and that is true. You can’t make her, but you can strongly encourage her, support her through it, and motivate her with consequences. During a meal, your best hope at helping your child to eat more than the eating disorder wants them to is to provide support and coaching. This means using encouraging phrases like “I know you can do this, you are so strong”. You can give them reassurance, “this is exactly what your body needs right now to get you healthy”. You can also provide more direct suggestions to help them when their brains are filled with anxiety and loud ED noise, “go ahead and take another bite of the chicken”. These direct coaching statements can be extremely helpful in the very beginning of refeeding when each bite will be intensely difficult for your child.
The amount of food needed to help your child gain weight is going to be more food than they have ever eaten. To gain weight, we need a larger and more dense diet than to maintain weight, especially when the metabolism has sped up to do restricting. Talk with your team about concerns with refeeding diets and amounts. Remember, you know how to feed your child. You fed them your whole life! Think about how you would feed someone who needed to gain weight quickly and go from there.
Step 3: Increase the variety of foods your child is willing to eat
With both anorexia nervosa and ARFID, your child has likely eliminated many foods and possibly entire food groups from their diet. In AN, these foods have been eliminated due to fear of weight gain. They are typically breads, pastas, sweets, deserts, fats, cheeses, “junk food”, snacks, prepackaged foods, candy or other typical foods avoided on many diets. It is important to begin including a variety of fats, protein and carbs into your child’s diet to ensure proper growth, brain development and functioning. Without these major contributors, your child could be deficient or develop other concerning medical issues. Check with your pediatrician about running labs and your child’s limited variety if you are concerned.
In addition to physical reasons to include variety, we also want to challenge the eating disorders rules about food. We can refeed a child on fruits, vegetables, and salmon, but we won’t be treating the eating disorder and we definitely won’t be getting rid of it. We want to confront the eating disorders misconceptions and fears head on, and show your child that they will be ok if they consume these foods that diet culture has deemed “unhealthy”, “bad” or “fattening”. We want your child to be able to have food freedom and eat a wide variety of food in different life settings so that they are living to the fullest and not missing out because of the eating disorder. It may seem far away right now, but the ability to eat pizza without tears and a brain full of anxiety is a great gift you can give your child. The best way to overcome those fear foods is to introduce them early in treatment and continue presenting them often throughout treatment. The only way to get rid of our fears is to face them.
Refeeding is an extremely difficult task that takes a lot of patience and perseverance. It is not easy and it will be tempting to give up and want your child to do it on their own. I encourage you to keep going and to surround yourself with support both in the form of a professional treatment team, and people you love who you can count on. If you need a treatment team, please schedule a free consultation call today to talk to a professional and learn more.
Schedule a free consultation call.
This blog is intended to be educational and informational and does not substitute for professional medical and therapeutic help, which is highly recommended when treating an eating disorder. If you would like help treating your child’s eating issues or want to learn more, Schedule a free consultation call today.
Resources
Lock, James, and Le Daniel Grange. Help Your Teenager Beat an Eating Disorder. The Guilford Press, 2015.