Things To Do Immediately Once You Learn Your Child has Anorexia Nervosa
You’ve just been told your child has Anorexia Nervosa.
In the next breath, you hear you are supposed to make them eat 3 meals and 2-3 snacks per day- wait what?!
You may be thinking “How in the hell am I going to get them to do that?! They’ve been refusing to eat. They aren’t a kid anymore, I can’t force them to eat. This is crazy, this person is crazy, I’ll never be able to help my child. They have to want to get help.”
These are common thoughts and reactions. I’m here to tell you, that though it may seem overwhelming, impossible, and quite frankly, stupid, these recommendations are given for a reason. Your child NEEDS your help. They need you to help them to eat up to six times a day. They CANNOT do it on their own. BUT- with your help, they CAN begin to make changes and begin to fight back against the anorexia. And YOU CAN help them to eat- even if they are 16, even if they are stubborn, even if you don’t always get along well and even if you don’t have the support of their other parent.
Eating Disorder Treatment providers recommend FBT or Family Based Treatment for adolescents with Anorexia Nervosa because it is evidenced-based, meaning, we know it works.
It has been proven to work. It has been proven to help adolescents regain weight, stop disordered eating behaviors and recover from Anorexia Nervosa to go on to live a full, engaged life. We have seen it be successful in our own practice and that is why we continue to teach it and recommend it as the first line of treatment against adolescent anorexia nervosa and other adolescent eating disorders.
As providers, we would also love if your child could help themselves and begin eating more on their own and we could avoid the stress and tension FBT puts on relationships. But we know it doesn’t work that way. And we wouldn’t ask you to do this if it wasn’t absolutely necessary for your child’s health and recovery.
I am going to walk you through those first, intimidating recommendations you may get from your child’s eating disorder therapist, dietician or doctor on the day of your child’s eating disorder assessment or first eating disorder treatment appointment.
Your child’s eating disorder treatment team (if they are using an FBT Model or FBT informed care) will likely give similar recommendations to what I’ll outline below. These are often recommendations that can be helpful even BEFORE you start treatment, if you are on a waitlist, or if you are just concerned about your child’s eating behavior. I ALWAYS recommend seeking professional, expert, help, but I know there are a lot of barriers with access to care, cost, and other circumstances.
Things to do immediately once you learn your child has Anorexia Nervosa:
1. Lock up or remove all scales from the home
Your child may or may not have been using the scale to weigh themselves. They may have admitted it in the assessment or you may have seen them using it. You may even have been using the scale to check their weight. We want to remove their access to the scale because the eating disorder can become obsessed with weighing and it is not helpful for your child’s treatment for them to be checking their weight on their own. Your provider will come up with a plan for weighing your child whether that is at the office in person, at their pediatrician, or at home done by you. If the plan is for you to weigh your child at home, you will need to keep the scale, but make sure it is locked and secured in a place your child cannot access it. You would be surprised how many parents have thought their child didn’t even know where the scale was (often in parents’ bedroom/bathroom) and had been accessing it for a period of time. The eating disorder will go to great lengths to find the scale. If your provider tells you that you don’t need the scale, I recommend throwing it out or giving it to a friend/family member to hold onto while your child is in treatment. Adults can use the scale at the gym or doctor and other children can be monitored by the pediatrician.
2. Parents need to take full control of plating and portioning meals
This may not be a recommendation at your first appointment, but it is coming. In Family Based Treatment, parents assume responsibility for all decisions around food and meals including when to eat, what to eat and how much to plate. This is often the most daunting and overwhelming requirement of FBT. It can seems impossible, like a huge mountain that has just been placed in front of you and you can’t see your way around. Your provider is here to help you and your family through this change and adjustment. No matter their age, you child likely had at least SOME say in their food and meal choices, if not complete say in when and what they ate. And likely, in recent months, the eating disorder had changed and influenced this greatly- that is why you are here, seeking help. In order to take the power away from the eating disorder, parents have to assume that role and remove choice from the adolescent or teenager entirely. This means no more, “What do you want for dinner” or “do you want a salad or tacos?”. Choices and options are to be removed and no input should be asked from the child. Parents will decide what foods to eat, prepare those foods, put them on a plate, and put them in front of their child.
3. 3 meals and 3 snacks. Eat within 1 hour of waking, and then every 3-4 hours after
Often with Anorexia Nervosa, there is weight loss and malnourishment- this means due to restricting or eating less than they needed, your child may meet criteria for “malnourishment” which carries risks for their healthy growth and development. We take this very seriously and it is why we often make these drastic recommendations as soon as the assessment or first appointment- there is no time to waste when it comes to adolescents, weight loss, and their development. We want to get your child back on track and gaining weight as quickly as possible to prevent further damage and mitigate further health risks caused by anorexia nervosa and malnutrition. Sometimes you will work with a dietician who will give you a meal plan with more structure, but in FBT, your therapist will direct you to feed your child how you feel is appropriate and provide guidance. Often times, for most adolescents, the structure of 3 meals and 3 snacks is appropriate. Eating within an hour of waking is encouraged to jumpstart the metabolism and give your child the fuel they need for their day, including school. Our body functions best being fueled every 3-4 hours. Staying on this schedule can also help with consistency and letting your child know what’s coming next. Though it might be overwhelming at first, eventually your child will respond well to the consistent schedule and will appreciate knowing when snacks and meals are coming.
4. Snacks to contain 2 components and meals to contain 3 components (main & 2 sides or 3 food groups). Meals to have a balance of fat, protein, carbohydrate.
This guidance can help parents and families who feel lost and don’t know what to serve or would like more guidance on meal planning. If you aren’t working with a dietician, following this basic structure can help to ensure meals are meeting your child’s general nutrition needs. Thinking of snacks in two components helps with adequacy that is so important in the beginning stages of refeeding and recovery. Instead having pretzels as snack, serve pretzels with peanut butter. Instead of an apple, serve oatmeal made with milk & an apple. Instead of yogurt, serve yogurt with nuts, granola and honey. It is not meant to be a strict meal plan, but general guidance.
5. Nutrient dense foods are going to be your best friend.
What do we mean by that? Our goal is for your child to regain any weight lost, and regain it quickly. The faster we can restore weight, the better outcomes research has shown for recovery. We want to reverse any medical risks and concerns from malnutrition by prioritizing fueling for weight restoration. The best way to do this is to give foods with high nutrient density in a smaller footprint. For example, a salad with fruits and vegetables will require a much larger portion size than a hamburger with French fries- causing more bloating and discomfort for your child due to the large amount of fiber- and one of those meals will get your child to where they need to be much more than the other one- I’ll let you guess…
You’re right! It’s the hamburger and fries. We want to serve foods that provide nutrients and calories in a footprint that is not going to be as physically challenging to digest. Often times, these foods might seem more scary to the eating disorder. Talk with your eating disorder therapist about how to navigate that.
Think of other ways to present nutrient dense foods:
-Milkshakes, smoothies made with nuts, nut butters, full-fat milk & yogurt
-Protein & cheeses- pizza, burgers, sandwiches, stuffed breaded chicken
-Deserts
-Protein waffles, buttermilk pancakes, topped with syrup & whipped cream & chocolate chips
-Pasta with cream sauce and protein
-Find more ideas here!
6. Stop or reduce excess movement
If your child is exercising, weightlifting, training, running or other movement, it may be time to stop that temporarily. Sometimes this includes sports. I know that can sound drastic, but anorexia nervosa is a drastic illness and it uses movement as a way to burn calories and often fuels the disease. Examining your child’s relationship with movement is going to be an important part of treatment. If your child is doing movement outside of sports practice, playing with friends, or walking as part of daily living, it is time to stop this extra movement. It is not moving them towards the goal of weight restoration and will make your job of restoring weight much harder. This might mean stopping their visits to the gym or conditioning practices, restricting access to home gym or equipment (locking doors) and stopping them from going outside to run/practice on their own. You make also have to limit their time alone in their bedroom because children with anorexia nervosa often do secretive exercise (push ups, sit ups) in the privacy of their bedroom. Your therapist and your child’s pediatrician will make specific recommendations for your child, but you always have the power and ability to limit or restrict activity if you are worried about your child. Exercise during anorexia nervosa can be harmful not only to their physical health, but also their mental health.
This post does not contain an exhaustive list of recommendations for adolescent anorexia nervosa treatment, but it is a start. Every child and every provider is different, so make sure you are getting the expert help you and your child need. This post is not meant to be treatment advice, but information and education. If you have questions or need help, please reach out.
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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.