Be patient and work on understanding your child’s thoughts and feelings.
February 10, 2022 – Iris Epstein
Hello everyone and welcome to the parent presentation discussion.
My name is Ariel and I’m a registered dietitian currently interning for Iris and her team at Nutrition Improvement Center. I went to NYU for my Bachelor’s in Nutrition & Dietetics, and I completed a year-long internship with a focus in clinical nutrition at New York Presbyterian Hospital. When I worked with eating disorder patients at my internship, I felt challenged and rewarded and was excited to start each day. Since then, working with eating disorders patients has always been my passion and my goal is to acquire immense knowledge and grow both personally and professionally in this field.
Eating disorders are not just about food. They are not a lifestyle choice or a diet gone “too far”, rather a serious, complex, and potentially life-threatening mental illness. Eating disorders are characterized by disturbances in behaviors, thoughts, and attitudes to food, eating, and body weight or shape. They can occur in people of any age, weight, gender, sexuality, cultural background, or socioeconomic group. Recovering from an ED can be a long, complicated, and difficult process, which often can be emotionally and physically draining for the parent or caregiver. It is common for parents to feel helpless, confused, and frustrated at times. Feeling this way is understandable, as it’s not easy to watch a loved one do damage to their health.
While treatment is key to recovery, there are many things you can do to help support your child at home and aid in their recovery process. In this presentation I will discuss what is helpful in parenting a child with an ED.
I just want to note that this discussion is not a substitute for treatment, and to always follow the advice of your treatment team.
I think that to truly aid in recovery, it’s important to first understand what an eating disorder is and its characteristics. According to Dr. Desarbo, a psychiatrist who specializes in the treatment of ED’s, an eating disorder’s main component is the obsessive and persistent thoughts pertaining to food, weight, and shape. A question that Dr. Desarbo often asks his clients is “What percentage of your free thoughts are about eating, food, and weight?” He notes that an answer of 90% is typical for an eating disorder. And to put things in perspective, a typical person normally thinks about these things maybe 10-15% of the time. Dr. Desarbo further notes that “you can’t see inside a person’s head, which is why oftentimes, a person with an eating disorder will feel misunderstood.”
So as parents it’s important to try and keep this focus. It is important to be patient, and work on understanding these thoughts and feelings, rather than to judge or become angry. While every child with an ED will feel differently and display different attitudes and behaviors, there are some feelings/emotions that are generally shared with this patient population.
According to the mental health foundation common feelings and traits include low self-esteem, worthlessness, powerlessness (no control over life), perfectionism, finding it hard to handle stress and cope with life, and effectiveness (trying to rid themselves of the feeling).
While it may be hard to associate these feelings with food, it’s important to understand that ED patients use food as a way of coping with these emotions and gaining a sense of control in their life. Food is something that is easily controllable and usually why it tends to be the main target in patients with eating disorders.
While it can be difficult to keep this in mind constantly when helping your child recover from an ED, this is vital in order to aid in recovery. As parents, it’s important to acknowledge and validate your child’s feelings, instead of judging or getting angry. You should view controlling or restricting food as a cry for help instead of being stubborn or rebellious. Your child wants you to believe in them, give them love and support and validate their emotions. I know this isn’t easy, but remaining compassionate is important in aiding your child recover from an ED
For example, after school one day your child comes back home and refuses to drink her shake. She says “I have a stomach ache and I don’t want to drink it.” Then you say, “You usually drink one right after school when you come home, this is on your list of safe foods and is on your meal plan and I’d really like it if you can drink it now.” Your child says back “I have a stomach-ache” and starts yelling “I don’t want to drink it!” and runs to her room. While the parent’s intention in this case was pure and to help the child, the child did not view it this way. In this case you can first say “I’m sorry you have a stomach-ache,” and validate their emotions. Then you can ask “did anything happen at school today? How are you feeling today?”
If everything was okay, then you can ask “maybe you can drink half now and finish the other half later”. Responding in this way shows your child that you’re listening to her and that you care and her feelings matter.
While it’s important to constantly be validating your child’s emotions and supporting them, it’s also important to be tough and not lose track of the required meal plan and food intake for the day. In this case, the child usually drinks one full shake after school each day, and it must remain that way. You must let your child know that you are able to make this one-time exception of drinking half of the shake now and half later, however this will not become a regular occurrence. You must communicate this to your child when this occurs, so that she is aware that it is a one-time exception and she won’t be able to do this again if she gets another stomach-ache.
While this can be difficult to balance, it’s important to keep both in the back of your mind as both are crucial for recovery.
I will now briefly cover some tips for meal support: 4 c’s of a meal support:
- Remain calm: children will pick up on your anxiety and will likely make them more anxious
- Be confident: the more confident they are, the more reassured they’ll feel
- Be consistent: stick with what you decided and don’t negotiate
- Be compassionate: understand that they are doing something that is very difficult for them
Lack of structure and stability can cause a lot of anxiety in patients with eating disorders. Planning meals and snacks ahead of time can help lower anxiety and control arguments during mealtimes. Meal planning minimizes negotiation by given youth choices in discussing meals ahead of time. Planning meals also ensures adequate nutrition and ensures there is enough food delivered at the right time as well as the food being served will provide their child with the right nutrition to be healthy.
When planning meals at home for patients with eating disorders, it can be good to plan a week ahead for the meals for each day. You can also involve your child in planning and give them a 2-to-3 choices to pick the entree for each day which gives them a sense of control.
Try to avoid your child being in the kitchen as sometimes this also can cause more stress and anxiety for your child if they obsess over what goes into it or if they see something they don’t like go in. Let your child know, well before hand, that they will be no negotiation with portion size.
It’s also very important to keep a positive and warm atmosphere around mealtimes. Eating together as a family and discussing interesting things (such as cool vacation spots) can help reduce anxiety and persistent eating disorder thoughts. Try to avoid talking about food during mealtimes to help deflect your child’s mind.
Post-mealtime is also important as there often is a lot of negative self-talk and regret for someone with an eating disorder. For some it may even be more stressful than the meal itself. They feel terribly guilty and feel physical pain from eating more than they are used to. To prevent these types of behaviors and thoughts use distraction and supervision to provide some time so these feelings can fade away to a more manageable level. It may be helpful to plan structured activities after meals with your child such as games or watching a movie.
It’s also important to Try to maintain an open and ongoing dialogue with your child. For example, if your child is being moody and complaining about being cold. Instead of saying you’re cold and moody because you need to eat something, stop being stubborn, I don’t want to deal with this right now”. Try instead… “I am noticing you are not yourself, having mood swings, always cold. I can feel something is bothering you. Is there anything you want to share with me? Know that I am here for you always. I love you no matter what you are going through. Help me to understand what you’re going through”.
It’s also necessary to understand that the “food” in eating disorders is not the problem, rather the behavior. You have to explain to your child that ALL food is good. There is no “harmful” food for you, rather it’s how and when you eat it. The behavior around the food is what can make it harmful. For example, your child says to you she will never eat potatoes because they aren’t healthy and they scare her. However, your child is not understanding that the potatoes (in itself) are not the problem, they are actually very nutritious and full of vitamins and minerals. In this case, the problem is the behavior of not eating potatoes and being scared of them.
I will now give another example. So, in this example your child has binge eating disorder. She had a very stressful day at school and later when she got home, she had a binge episode and ate multiple different foods. In your child’s head, she was thinking “food makes me feel good, so I’m going to eat”, and this behavior doesn’t stop because your child doesn’t want to feel bad. And once she finished her binge episode, she went right back to feeling bad, if not worse. That is what creates this vicious pattern.
This is your child’s coping mechanism of trying to feel better in that moment.
The examples (I mentioned above) are examples of eating disorder behaviors. There are other examples of eating disorder behaviors such as trying to skip a meal, taking a long time to finish the meal, making comments about the temperature of the food, hiding food, throwing food, a high level of irritability, slamming door, leaving the house around mealtime, and taking really small bites of food. While the list can go on and on as there are still many other behaviors I did not mention, when you see your child doing these kinds of behaviors, try explaining to them that the food is not the problem, rather the behavior. Help your child identify these behaviors so that they can learn from it and stop it from happening. Help them recognize why they are doing these behaviors- like I mentioned before it’s a coping mechanism, so help your child discover new and healthy ways to cope. Some examples of healthy ways of coping could be calling a friend, organizing things in the house or room, blowing out her hair, or buying a new present. If you ever see these kinds of behaviors, you can also speak with your child about it, and ask her why she may be doing these behaviors today. Allow your child to open up to you and also show your love and support.
It’s also important not to comment on weight or appearance! And be careful not to tell them to “just eat.” Instead, reinforce that you are there for them no matter what, that they seem to be struggling with some feelings around food and eating or body image, and get permission to discuss it.
You can also Emphasize and provide positive words towards any small effort made by your child.
As mentioned earlier, It’s also important to manage your own emotions. Be honest, calm, consistent and loving. Try to avoid becoming emotional and angry. Stop and think before reacting to your child. You can try to practice breathing and meditation to help with this. You can also Acknowledge that it is okay for you to shed tears in the process. Recognize that it’s a process and a journey, so try to keep calm and take things day by. It’s also important that you Practice self-care and take time for yourself, time to vent your frustrations and clear your thoughts. Try to remain healthy for yourself and don’t let the issue consume your life. In order to give the best care and support for your child, you have to be in a good place yourself and love yourself. Like how the saying goes, before you love someone else, you must first love yourself. You can also try journaling daily. Getting those feelings out allows you to cope with all the stuff that comes with a child with an eating disorder. You can also try Seeking support from other parents/caregivers that have been through it. Talking with others who have been through the same thing or going through it really helps with coping and helps you realize you are not alone.
As a parent it’s also important to recognize and acknowledge that no family is perfect and that everyone has their own problems. Do not blame yourself or anyone else. It is very important for parents NOT to feel guilty, because while parental behavior cannot cause the disease, parental behavior is a big part of the most successful treatment. Guilt and anger are not constructive for moving forward!
Thank you so much for listening, I hope that this presentation was helpful.
If you have any questions, please email info@nicrd.com. Which is…
Thank you again!
Email: info@nicrd.com
