How to handle food issues in the home when you have a child suffering from an eating disorder.

Ever since your daughter started going to a new school, she always has too much homework and doesn't seem interested in spending time with you any more. Not only that but she never eats with the family anymore and you've noticed that she's lost a lot of weight lately. The other day you saw an empty box of laxatives in the garbage and vomit in the toilet. You're growing more and more concerned but feel as though whenever you try to talk to her, she never has the time. You feel frustrated and scared. You start to feel guilty about the comments you used to make about her weight and all the junk and candy she was eating. You wish you could take them all back but you can't. So you decide to just leave her alone and not do anymore harm...

Some parts of this scenario you may relate to, these are often the types of thoughts that run through a parents head when they discover or think their child might have an eating disorder. Some feel guilty and ashamed others blame themselves but most are very confused and scared. The important thing is to not abandon your child. At this time especially, she needs your encourage-ment and support. Most of all, you need to tell her how you feel: Tell her you love her and you are concerned.

Talk about it!

No matter what stage of the eating disorder your child is going through, it is important not to take the easier and less travelled route, of ignoring or making light of the situation. First of all if the eating disorder is life threatening, then you have no choice but to intervene.1 If the eating disorder is not, then it is recommended that at the least, you show that you are concerned and offer a helping hand.1 Research shows that parents that show both support for their child and try to better understand their child's condition, have had a positive effect on their child's recovery.5,6 In addition acquiring knowledge and seeking support for yourself leads to an increased ability to cope with the issue.5

About the food...

Mealtimes can be the most stressful times of the day both for a child suffering from an eating disorder and his or her family. Often the child is so focused on the food on their plate that they find it hard to join in on the social conversations at the table.4 Moreover, it is very common for the child to avoid eating with the family all together. Also, since the family might be worried about the child's intake, they may become excessively preoccupied. Therefore, since this is a particularly stressful time for the child and family, confrontation should be avoided at this time.4 However, discussing food in a non-confrontational way, outside of mealtimes is appropriate.

In fact in the initial stages of recovering from an eating disorder, it is important to try to negotiate with your child what foods they will accept to eat. The negotiation process should be highly collaborative. That is, you should, as a parent, give structure to your child's meal in term of quality. And your child's opinion should be respected in terms of preference in order to encourage his or her involvement in the process. The goal that you should bear in mind is to provide meals that fulfill your child's needs, that are well balanced, varied and highly enjoyable.

Since it may difficult as a parent to determine your child's nutritional requirements and to negotiate in a positive manner, it might be a good idea, when your child is seeking help, to meet with a nutritionist who has had experience dealing with patients who have eating disorders. Your child can work with the nutritionist to establish a meal plan that they both agree upon. This meal plan is one of the most important steps to recovery for a child with an eating disorder. Its goal is to normalise eating patterns.2,3 Usually it consists of 5 to 6 small meals that are at set times.3 You should facilitate this by planning meals around your child's schedule (at least for now).2 This is done because most patients suffering from eating disorders have lost the ability to gage when they are hungry or full.3 Eating at regular intervals (no more than 3-4 hours apart)2 helps your child to recognise feelings of hunger and satiety.3 It seems paradoxical but a more rigid and structured eating pattern will actually in the long run help your child to eat in a more carefree and relaxed manner.3 You can reassure your child that by developing a meal plan he or she will likely maintain or lose weight (unless they are under weight).3 The reason for this is that those that suffer from binging and purging often gain weight, despite purging (which regardless of the method always retains the majority of the ingested calories).3 It may help to re-assure them that weight is not gained through normal eating but it is gained through binging, and that a regular meal pattern will prevent binging.2,3

For the younger child who needs to gain weight, rewards sometimes work.3 Once a meal plan is being followed, offer a reward (non-food related) for a sufficient weight gain. It is important that these rewards be given for a sustained weight gain and not just eating. This is the only way to ensure your child is on the road to better health. 3
Finally, be patient with your child! I heard a young women suffering from anorexia once say that after finally trying a meal plan for a few months, she went to her parents for dinner. Her mother thought her daughter was "cured" and was surprised that she was upset when she served lasagne and chocolate cake. Although your child may be eating better than they used to, this does not mean that they are ready to accept all of their past "forbidden" foods. It is a long road to recovery and patience is the key.1 It is also very normal for your child to experience a relapse of behaviour, do not give up hope!
Finally do not forget about yourself! It is important for you to try and help your child out but you will be a better help if you remember to take care of yourself too!

References

1. Helping your child overcome an eating disorder. Ch 4. What do you say? Family communication and eating disorders.

2. The parent's guide to childhood eating disorders. Ch.10 Normalizing eating with a food plan.

3. The parent's guide to childhood eating disorders. Ch.11. Getting the most of the food plan.

4. Beumont P.J.V., Beumont C.C., Touyz S.W., Williams H. Cognitive behaviour and educational approaches. Ch 9. Nutritional couseling and supervised exercise.

5. Garro A. (2004). Coping patterns in mother/caregivers of children with chronic feeding problems. J. Pediatr. Health Care. 18: 138-144.

6. Robinson P.H. (2000). Review article: Recognition and treatment of eating disorders in primary and secondary care. Aliment Pharmacol Ther. 14: 367-377.