Over the past 20 years (yes 20!) of re-feeding children with eating disorders, we at Kartini Clinic have learned some tips and tricks, which I thought I would pass along. Whether you are re-feeding a child at home or in a clinical setting, I hope these pointers can be helpful to you.
Remember: even though life stops until you eat and that without weight restoration you will get nothing, there are ways to help make the process less painful and more supportive. At Kartini Clinic we operate in a “peaceful, friendly, no-negotiation atmosphere” and recommend you do the same.
Knowing that negotiation is not possible will actually make your child less anxious. If they think there is the possibility of negotiating even a teeny bit on behalf of the eating disorder, many kids will beat themselves up if they don’t try. Negotiation, or the possibility of it, will force them to try and bargain with you at every turn. They will be miserable and you will go crazy.
So when is compromise useful and fair?
Example: “Can I listen to hip hop music during lunch instead of classical music as a distraction?” Answer: Yes. Such a compromise, if it helps your child eat in a reasonable amount of time is cheap at twice the price.
Example: “Can I save half of my lunch sandwich and eat it at snack?” Answer: Emphatically no. Pushing food off until later is a common eating disordered behavior. “Later” either never comes or is miserable.
Example: “Can I skip my evening snack and eat it tomorrow? I promise, promise, promise I will.” Answer: Certainly not.
What are the tips and tricks, courtesy of experienced Kartini staff?
1. Set the table, let them put flowers on it; make the food environment less grim (Dr. O’Toole)
2. Always eat with them, and never less than they are eating. No one likes to be stared at while they eat and others do not. (Dr. O’Toole)
3. Help them identify the most difficult food on their plate and eat it first (Dr. O’Toole).
4. When bringing food to the table, always make their plate the last one you put down, then sit down and do not get up for any reason until they are done (Jade Buchanan, Clinical Director).
5. Either check napkins at meal’s end or eliminate them (Jade Buchanan).
6. No dogs roaming around the room. Too easy to “drop” food. (Dr. O’Toole)
7. Don’t eat in the car ( Dr. Moshtael)
8. Voice tones are important…. Keep calm and soft-talking as if this is not such a big scary deal to eat (Amy Stauffer, milieu manager)
9. Food rolled up in a tortilla looks smaller and easier to eat (Amy Stauffer)
10. Fun activities at the table could be toys set out that they put next to their place mat to feel supported... drawing paper instead of table cloth.... Personal supportive things set at their personalized place setting ... Telling stories is great distraction.... (Amy Stauffer)
11. Spinach as a vegetable cooks down into a tiny amount and makes the plate look less full (Dr. Moshtael)
12. Absolutely refrain from commenting (or allowing others to comment) on “how much food” it all is (Dr. O’Toole).
13. Sometimes we'll have the kids pace after us, taking bites at the same time so we role-model eating for them (Josh Barrett, milieu therapist).
14. Laughter and compassion go a long way. (Josh Barrett)
15. Give them sufficient time prompts that they can track their progress, but not so many that it stresses them out. Typically I give one every 10 minutes, half way through, 5 minutes left, 2 minutes left, 1 minute left. (Josh Barrett)
16. Have a mantra/positive affirmation they can repeat (e.g. "not finishing is not an option," "The meal plan is just right for me" (Josh Barrett).
17. Understand that what might have worked for a past patient, will not necessarily work for a new one. I have found that it is helpful to approach each child who is reluctant to eat with an open mind, not assuming that a template will work for them. (Ellie Franco, milieu manager)
18. Keep a consistent structure at meal times. (Ellie Franco)
19. No judging voice tones or pressuring demands. (Amy Stauffer)
20. Set reasonable meal-time limits and stick to them. If they cannot/ will not finish in a timely fashion, have them drink a Boost or an Ensure to make up the difference at the end of the expected time (30 minutes for breakfast and lunch, 15 minutes for snack, 45 minutes for dinner). Do not sit at the table for hours (entire team).
And now about some tips or tricks of your own, dear parents and colleagues?