by Eva Musby
How long should you keep your child at the table if they are not managing the food in front of them (usually, plated by you along principles of ‘Magic Plate’)?
If your child has ARFID or Autistic Spectrum Disorder (ASD), what follows may not be applicable. Discuss with your specialists.
Can you manage one more bite?
Ideally, a meal will last as long as you continue to see signs that your child can eat more. Think, “Can I manage to feed one more bite?”.
Read up on Tips for Helping Your Child to Eat. This shows you how to keep going with compassionate persistence using direct prompts, distraction, hugs and empathy.
Signs your child may manage more
- They haven’t run away
- They glance at the food or push it around on the plate
- They have started crying instead of fighting you
- They are trying to negotiate alternatives
- They seek reassurance
These are not reasons to stop
There is still plenty of hope of succeeding even when:
- Your child has thrown the food away (have more ready)
- They threaten to eat less next time, or any kind of threat (it’s just how they feel in this moment)
- They have a sore tummy (you can give them a short pause, and a hot water bottle)
- They are crying, scared or angry (treatment, sadly, means eating in spite of distress)
- You’ve never before managed to get them to eat when they have ‘that look’ (your persistence gives an important message, and it may work this time)
Make the meal your priority
Your normal life stops while you support your child to eat. Be there for them one hundred percent. Cancel appointments, stay off your phone. Eat alongside them. Set up whatever environment works for them. Be punctual with mealtimes. You are the one making it possible for your child to eat in spite of the illness.
In the early days you will probably put much of your life on hold to support 3 meals and 3 snacks a day. Plan how to also sustain your own wellbeing.
When to stop
If you are about to lose your temper, shout, blame, accuse, catastrophize or go into full-blown victim mode, consider ending the meal before you act this way. Our extreme behaviours may win us this meal but often they strengthen our children’s opposition for the next meals.
You could decide to stop when there has been no progress for a while and the meal will soon run into the time for the next meal or snack.
Pros and cons of a set duration
In institutions, it’s common for meals to have a set duration — half an hour, for instance. In this setting, patients who don’t manage all the food in the set time get a nutritional supplement drink or feeding by nasogastric tube. There’s a risk in people getting overly dependent on these alternatives to real food, so as a deterrent, patients may be told this will give them ‘extra’.
Sometimes a time limit helps give people the impetus to eat, when they would otherwise fiddle with the food or eat excessively slowly.
At home, while weight gain is your priority, a set time could work, but only if your child generally manages a high-calorie drink when the timer goes off. Make sure the drink amply makes up for the missing calories.
If it’s just as hard to get your child to have the drink, the risk with a time limit is that your child will patiently wait it out. So it’s usually better for parents to remain in charge of when they may end the meal.
How to end a meal without looking beaten
Your child must keep confidence in your ability to support them to eat. If you’re calling an end to a meal, do so with confidence. You can show regret, but not defeat. You are on your child’s side, not against them. You could say, ‘OK, let’s call it a day. Let’s go do [something nice] to change the mood.’ Or, ‘Let’s leave it at that. It’s been hard for you this time. It will get easier.’ Your child is already full of guilt, fear and confusion, and hammering home your disappointment will hardly bring out their better self.
Of course you will feel discouraged. Carve out some time for self-care and for more learning so you’re at your best for the next meal. Don’t catastrophize. It’s normal for some meals to fail. Our children still recover.
Should you replace uneaten food?
If you’ve persisted as much as you can bear, you have choices:
- If your child is willing to eat something of equal value, then go ahead (if your priority is calories rather than getting your child to overcome a fear of that particular food). But if your experience is that negotiating alternatives leads to more reasons to refuse what you bring, negotiation is not a good route for now.
- If you’ve ended the meal and your child is short of calories, do your best to add more calories to the next meals. Should you tell your child you’re doing this? It depends on the person, so experiment.
- If your child regularly leaves a few crumbs in spite of your persistence, should you be even more tenacious? Judge what works best for your child, for instance if in your experience the amount of leftovers is likely to grow.
Should you use ‘consequences’?
The treatment supported by the best evidence, Family-Based Treatment (FBT), does not dictate whether to use carrot-and-stick tactics, nor does it require parents to persist for hours until food is eaten.
Some parents, using the motto ‘Life Stops Until You Eat’, advocate the use of ‘consequences’ if a meal doesn’t succeed 100 percent, after keeping their child at the table for an indefinite length of time. ‘Unconditional acceptance’ of your child is an essential component of FBT, so if you use this type of approach, make it clear your intention is not to judge or punish, but to motivate and get results.
Other parents find that threats escalate a battle of wills which a child can always win by eating less and by sinking further into despondency. Who cares about a mobile phone when life doesn’t even feel worth living? Parents succeed with skilled and compassionate persistence, as described in this post.
Rest or cancelling activities
If your child did not manage a meal, or not enough of it, weigh up the risks and benefits to allow the next activity, or insisting on rest. Make it clear you are not punishing them — for instance, “I’m really sorry, you haven’t had enough nourishment to be fit for school. These things happen. I bet it’s a big disappointment for you. It’s not meant as a punishment. Nobody chooses to have an eating disorder. Shall we find a good movie?”
What are my choices?
The right decision depends on your child and your capabilities at this point in time. It also depends on what stage of treatment they’re in. In the early days, insisting on the last crumb shows you mean business. Whereas when your child has been eating well and is freaking out over a new fear food, your aim could be that they manage one bite.
My video below lays out the choices you have when a meal isn’t working:
It’s not working
If you cannot get your child to eat what they need, insist on getting more help. It is not OK to have a child eat insufficient amounts for weeks. If they are underweight, it is not OK to just keep them stable. Can your clinical team provide you with coaching, or with meal support at home or in a day unit? Otherwise, a spell in a higher level of care may get your child eating again, and you can take over more successfully once they’re back home.
