Learning how to handle your child’s food anxiety before, during, and after mealtimes is essential to recovery. Often anxiety lies at the root of meal refusal: worries about eating, worries about the food, and worries about what will happen after eating are common.Parents can help children heal from eating disorders by learning to help them tolerate food anxiety.
Eating disorders very often coexist with anxiety disorders. This means that while the presenting issue is the eating behavior, often the underlying issue is anxiety. And while there is relatively little research and data on eating disorders, which are chronically under-funded, there is a wealth of information about anxiety.
Studies have shown that parents can have a tremendous impact on either increasing or decreasing their child’s anxiety. And the good news is that parents can learn to reliably reduce their kids’ anxiety by acknowledging it and helping kids face, rather than avoid fear.
When parents learn to handle their child’s food anxiety, they can significantly help with recovery.
Anxiety and eating disorders
Anxiety is a nervous system response to a threat. Mammals are biologically wired to seek comfort and security from their parents when faced with a threat. Therefore, when a human child senses a threat, they seek the parent’s comfort and security to feel better. And this can work really well.
But when we’re dealing with an anxiety disorder, a child’s fear can seem overblown or ridiculous, and parents will often brush it off without realizing that the child is seeking comfort and security. In other cases, parents can’t recognize that the problem is anxiety because it often masquerades as anger, withdrawal, and obstinance.
Patti and Ava
That’s what happened with Patti (not her real name), who consulted with me about her daughter Ava’s (not her real name) eating disorder. “She often won’t even sit at the table. She just goes into her room and slams the door,” said Patti. “If she does come to the table she just sits there staring out the window and refuses to do anything.”
This is a tough situation to be in. I explained to Patti that withdrawal is one way a child can respond to stress and worry. I suspected that Ava felt overwhelmed by her feelings of fear about food, and rather than ask Patti for help, she just shut down.
With this in mind, we explored Patti’s feelings about Ava’s big feelings, especially worry. And Patti told me that when Ava was young she was worried about everything. “It was so frustrating and irritating,” Patti said. “I thought the best thing to do is just ignore it, and I guess that’s where I went wrong.”
Patti did what a lot of parents do. It’s not so much that she did something “wrong,” but her behavior taught Ava that she needs to process feelings by herself, and sharing them with her mom wouldn’t help. Without the skills to process her feelings of worry, Ava became stuck in her anxiety, and in those conditions an eating disorder can flourish.
I worked with Patti to help teach Ava to express her worries in lots of small and big ways. This took effort and practice. Neither of them had experience doing this. But pretty quickly, Ava started opening up. She started telling her mom she was afraid of eating.
Sometimes she would yell, sometimes she would cry. No matter what, Patti worked on being present with Ava’s fear even when it was uncomfortable. Patti’s behavior “unlocked” Ava’s anxiety. And once Ava started to express herself, Patti was able to respond to anxiety to help it become less of an impediment to eating.
We need to face anxiety head-on to recover from eating disorders
So what’s a parent to do? How can we help our child handle food and eating anxiety? As I said, we know a lot about how anxiety works, and the most important thing to know is that it’s predictable. Anxiety tells us we must avoid whatever it is afraid of. And this is the key to recovery. Rather than trying to stop the anxiety from happening, we practice feeling the anxiety and not avoiding the thing we’re afraid of.
This is where parents can help. You see, often parents accidentally empower the anxiety by helping the child avoid the thing they are afraid of. We feed eating disorder behaviors when we make accommodations to avoid or step around their fear.
For example, if your child is afraid of fat, you may make low-fat meals. If they reject carbs, you prepare low-carb alternatives. If they’re afraid of restaurants, you stop eating out. These accommodations may seem to help in the short term. But they teach the child that they are not capable of facing fear. Instead of empowering them to walk through their fear, accommodations enable them to avoid it.
Avoiding fear feeds fear. The only way out of anxiety is to walk through the fear, over and over, and see that you can survive anxiety and fear.* When a parent is next to you, holding your hand while you walk through the fear (but not turning back), it’s easier.
We need to face our food anxiety head-on to recover from an eating disorder. We need to see that we are strong enough to endure our anxiety and be OK on the other side.
*Note: if your child has PTSD or a history of trauma, it may not be safe for them to approach fear in this manner. Please check with a qualified trauma therapist.
Prepare yourself first
If your child has an eating disorder, then food is a trigger for their anxiety. They key to handling your child’s anxiety is to be prepared. Expect fear to show up and be prepared to respond without accommodating.
Before you can help your child with their food anxiety, it’s important to calm your own nervous system. As mammals, our children seek us for co-regulation. That means that if our emotional state is relatively calm and confident, our children are more likely to be soothed.
You have to calm yourself to calm your child
This is hard. When a child has an eating disorder, all you want is for them to stop whatever they are doing with food and “be normal.” Also, anxiety tends to be annoying. It can be really irritating to be with someone who is afraid of food. But, as you know by now, your emotional state is contagious.
So how do you soothe yourself so you can soothe your child?
There are lots of options. As a baseline, get plenty of sleep each night, which will hugely impact your nervous system. Next, begin a mindfulness practice. Get enough sleep and practice at least 10-minutes of mindful meditation every day. This will train you to tune into your body and soothe your nervous system.
Then, immediately before you serve your child food, do a 2-10-minute mindful meditation to calm your nervous system.
This may seem like a lot of work. It is. But this preparation will make a significant impact on your effectiveness. If you dive in without preparing yourself emotionally, you may exacerbate the anxiety. Unless it is impossible, make this investment in your child’s recovery. It will also improve your own mental health. It’s draining to talk to someone who has an eating disorder, especially when you are emotionally activated.
When child and parent are both anxious, very little good can occur.
How to co-regulate with your child
Your child is going to experience anxiety around food until they have recovered from their eating disorder. While parents can’t fix their kids’ disorders, they can help them tolerate anxiety around meals.
1. Before a meal beings
Check in meaningfully with your child. Make contact with them however you can, such as:
- Ask them about their day
- Do some yoga poses together
- Go for a gentle walk together
- Throw a ball back and forth
- Massage their hands, back, or shoulders
- Color together
This will help your child and you get in the co-regulation mode. Doing something physical together can help you attune to each other as much as talking does. Once you are co-regulated, it’s more likely that you can help them get on-track if their anxiety flares up.
2. During a meal
You should anticipate and be prepared for anxiety. But avoid allowing anxiety to run the show. It helps to tell your child in advance what you expect from them during meals.
For example, if they have a meal plan, you can expect them to follow it. And maybe you expect them to stay at the table while everyone else is eating.
They will likely complain about anything you ask them to do during meals. Your goal is to compassionately acknowledge their complaints without accommodating them. In other words, don’t let them ditch the meal plan or the table mid-meal. Agreements should be honored even if it’s uncomfortable for them.
3. When they have anxiety during a meal
Your child may do all sorts of things to try and control the meal to accommodate their anxiety. Your goal is to stay steady and acknowledge but not accommodate the anxiety. Here is a great phrase to use during a meal when your child is struggling to eat:
First, acknowledge the anxiety: “I can see that you’re struggling and I know this is hard.”
Next, express trust in them: “And I believe that you can do this.”
It’s important not to get pulled into an extended conversation about this. Calmly and consistently repeat the phrase rather than engaging with the anxiety.
4. After a meal
If things didn’t go well during a meal, you may need to check in after the meal. You can ask your child what they think went wrong. Time this so that it’s well after the meal itself and well before the next meal. Try to focus on creating a plan for tolerating anxiety vs. avoiding anxiety in the future. In other words, if they refused to eat carbs, don’t talk about the carbs or tell them they don’t have to eat them. Talk about the anxiety about the carbs and how they can tolerate the anxiety.
Example: Breakfast breakdown
Here’s an example of a breakfast that’s gone sideways:
Jamie is pushing her plate away without eating.
Mom: “Jamie, it’s on your meal plan that you will eat an apple and peanut butter for breakfast.”
Jamie: “But I can’t. I feel sick. I can’t eat. You can’t make me!”
Mom: “I understand, and I know it’s hard to eat when you don’t want to. But I also know that we talked about this and agreed that you will face your fears and eat what you said you would eat.”
Jamie: “But I can’t!”
Mom: “Jamie, remember that we agreed that we don’t change the plan during mealtimes. This is a mealtime, so I need you to eat. We can re-examine how we handle breakfast another time, but for right now this is the agreement.”
Jamie: “It’s not fair.”
Mom: “I understand, but remember that we made this agreement together.”
Jamie begins to eat breakfast. She puts on a show of gagging and suffering while eating. Mom is compassionate and firm at the same time. Jamie finishes breakfast reluctantly.
Later that afternoon, Mom revisits breakfast:
Mom: “So this morning you had trouble with breakfast. Do you want to talk about it?”
Mom: “OK, but what I saw is that you felt anxious about eating what was on your meal plan. Would you like me to adjust how I responded to your anxiety about eating, or was it OK?”
Jamie: “I guess.”
Mom: “Jamie, this only works if we’re in agreement. Do you agree that we’re on the same page about following the meal plan and facing food anxiety together like we did this morning?”
Mom has acknowledged Jamie’s feelings and gained agreement to continue facing food fear rather than accommodating anxiety.
What happens when eating
No matter how well you have planned, eating disorder behaviors will probably show up during meals. This is usually not because your child is stubborn or not committed to recovery. It’s usually because eating disorders are rooted in a lot of anxiety, and food is a major anxiety trigger for your child.
Remember that your goal is to handle – not accommodate – your child’s food anxiety.
If your child had anxiety about getting on a plane, you would recognize that going to the airport and getting on a plane will create anxiety for your child. With an eating disorder, meals will create anxiety.
The key is to remember that the anxiety is the root issue, not the food itself. Work on your ability to tolerate your child’s anxiety and help them walk through it. Have a plan for how to handle anxiety when it arises during meals.
And, most importantly, take care of yourself and get the care you deserve. Parenting a child with any anxiety is taxing. We can help our kids so much, but we have to make sure we’re getting help for ourselves, too.
Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders. She’s the founder of More-Love.org and a Parent Coach who helps parents navigate eating disorder recovery.