February 09, 2022
Hope and Healing
By Dr Cassie Rhodes
Regular readers of Wednesday Wisdom will know that children’s mental health is a matter close to my heart. Pre-pandemic, it was already accepted that there was a mental health crisis among children and young people, but as the Covid tsunami recedes, the mental health impact of the last two years is emerging.
We know that a rise in referrals for eating disorders (or EDs, as they are known in the research literature) coincided with the reopening of schools, when life started to return to a degree of normality. The stressors that led to the surge in EDs were numerous and complex. However, Dr Dasha Nicholls, a psychiatrist working in this area, has highlighted factors such as the heightened national interest in losing weight during lockdown (widely seen as beneficial in beating Covid), the interest in food and exercise that followed, and the denial of social connection for many young people within the age range most associated with EDs. The mean age of onset is generally considered to be 14. However, since the pandemic, cases of EDs in younger children are being more widely reported. Whilst we may associate them more commonly with girls, this is a myth. EDs don’t discriminate and many boys are affected.
If you have never had any experience of an eating disorder, or known anyone who has suffered from one, it can be impossible to imagine how difficult the journey is for those who love them most. Supporting a child with an ED demands courage, strength, vulnerability, reflection, enormous stamina and self-compassion. The commitment to keep going through the lengthy journey of supporting a poorly child is anchored in unflinching love and concern.
This odyssey of love is described in poignant detail by Eva Musby in her book Anorexia and Other Eating Disorders: How to Help Your Child Eat Well and Be Well. Eva details the story of her daughter’s anorexia (which began at the tender age of 10) and spells out her route to recovery and what she learned along the way.
One of Eva’s most prominent and powerful messages for all parents supporting a child with an eating disorder is that of hope.
She comments, “you need to know that this illness is treatable so that you can hold the candle of hope up for your child, who currently sees only a dark tunnel”. She goes on to remark that their family therapist made it clear that she expected nothing less than her daughter’s full recovery. Thankfully, she’s now a thriving young adult. Prognosis for eating disorders has improved dramatically since the advent of family therapy, also known as ‘family-based treatment’ or the ‘Maudsley Method’, after the London hospital where it originated. Now the most well-researched type of treatment for children and young people, it is firmly recommended in the UK’s NICE guidance on recognising and treating eating disorders.
Under the supervision and care of clinicians, this treatment method asks parents to play a leading role in feeding (or ‘refeeding’) their children, by taking full responsibility for three meals and three snacks every day, helping to restore their child’s weight to an appropriate level. When it comes to eating disorders, early intervention is key, and treatment plans do not wait for children to be motivated to ‘beat’ their illness.
During the first stage of treatment, parents take a strong lead in all food decisions, including shopping, cooking and portioning. They will likely not engage in discussions about food or give options to their child. Food simply appears, almost by magic, at the table. Parents then need to support their child with empathy and compassion through each and every bite, balancing this with the consistent message that eating is not a choice, it’s a requirement. All the while, they will be acutely aware that not every mealtime will go to plan, and that they are likely to face tears, anger, detachment and palpable fear from their anguished child, for whom eating may feel like an impossibility.
During meals, parents are likely to need a whole toolbox of strategies at hand to help. Dinnertime distractions, such as TV shows, audio books or card games can be useful. Conversation topics have to be picked with care, avoiding all things relating to eating, health, food, models, clothes or exercise. Parents will need to be calm and confident, making their child feel safe and encouraging them to trust their advice; reiterating the message that “we know what is right for you”. They’ll need to try to put their child in touch with things they enjoy with mental pictures and visualisations and use humour where possible to lighten the mood. They’ll need to use skilled eating prompts, choosing language carefully, with what Eva describes as “compassionate persistence”.
As Eva’s book makes abundantly clear, it’s all incredibly tough, but evidence shows that this process of ‘refeeding’ is generally the only way to forge sustained progress. An appreciation and understanding of the fact that a young person doesn’t develop an eating disorder due to vanity, a desire for attention, or as a lifestyle choice is critical. Parents will also need to foster reserves of self-compassion with which to respond to negative or catastrophic thoughts, reminding themselves that they are not to blame and remembering the need to look after themselves too.
As the young person begins to improve, the next phase of treatment involves giving them some control over their eating. Perhaps they are able to choose between two different snacks or serve their own portion of food. It’s a slow and gradual process which involves close supervision and rigorous risk-assessment. Eventually, parents can begin to recultivate their child’s independence and sense of self and help them to enjoy more typical childhood or teenage experiences.
Helping parents with the minutiae of exactly how they might be able to achieve this are Eva’s book, website, resources and workshops. Widely recommended by clinicians worldwide, Eva’s practical book, borne from personal experience, outlines ways in which her family coped with the challenges that faced them and provides a wealth of evidence-based knowledge to give parents a better idea of how they might put their child’s clinical treatment plan into action at home. She suggests methods for coping with mealtimes and exercise compulsion more effectively, ways to work together as a family unit, how to forge a meaningful partnership with a child’s school and, importantly, reminders to look after yourself. It’s packed with practical suggestions, including numerous eating prompts that work (and those to avoid).
If you have any suspicion at all that your child has an eating disorder, book an appointment with your GP as soon as you can. It's imperative that children with a suspected ED are assessed by eating disorder services as quickly as possible.
There are many useful lists of common symptoms available online, but some more unusual behaviours to look out for could include eating vicariously (for example, a sudden passion for cooking or food on TV, but where your child doesn’t eat it themselves), signs of distress around food during holidays or time away from home, sudden changes in diet, an obsessive need to exercise or talking about health and fitness a lot. Any weight loss needs investigating quickly and acting fast is important.
Go to your GP armed with notes which list your child’s symptoms, along with some anecdotes. This might include what they ate and drank yesterday, foods that they refuse, their levels of exercise, physical and psychological changes or the kind of things that they talk about. Be clear that you think they are in need of help and ask for an immediate referral. If your child resists medical intervention, it’s important to be firm, persistent and compassionate. Stress your need to seek advice and that you are worried about them.
Pay attention to your child’s digital diet and their sleep. They may need help and guidance with both. If your child is attending school, initiate open and honest conversations with staff about their needs, ask them to carefully consider the messages they are giving about health, exercise and food, and think together about points of transition or change, or unusual events such as school trips.
Eating disorders are greedy. They take huge amounts of energy and time for both the parents and the child with the illness. It’s important to be mindful of the impact this may have on siblings, who are likely to be worried (even if you try to protect them), and who may seek to hide their own problems, for fear of adding to the family plate. Don’t be afraid to draw on your own support network for help. Ensure, as best you can, that siblings have opportunities for joy and fun and make sure that you send the clear message that you are emotionally available for them too.
There are many excellent resources available online to help families that are navigating this testing experience. Eating disorders charity Beat operates helplines for all areas of the UK, which are open for advice 365 days of the year, from 9am – midnight on weekdays and 4pm – midnight on weekends and bank holidays.
Are you a Tooled Up member?
Parents and staff in Tooled Up Schools who want to find out more about Eva Musby’s fantastic book, and her other work, should tune into our brand new podcast interview (and read the accompanying notes). We also have several other interviews on eating disorders already in the library which we urge any concerned parent to listen to or watch.
Eating Disorder Awareness Week is coming up at the end of February. To help raise understanding and knowledge of this group of illnesses, we have planned a series of interviews and webinars with leading experts, which we’d love you to join us for. Tooled Up members can book a free place on any of the below now.
Social Media Trends, Eating Behaviour and Body Image: A Navigation Guide for Educators and Parents, 28 February, 7.30pm GMT
Sophie Medlin, Chair of the British Dietetic Association for London and Director and Specialist Dietitian at City Dieticians joins us for this live webinar on current trends within social media and how these factors affect eating behaviour and body image in children and teens.
Nora Trompeter: Eating Disorders and Bullying: Some Reflections on the Research Evidence, 3 March, 8pm GMT
Former Researcher of the Month, Nora Trompeter, joins us live from Australia to discuss the latest research into the relationship between bullying and eating disorders, providing an insight into how these factors relate and some practical guidance on what this means for parents and educators of tweens and teens.
Staff Only – Spotting Eating Disorders and How to Talk to Parents and Students, 4 March, 12pm GMT
Consultant clinical psychologist Dr Sophie Nesbitt, talks to us about how to spot the signs of disordered eating within an educational setting, discusses pathways for seeking help and gives advice on how to talk to parents and students about this topic.
We will also be releasing a recorded webinar with eating disorder specialist, Professor Tracey Wade, reviewing the evidence on the impact of social media on teens’ body image.