How to Nourish Your Child Through an Eating Disorder
How to Nourish Your Child Through an Eating Disorder
By Casey Crosbie RD CSSD& Wendy Sterling MS RD CSSD
Eating disorders create an ironic pull for twenty-first century parents of teens. Ninety percent of eating disorders are identified in children age twelve to twenty-five, leaving the responsibility for identification, treatment and ongoing care front and center in the home. Parents face this task at the exact time that biology and society set adolescents to embark developmentally on a path toward the push-pull of young adulthood. And then the challenges arise: How are parents to both provide for the tightrope of control and independence so essential to this life stage? The lonely burden of identifying appropriate treatment for the teen requires recognizing the very control issues that face teens with eating disorders while also providing for the family that is drawn into each stage of the recovery process. It also places parents at the head of the table, tasked to shepherd their eating-disordered children toward improved eating as they juggle providing nutritious fare the children must accept and shifting the tone of about food intake and appearance against the backdrop of breakfast and dinnertime drama.
Enter Casey Crosbie and Wendy Sterling, specialists in adolescent eating disorders and adolescent and sports nutrition, who provide a ‘plate-by-plate’ approach for this daunting experience in How to Nourish Your Child Through an Eating Disorder. They, along with a contributing adolescent medicine and social worker, frame their approach per the Family-Based Treatment (FBT) paradigm, with an eye toward real-time strategies that keep the family front-and-center. The book provides information for parents at each stage of the process, from identification to treatment and refeeding, appreciating the home experience as well as other contexts such as school, summer camp, and college.
Family-Based Therapy offers a perspective and action plan for parents through its three-phase approach: From the hands-on, parent directed Phase 1 to introduction of some independence in food choice in Phase 2 and toward Phase 3 when parents support their children as they maintain a consistent and healthy body mass index (BMI). The authors recognize and model a systematic, team-based approach that involves an ‘inner circle’ of medical and mental health professionals as they partner actively with parents and the children. The book’s unique vantage point offers practical materials to highlight information through this lens. Most notable are the nutrition charts, solutions to scenarios that may arise. What do families discuss at the table if they want mealtime to be pleasant rather than a battleground for disagreement over food intake? They also offer examples of early indicators that a child may be obsessing over caloric intake or otherwise showing a rigidity that can tip off parents to practices and rituals that put the child at risk. Brief case studies offer information and insights that bring to life the children’s and families’ experiences in a manner that can be both instructive and diminish the isolation that parents can feel during this medical and family crisis. The focus on strategies that work for behavioral change and better health is effective (research-based) and practical for families often drained by this consuming process — a helpful vantage point for families that are often tapped out with little energy left to exploring patterns of relationships or theoretical insights.
The authors remind readers that recovery, as for all developmental and learning processes, is not an even course, that setbacks and spurts are part and parcel of growth. The book, however, offers strategies and solutions for when these issues arise, whether at times that increasing mindfulness can help maintain a growth mindset, or as families adapt at the three critical FBT recovery stages to managing different eating contexts such as preparing meals or restaurant eating.
Perhaps the strength of this model is its potential to draw upon this ‘we know it takes a team, mom and dad’ approach and to expand it. For example, it would be helpful to offer a module for school faculty that extends this vantage point to school since so many of the core issues and challenges can arise, albeit in a unique way. Similarly it can be extended to provide fruitful discussion with other ongoing care providers (such as learning specialists and tutors) who can both reinforce the FBT mindset and serve as sounding boards who observe children’s successes and setbacks. Given the high overlap of learning and attention issues among individuals with eating and substance use issues, those professionals offer ongoing expertise and relationships with the youngsters that can be reinforcing. This is particularly critical given the school stressors that adolescents face and the disruptive realities of eating disorders — whether the uneven nature of recovery or time and location disruptions that often happen as part of treatment. Schoolwork and SATs march on as the focus for teen and parents must also remain on safe foods and skirt size.
Since any medical or behavioral matter impacts the entire family, it would be helpful to extend the reach of this method in helping other stakeholders such as siblings, grandparents and stakeholders. For better or worse, parents and professionals hold the responsibility for helping teens launch at the time when access and uncertainty often loom large. The approach that Crosbie and Sterling provide offers an interesting, straightforward perspective that could help families manage similar stages of recovery for other substances essential to life and from which we can not opt out. Might the FBT stage model be the belleweather parents facing newer millennial behavioral challenges facing screenagers, as well? #
Dr. Rebecca Mannis is a learning specialist and serves as the executive director at Ivy Prep Learning Center in NYC. She earned her B.A. in Psychology at Yeshiva University, her Ed.M. in Reading, Language, and Learning at Harvard, and her Ph.D. in Developmental Psychology with a Concentration in Neuroscience and Education at Teachers College.