If your child or teen has anorexia, you want to find the most effective and healthy way to help them gain weight and reduce their symptoms. Many parents find themselves stuck in a hard spot. They believe their only option is to convince (often beg!) their child to eat. If that doesn’t work, they think the only other option is a residential treatment center.
Luckily, there is an evidence-based alternative that can help your child eat, gain weight, and get into recovery. With Family Based Treatment (FBT), parents facilitate weight gain and increase food flexibility. Above all, FBT doesn’t require that the child or teen be engaged in their own recovery. Parents take responsibility for treatment. Therefore, the child or teen does not have to agree that they want to recover for it to work.
In the first phase of FBT for a child or teen with anorexia, parents will:
- Take 24×7 responsibility for all feeding decisions, including what, when and how much to eat
- Prepare, serve, and supervise all meals
- Encourage eating despite resistance
- Respond with compassion and strength to stress and anxiety around eating, including food refusal, negotiating, anger, frustration, and violence
Learning how to do FBT for your child or teen who has anorexia usually requires professional support. After all, recovering from anorexia requires being encouraged and even pushed into discomfort. This is hard for most parents to do. That’s why support is so helpful. FBT lets parents take the lead on recovery. Parent coaching when you’re doing FBT for anorexia will give you the support and skills you need.
How do parents get kids and teens with anorexia to eat?
Getting a child or teen who has anorexia to eat is very difficult. Anorexia is “egosystonic.” This means that the person who has anorexia does not believe that anorexia is a problem or at odds with their best interests. For comparison, bulimia is “egodystonic” and typically involves feelings of shame about the behaviors.
In the first phase of FBT, parents take control of feeding. Over time there is a gradual reduction in supervision as your child gains weight. Getting a child or teen who has anorexia to eat involves the following key steps:
- Setting a firm feeding structure and expectations
- Supervising all meals and eating with the child or teen
- Staying calm and confident during meals
- Sitting close to the child or teen and encouraging and prompting eating
- Using distraction, validation, and other techniques to reduce stress
- Not negotiating about food and eating
- Implementing “life stops until you eat” consequences if a child or teen refuses to eat
FBT = weight gain
FBT is intense, especially in Phase 1. This is intentional, because as I said, it is designed to replace residential treatment, which facilitate weight gain. FBT understandably requires you to parent differently than you ever have before. Changing your own patterns is the key to success.
FBT does not treat the causes of the eating disorder. But weight gain will restore brain function, which is compromised when your child or teen is malnourished due to anorexia. When your child restores brain function with weight gain, they can make progress on other things like self-regulation, body image, self-worth, anxiety and depression.
Using FBT after residential treatment
FBT can be useful for parents whose child or teen is returning from residential treatment for anorexia. In these cases, the child or teen is already weight-restored. Therefore, parents can begin at Phase 2. They will establish a firm feeding structure and expectations. Weight will be monitored and food flexibility will be actively increased. Additionally, the parents will begin to work on emotional regulation skills and general mental health practices.
3 phases of FBT
FBT is administered in three phases. They are:
FBT Phase 1
Primary Goal: Weight Gain
Parents control all eating and feeding decisions, including what, when, and how much to eat. This stage typically lasts 3-5 months and should include steady weight gain. The child is weighed weekly and the weight gain chart is reviewed at the beginning of each session. Parents attend weekly meetings for guidance and support.
FBT Phase 2
Primary Goal: Eating Flexibility
Parents gradually return eating decisions to the child. For example, they may begin to prepare and eat lunch by themselves but continue being served and supervised at other meals. This stage typically lasts 3-4 months. The child is weighed and weight is reviewed every other week. Parents attend meetings every other week for guidance and support.
FBT Phase 3
Primary Goal: Mental Health
The focus shifts to maintenance and relapse-prevention. Parents may address things like family dynamics, emotional regulation, and other mental health and behavioral issues. This stage typically lasts 3-4 months. The child is weighed and weight is reviewed every month. Parents attend monthly meetings for guidance and support.
FBT Parent Coaching for Anorexia
Getting parent coaching can help you be more effective in doing FBT for your child or teen with anorexia. FBT is hard, and parents who get support, training, and skills are more effective and less burned out. If you’re interested in learning more, drop me a note:
I know this is a difficult time in your life. Facing anorexia is hard for everyone in the family. I’d be happy to support you.
Important note: Ginny is a parent coach, NOT a licensed therapist. She cannot diagnose or treat mental illness, addiction, eating disorders, etc.