Helping your Child

Behaviours 

• ▪ Increasingly restrictive eating pattern (e.g., adopting a new diet, progressively cutting out foods or food groups from their diet)
• ▪ Eating more than normal in frequency and quantity, even when not hungry
• ▪ Eating to the point of discomfort
• ▪ Avoiding foods based on their colour or texture
• ▪ Eating abnormally small spoonfuls at a time
• ▪ Disappearing to the bathroom after meals
• ▪ Eating alone or in secret, fear of eating with others
• ▪ When upset, food is one of the only things that comforts them
• ▪ Increased irritability/emotional dysregulation
• ▪ New or increased interest in grocery shopping, cooking for others, cooking or weight loss shows, diet books, etc.
• ▪ Highly intense and ritualistic exercise routines
• ▪ Opting for clothing that is either more concealing or revealing of their body shape or size
• ▪ Loss of interest in life, hobbies, friends, old favourite foods, etc.
  
  
  

Physical changes 

• ▪ Abnormal weight gain or loss
• ▪ Lack of growth in height
• ▪ Feeling cold all the time
• ▪ Frequent stomach aches or gastrointestinal issues
• ▪ Frequently fatigued
• ▪ Changes in sleep patterns (e.g. sleeping a lot more or less)
• ▪ Dizzy spells
• ▪ Brittle nails
• ▪ Constant dry mouth or bad breath
• ▪ Menstrual irregularities (e.g., loss of periods

• Fear: your child may be fearful of eating because they are afraid that it will lead to weight gain, or that eating certain foods will result in becoming ill, choking, or vomiting. They may be scared of losing control over what they eat, or being judged by you or their peers. They may not want to disclose that they are struggling because they may be afraid of burdening or upsetting you. However, they will likely be relieved that you are going to help them and that they will not be alone.
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• Anxiety: it is common for people with eating disorders to experience high levels of anxiety, not just around food, but in general. Depending on their eating disorder, they may find that restricting, exercising, and/or purging reduces their anxiety, or that eating is soothing. 
  
  
• Shame: your child may not welcome your concern when you first approach them, and may even react with anger or denial. Shame and ambivalence about the eating disorder and about recovery are common. Eating disorders are often stigmatized, which can influence your child’s behaviours. 
  
  
• Beliefs: your child may believe that their body is flawed, that this is connected to other problems in their life, and that controlling their body size or losing weight will solve those problems. They may have internalized societal messages that promote the belief that only certain types of bodies are beautiful and worthy. They may have misconceptions about food and different kinds of foods (e.g., fats/carbohydrates/sugars are bad) or about certain eating practices (e.g., that it is sensible to “trick” their body

Demonstrate empathy

• ▪ "I understand how upsetting this experience is for you.”
• ▪ “I can appreciate that you don’t want to talk about your difficulties, but I care about you too much to drop the subject. How can I make it easier for you to talk about what’s going on?”

Seek to understand

• ▪ “How would you describe what you’re going through?”

Assure your commitment

• ▪  “Recovery can be a long and tough process but I’m here for you every step of the way.”

Be clear and explicit

• ▪ “I’ve noticed you seem to be avoiding a lot of foods lately – even your favourite foods – and I’m concerned that you may not be eating enough for your body to work well and grow as it should. I would like for us to see a doctor together.”
• ▪ “You seem to be having trouble with knowing how much food is enough for you. I’ve noticed you sometimes eat hardly anything and other times you eat more than usual. You seem unhappy. I think we need some guidance

Because there is very little training about eating disorders in the medical curriculum, your family doctor or pediatrician may or may not have expertise in eating disorders. Parents are usually the first to notice changes in their children, so take confidence in your own knowledge of your child. 

Ask for an appointment that will give you adequate time to discuss your concerns. Be specific with the doctor about the changes you have noticed and ask to speak with them alone and together with your child (the doctor may also want to speak with your child alone). Tell the doctor why you think an eating disorder may be developing and that you understand that early identification is critical to recovery. 

If the doctor is familiar with eating disorders, they will take your concerns seriously and will check your child’s weight and height, and blood pressure and heart rate (lying and then standing). They might compare the current weight with earlier weights on a standard growth curve chart to see if your child is growing appropriately. They might ask your child about other issues like sleeping disturbances, stomach aches, friends, bullying, school work, self-harm, and so on. 

If your doctor does none of these things, you can respectfully ask: 

• ▪ “I’ve done some research and obtained some eating disorder assessment guidelines. Would you be willing to take a look at them?”
• ▪ “It may seem to you that I’m over-reacting, but I won’t be able to rest until I know that we’ve checked this out thoroughly. I believe there is some medical work to be done. When can we do this?”
• ▪ “We need a referral to a specialist with eating disorder experience. Who do you recommend?”
• ▪ “We need a referral to an eating disorders treatment program. I have the papers here and would like you to fill them out.” (Forms are usually available online or from the program’s intake office)

You can download NEDIC's Guide for Parents and Caregivers (PDF). A checklist (PDF) for discussions with your child's primary care provider is also available.  You may also wish to review NEDIC's Tips for Choosing a Provider (PDF). 

F.E.A.S.T. is an international non-profit organization of and for caregivers of loved ones suffering from eating disorders.  Their mission is to support caregivers by providing information and mutual support, promoting evidence-based treatment, and advocating for research and education to reduce the suffering associated with eating disorders. You can learn more on their website. 

Young adulthood is a unique phase in life, hallmarked by many transitions and a feeling of being ‘lost’ or ‘in-between.’ Young adults are no longer as reliant on family support and, at the same time, they’re not yet fully independent either!It is a time of amazing possibilities and growth, but this tension between support and independence while so much is changing can also make it a time of uncertainty and self-doubt. 

Typically, young adulthood spans from ages 17 to 27 but it can start earlier or end later depending on each person’s unique experiences.  The various transitions that tend to happen during this phase may include: 

• ▪ Finishing high school
• ▪ Transitioning from paediatric to adult models of health and mental health care
• ▪ Leaving home for the first time
• ▪ Beginning to pursue post-secondary education
• ▪ Experiencing varying degrees of financial (in)dependence
• ▪ Major changes in social support, friendships, and partnerships
• ▪ Exploration of identity and personal values
• ▪ Employment and career transitions
• ▪ Living independently, with roommates, and/or with partner(s)
• ▪ Partnership or marriage
• ▪ Parenting

1. Differences in mental health care systems

Systems of mental health care change based on chronological age from paediatric care (typically up to the age of 18) to adult care, and the changes can be dramatic. Some treatment programs are developing transition programs to ease the change between paediatric and adult models, but, for most, the transition between systems is sudden.

Paediatric systems often offer treatments that are family-based, where caregivers can support their child in treatment and can communicate directly with the treatment staff. Often, it is caregivers who are trained to provide meal support and coping strategies in times of distress.  In adult models of care, treatments are individual or group based, and the young adult is responsible for accepting treatment and communicating directly with staff. Unless the young adult gives consent for treatment to involve their caregivers, it is fully their own responsibility. 

This change in who is considered most responsible during treatment can be a hard transition for both the young adult and their family members, especially if the young adult is ambivalent about treatment or is still reliant on the support of caregivers.

Recommendations: 

• ▪ Communicate early and often about a transition plan to adult care. If possible, begin planning for transition at least a year before it happens.
• (See the handbook on transition from the CMHA)
• ▪ Experiment early and often with the young adult taking a leadership role in their care. This helps the young adult develop the skills and confidence needed in adult systems, and helps caregivers experiment with what it is like to take a step back. Opportunities to take a leadership role in care might include: making a phone call to book appointments, asking direct questions to health care providers, or advocating for a scheduling change.
• ▪ Write out a detailed plan that includes specific details about health history, treatment, and relapse prevention so that it is easier to communicate with new health care professionals.
• (See the transition planning checklists from the Sick Kids Good2Go Program)
  
  
  
  

2. Mental health during transitions

It is common to experience a recurrence or worsening of mental health struggles during times of stress and change.  Given that young adulthood is hallmarked by transitions (i.e. moving, going to a new school, career changes, dating, marriage, and financial strain), many young adults struggle. 

Recommendations: 

• ▪ Plan ahead! It’s great to expect for things to go well – Let’s call that Plan A.  It is also good to have a series of safety nets in place just in case. Let’s call these Plans B-Z.  Planning ahead for bumps in the road can feel like a step backwards, but it is actually an important part of learning how to take care of your health as an adult.
• ▪ Make sure you write these plans down in detail and share them. This way, if you need them, they are easy to access and follow-though.
• ▪ Consider details like where you would go to access help (family doctor, accessibility services on campus, etc.), a structured plan for sleep and nutrition, a list of coping skills and strategies you can rely on, and trusted friends and family who you can call.
• (See the workbook that gives an example of planning to go away to college or university)
• ▪ Practice good self care and self compassion. It’s easy to start making comparisons to others, beat ourselves up, or develop self-doubt during challenging times. Try instead to stay focused on the here and now so you can be effective.
• (See the  self-compassion exercises from Dr. Kristen Neff)

It’s important to remember that caregivers are experiencing these transitions, too.It can be its own challenge to navigate the change of being very involved during paediatric treatment, to having very little say in adult models of care.

Along with the suggestions above, also try to practice helpful communication strategies that support collaboration, openness, and compassion. 

• (See the handout on common do’s and don’ts of communication)

• ▪ CMHA Transition Resource: https://ontario.cmha.ca/documents/transitioning-from-youth-to-adult-mental-health-services/
  
  
• ▪ Good2Go Program Documents: http://www.sickkids.ca/patient-family-resources/resource-navigation-service/transitioning-to-adult-care/Transition-tools-and-resources/Index.html
  
  
• ▪ Self Compassion: https://self-compassion.org/category/exercises/#exercises
  
  
• ▪ The ABCs of Going to College: http://www.freemantherapy.ca/uploads/5/4/2/9/54291695/is_college_the_best_next_step__young_adult_.pdf
  
  
• ▪ Maudsley Caregiving Animal Analogies: https://thenewmaudsleyapproach.co.uk/pdfs/AnimalAnalogies.pdf
  
  
• ▪ Short term maintenance plans for recovery: https://www.credo-oxford.com/pdfs/T12.1_Short-term_maintenance_plan.pdf
  
  
• ▪ Long term maintenance plans for recovery: https://www.credo-oxford.com/pdfs/T12.2_Long-term_maintenance_plan.pdf
  
  
• ▪ Tips for choosing a provider: https://nedic.ca/download-file/1569597819.103362-145/