By Ellen S. Rome, MD, MPH
Holidays can be exceptionally stressful for children, adolescents, parents and families who have food or body concerns. Pediatricians are in a prime position to anticipate potentially stressful food-related situations and provide guidance and support to navigate holiday gatherings. Sometimes a child is worried about what or how much to eat. Others dread a confrontation with that relative who always comments on your child’s weight or engages in other fat-shaming behaviors.
Pediatricians can help families anticipate these challenges and partner in problem-solving in advance.
Here are some common concerns and strategies that can help families prepare for holiday meals.
That Relative who Always Comments on Your Child's Weight
- Perhaps mom or dad can call the relative before the event and have a frank discussion on how "weighty talk" can have impact on health and wellbeing. They can suggest conversation starters to engage the young person in more positive dialogue. Some examples: "Tell me more about your recent play/activity or sporting event.” Or, “What is one thing at school that you would fix, and how?" That question can spark lively discussion. To ask in a strength-based framework, the prompt could be, “What is one thing that your school does well? How can you help school build on that?”
- If the family uses humor as a survival strategy, you can help the young person and parent come up with a game, so that every time the relative says XYZ, then the adolescent earns $1, or gets an extra hour of their favorite game, or other tangible goal that the parent can agree to. Parents and kids can use hand gestures to keep score, or other subtle measurement strategy.
- Parents often don't recognize their own role in weight-related talk, such as, "Do I look fat in this?” or “I ate so much at Aunt Betty's holiday part," or, "Oh, this food is so unhealthy, I'm just going to eat a salad. Helping the parent eliminate their own weighty-talk can be a big family win.
What Can I Eat?
Those with restrictive eating disorders may worry about what they can eat. These include individuals with anorexia nervosa, atypical anorexia nervosa, or avoidant restrictive food intake disorder (ARFID). ARFID is characterized by limited food intake and a narrow variety of foods eaten that isn’t caused by a negative self-image or a desire to change body weight. Individuals with bulimia nervosa and binge-eating patterns also may share concerns about what to eat.
- If binges are a risk, a teen and parent can partner and go through the buffet line and then switch plates with each other, so that the parent is keeping the child or adolescent's portions appropriate. Each person would agree to be "nice," and not load the other with foods that the other actively dislikes. For instance, if the young person never eats mashed potatoes and that is a fear food, this would be the wrong venue to challenge them with mashed potatoes.
- For youth who purge, make sure they go to the bathroom before the meal and not for an hour after to help break the cycle of vomiting. Perhaps that means planning family games for an hour after meals.
- For youth with avoidant restrictive food intake disorder, the parent can help get the safer foods on the plate in the right proportions. Planning a reward system for meal success also can make a difference. Parents can also anticipate which meals and settings are truly challenging for their child and bring a substitute safe meal for the child to consume while at a holiday feast.
- Devise a game to keep score on weight-related talk with an appropriate non-food reward. And then follow through with the reward. Point out moments of kindness, or caring, or non-weight related positive moments, to place value and importance on those actions and behaviors.
Holding Out for the Holiday Meal
Another scenario might be an adolescent who tries to avoid eating all day to just get through the one holiday meal.
- Parents, caregivers and pediatricians can help their teen plan ahead so that they eat an adequate breakfast, lunch, snacks and meals before the family celebration begins. In this case, a family develops a contingency plan on what to do if the teen does not consumer enough food during the family party.
“I Don’t Want to Go”
When a child does not want to attend a family get-together, probe gently to elicit the reasons why, and problem-solve to create viable solutions. Is the young person bullied by cousins? Molested by a relative or otherwise traumatized? Are they afraid of the foods served? For some with obsessive compulsive disorder (OCD), they may be distressed by the prospect of germs or how foods are prepared.
- Parents can plan in advance to leave the party early, recognizing and responding to a young person's stress level in the moment. In this way, they plan that part of a health journey together without inciting extra drama or shame or guilt. Parents and youth can create a safe word to enact the “Get Me Out of Here” response.
- Parents can also bring a meal from home, with “safe” utensils, for the child who is particularly germ phobic. Exposure therapy at restaurants or family events can also be used, with guidance from a therapist skilled in ARFID, to get over food fears that may escalate in holiday situations.
Pediatricians and dietitians can partner with patients and families to address food myths and fears; anticipate what foods or situations are challenging and see if the parent or caregiver can help address that stress and increase tolerance of a fear or challenge situation. They can also help the young person find the positives by complimenting them for non-food related reasons, such as an act of kindness to a younger sibling. A strength-based approach builds self-esteem and skills, aiming for the positives rather than merely avoiding the negatives.
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