An­nal­isa Bar­bieri

My niece, 10, eats very lit­tle and hides food. I’m wor­ried about her phys­i­cal and men­tal health

The Guardian - Family - - Family | Family Life - @An­nal­isaB

I am con­cerned about the eat­ing pat­terns of my nieces, who are five and 10. I have a close re­la­tion­ship with my brother and sis­ter-in-law, and spend a lot of time with them. Both girls have al­ways been ex­tremely picky about food, with tantrums at most meals. They reg­u­larly refuse to eat any­thing, and a “win” for their par­ents is if the girls eat more than a few fork­fuls of plain pasta or rice. The re­sponse has been to give up ar­gu­ing with them as it is too dis­tress­ing, and to agree to them eat­ing any­thing they want as long as some­thing is go­ing in. The re­sult is that their di­ets are very nar­row. It is not just the qual­ity of food that wor­ries me, but the amount – not much.

The five-year-old’s moods are very up and down, with a reg­u­lar pat­tern of tantrums and hy­per­ac­tiv­ity. How­ever, I am par­tic­u­larly con­cerned about the 10-year-old. She is quiet and with­drawn at meals and I have no­ticed she “hides” food, by mov­ing it around the plate or putting it on her sis­ter’s plate. I feel she has be­come adept at giv­ing the im­pres­sion of eat­ing with­out ac­tu­ally do­ing so. She seems ner­vous at the prospect of hav­ing to eat and cre­ates dis­trac­tions. My brother has dis­cov­ered that she has been throw­ing her school packed lunch away so that she “doesn’t get told off for not eat­ing it”.

The sit­u­a­tion came to a head for me on a re­cent hol­i­day, when on three con­sec­u­tive days she ate very lit­tle. She is very thin, con­stantly tired and with­drawn and picks up reg­u­lar colds, as well as reg­u­larly com­plain­ing of be­ing too cold even on warm days.

My sis­ter-in-law says she is not con­cerned as she her­self was very slim as a child. I know that many children can be dif­fi­cult and picky about food, and I am re­luc­tant to crit­i­cise any­one’s par­ent­ing, es­pe­cially as I don’t have children my­self. But I’m wor­ried.

I strug­gled with a com­plex re­la­tion­ship with food as a teenager, and am find­ing it hard to gauge whether I am pick­ing up on real prob­lems or pro­ject­ing my own ex­pe­ri­ences on to a sit­u­a­tion that is not ideal, but rel­a­tively nor­mal. Meal­times, if the whole fam­ily sits down, can be where fam­ily prob­lems are played out. If a per­son wants to make a state­ment they feel they can’t make any other way, re­fus­ing food is a very good way of do­ing it. Even though your longer let­ter was de­tailed, it was hard to see how per­ni­cious a prob­lem this re­ally is. It is as­tute of you to think your own his­tory may be colour­ing this; does your brother know about your com­plex re­la­tion­ship with food?

Ruth Glover, a child and ado­les­cent psy­chother­a­pist (childpsy­chother­, says: “It can be dis­tress­ing if children refuse food, as we can equate it with love. Food and eat­ing can be very emo­tion­ally and re­la­tion­ally charged.”

Glover also says that some­times “tak­ing in food, or not, can rep­re­sent how scared some­one is of tak­ing in other ex­pe­ri­ences in life”.

Both of us won­der what the wider pic­ture for your brother’s fam­ily is like, away from the din­ner ta­ble. Ob­vi­ously, you are wor­ried not only about the chil--

dren’s nu­tri­tional in­take, but also about them de­vel­op­ing an eat­ing dis­or­der and the el­dest’s be­hav­iour seems wor­ry­ing.

Although you say you are close to your brother and sis­ter-in-law, it wasn’t clear how much, or in what depth, you have spo­ken to them about this. Throw­ing lunch away is not that un­usual, but it war­rants look­ing at if it hap­pens of­ten, as does pre­tend­ing to eat when you haven’t. How do the children eat when they come to your house?

Glover says: “Some­times, tak­ing the pres­sure off from food can work. It may re­duce anx­i­ety by of­fer­ing a range of (rel­a­tively healthy) foods that ev­ery­one can help them­selves to.” This can give back an el­e­ment of con­trol where there may be the per­cep­tion of none. But this will take time, and pa­tience and won’t nec­es­sar­ily help if an eat­ing dis­or­der is al­ready tak­ing root.

Your brother and sis­ter-in-law do sound cu­ri­ously dis­en­gaged – and that may be the right ap­proach to a sit­u­a­tion I am not privy to. But it does jar slightly.

Of course, it could be that, be­cause of your own his­tory, you are look­ing for ev­i­dence that some­thing is wrong. Glover asks: “Who else is in the fam­ily – grand­par­ents etc – and are they con­cerned? What do they think?”

So, what to do? “Fac­ing the re­al­ity is dif­fi­cult,” ac­knowl­edges Glover, “but it should bring relief to ev­ery­one. You mak­ing con­tact is a pos­i­tive first step. Make it clear when you talk to your brother and sis­ter-in-law that you can see it is dif­fi­cult, but you re­ally want to sup­port them.”

She con­tin­ues: “The first step then would be for the par­ents to take the children – es­pe­cially the el­dest, given her symp­toms – to the GP to get checked out phys­i­cally as well as emo­tion­ally, to en­sure there is noth­ing or­ganic that is af­fect­ing why she can’t eat, to make sure she is grow­ing prop­erly, and to have her iron lev­els checked, etc. And for a pos­si­ble re­fer­ral to Camhs [child and adult men­tal health ser­vices].”

You could also try to ap­proach your niece your­self – with per­mis­sion from her par­ents – as you may have use­ful in­sight based on your own ex­pe­ri­ence. But you must be care­ful not to project, chas­tise or add more pres­sure – and lis­ten rather than talk.

Your prob­lems solved Con­tact An­nal­isa Bar­bieri, The Guardian, Kings Place, 90 York Way, Lon­don N1 9GU or email an­nal­isa. bar­ An­nal­isa re­grets she can­not en­ter into per­sonal cor­re­spon­dence

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