Here we go into our season of Thanksgiving again. And we, at Kartini Clinic, give thanks for a lot of things: for the healing of our patients, for the continued evolution of  (more) affordable healthcare for families, for enough food to put on the table, for the health and safety of our loved ones. 

That’s the good side of Thanksgiving for us, but there is a challenging side as well.  Thanksgiving is not just about gratitude in this country.  Traditionally it has also been about food.  Is this a bad thing?  Emphatically not.  Food, the eating of it in a social setting, the preparation of it, the celebration of it, has been the glue of human societies everywhere for as long as there have been humans.  But for children with eating disorders, food celebrations offer special challenges which we as their providers and family members must meet with the only tools we have: preparedness, thoughtfulness and planning.

Children with anorexia nervosa, for example, cannot just suspend anxiety for a day and “eat normally”.  And those whose challenges include bingeing and/or purging behaviors cannot just “quit doing this” because it is a special day and Grandma’s coming over.

At Kartini Clinic we have our family therapists make a plan with each and every family here, one that reflects their traditions (where possible) but does not put our patients in an anxiety-provoking situation.  The Kartini Clinic meal plan perfectly fits a traditional Thanksgiving dinner (minus the pumpkin pie)—so where’s the potential problem?

Problems usually come in the form of comments by others, or of anxiety made worse by unpredictability.  Everything we know about these difficulties the kids have taught us, and for those you who do not have access to a Kartini Clinic family therapist to help guide you, here are some suggestions from the kids themselves over the years:
 

• please do not expose a very recently treated patient to a big gathering at Thanksgiving where all conversation will be about food: who is eating what, who is on a diet, who plans to binge on dessert, etc.
• clue trusted family members into the etiquette of not saying anything about your child’s food, whether it seems to be a lot or a little to them
• please do not allow conversations about weight, diets, your child’s treatment
• please ask close family members not to comment on your child’s appearance (how about they talk about what they are doing instead of how they look?  About their interests rather than their weight?)
• let your child know what will be served ahead of time so they can get comfortable with it
• set a time limit for participation and if it gets uncomfortable, leave.
• Make arrangements ahead of time with your child who purges, arrangements that ensure that they will not be left alone and unsupervised with this temptation

If these arrangements seem unrealistic to you, given the press of demands from many quarters, remember that Thanksgiving is just one day and 2017* is just one year and that this might very well be the year you just skip it.  Then, stay at home with your child, eat something they are comfortable with and…give thanks.

Originally posted 11/16/12 7:34 PM.