On television and in many people’s imagination, mealtimes are depicted as enjoyable moments of breaking bread with family and friends. This couldn’t be further from reality for families of children with pediatric feeding disorder (PFD) or avoidant/restrictive food intake disorder (ARFID).

Instead, mealtimes are recurring stressful flashpoints that can bleed into every other part of family life. Children with PFD or ARFID carry the weight of thousands of aversive eating experiences to the table. Parents and sibling bystanders feel much of that stress.

Nancy Zucker, PhD, has spent her career researching ways to support children with eating disorders and their families. One of her many goals is to help recondition families’ mealtime context. “One of the things that I try to do in interventions I develop is to make meals fun and relaxing,” she says.

That may sound fantastical to families facing feeding challenges, but Zucker has seen countless families get the support they need to make slow but meaningful progress toward a more positive mealtime culture at home.

She outlines in-depth tips in her book for parents, Off the C.U.F.F.: A Parent Skills Book for the Management of Disordered Eating, and shares some of that wisdom here.

Distinguish between family mealtime and therapy

Building a positive environment during mealtime takes time, especially after years of struggling. The key to starting is separating family mealtime from teaching moments of feeding therapy. Zucker calls feeding therapy activities “food adventures.” These are the times when the child focuses on feeding skills, such as trying new foods.

“There’s a whole toolbox of ways to get kids to try food adventures outside of the meals –– exercises to help them to be aware of their body, to recognize hunger and fullness, to understand their emotions and to build feeding skills,” says Zucker.

In contrast, meals should be a time to build a positive food culture and family bonding. This means offering incentives and removing friction to get your child to the table. “You want to get them to the table so they learn from the smells and sights of the other people’s foods. Whatever games and relaxing things get the child at the table are necessary,” she says.

For example, if bringing your child to the table is challenging, Zucker recommends allowing technology as a temporary tool. This can feel counterintuitive if your goal is family bonding, but it might be a necessary first step. “I have a hierarchy, so the child with an eating issue might initially need a screen if it helps them relax and causes less behavioral disruption,” she says.

Zucker also recommends the following:

• Focus on “safe foods” at meals: Start by serving foods your child is comfortable with at mealtimes, reserving exposure to new or challenging foods for “food adventures.”
• Use conversation starters and games: Light-hearted conversation cards or table games, like Chat Pack, can keep the atmosphere relaxed and even fun fun, regardless of what’s on the plate.

Collaborate on positive food incentives

Sticker charts are an obvious behavior incentive tool in most parents’ arsenal. Zucker uses an image of a mountain with milestones along the trail. This acknowledges that the goal is difficult, but your child can get there in incremental steps.

Zucker encourages parents to allow kids to design the mountain themselves, using different food adventure steps along the way. The child collaborates on the food and when they get stickers. “These kids are terrified, so they need to feel like they have agency in approaching fears in a way they can handle,” says Zucker.

Establish structure and routine to cultivate hunger cues

Setting specific eating times helps children with PFD and ARFID learn to recognize hunger and fullness cues, which can reduce friction at mealtime.

Zucker also recommends limiting mealtime duration. If meals extend too long, stress can build for the child with PFD or ARFID and the siblings. Set a reasonable time limit to keep meals more relaxed.

Zucker also says managing parent expectations at meals can reduce stress. “In the short term, your child might eat less at meals because you’re working toward more positive interactions, so you have to be willing to have the long view about that.”

Support siblings by balancing individual needs

It’s common for parents to fear that one child’s feeding challenges will negatively affect siblings’ eating, behavior or emotions. “Parents are terrified that siblings will learn poor eating habits than the child with a feeding disorder or with ARFID,” says Zucker.

At mealtime, when parents set different expectations for each child’s eating, Zucker recommends reminding siblings that each family member has individual goals to work on. One child’s goal might be trying new foods, while another’s goal could be making their bed every morning.

Zucker has also seen some siblings join in on their own “food adventure” mountain with their own goals and rewards around food exploration that help them grow their palate while empathizing with their sibling’s journey.

Parents also fear that their focus on the child with feeding challenges leaves less time for other siblings. The cultural term “glass child” was popularized by a 2010 TED Talk about siblings of children with special needs who feel invisible. Zucker reassures parents that it doesn’t take much time for a kid to feel seen. “Find little snippets where you can be completely locked in, focusing on your child,” she says.

Fill your own cup

Caring for a child with PFD or ARFID is taxing. Even taking a step like adding games at family meals can be overwhelming.” Zucker says prioritizing self-care by finding time alone to recharge and getting help from family or friends is foundational to building a positive mealtime culture. “You can’t do any of this with an empty tank. Take steps to recharge when you can and seek support that genuinely energizes you,” she says.

Most importantly, Zucker recommends parents remind themselves that whatever they are doing is good enough. “We can’t control other people’s behavior. We create the context that increases our kids’ likelihood of making certain choices. If the child cannot do their part, then we increase their support, but in the end, it’s up to the child to eat.”

By creating a positive food culture and restructuring the mealtime environment, families can help children with feeding disorders build a healthier, more sustainable relationship with food, one step at a time.

Nancy Zucker, PhD, is a child and family clinical psychologist and eating disorders specialist at Duke Health and a professor in psychiatry and behavioral sciences at Duke University School of Medicine.