By: Ellen S. Rome, MD, MPH, FAAP
Holiday gatherings can be tough for kids and teens who struggle with eating disorders, body image or food-related anxiety. Big meals, family traditions and comments about weight can turn what should be a joyful time into a stressful one. Some young people worry about what or how much to eat, while others fear awkward conversations or judgment from relatives.
Here are some practical tips to help your child prepare for holiday meals, reduce stress and support healthy habits and self-esteem.
That relative who always comments on your child's weight
Talk with the relative before the event.
Have a frank discussion on how "weighty talk" can impact health and wellbeing. You can suggest conversation starters to engage your child 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?" Questions like these can spark lively discussion.
- "What is one thing your school does well, and how could you help build on that?" This keeps the conversation positive and focused on your child’s strengths.
Make a game of it.
If your family uses humor as a survival strategy, consider coming up with a game. Every time the relative says XYZ, then the adolescent earns $1, gets an extra hour of their favorite game or other tangible goal you can agree to. Use hand gestures or other subtle cues to keep score. Point out moments of kindness, or caring, or non-weight related positive moments, to place value and importance on those actions and behaviors.
Be mindful of your own weighty talk.
Parents often don't recognize their own role in weight-related talk. Comments like, "Do I look fat in this?" or "I ate so much at Aunt Betty's holiday party" can reinforce harmful attitudes. Instead, focus on positive, non-weight-related conversation and model healthy behaviors.
"What can I eat?"
Kids with restrictive eating disorders may worry about what they can eat. This type of disordered eating includes anorexia nervosa, atypical anorexia nervosa, or avoidant restrictive food intake disorder (ARFID). ARFID looks different from anorexia—it's not about body image or wanting to lose weight. Instead, kids with ARFID eat very little or stick to only a few foods.
Those with bulimia nervosa and binge-eating patterns also may share concerns about what to eat. Kids with bulimia or binge-eating disorder may also struggle with worries about food choices, but for different reasons.
If food binges are a risk
You and your child or teen can partner and go through the buffet line and then switch plates with each other. That way, you can keep their 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.
If purging is a risk
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 kids with ARFID
You 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.
Holding out for the holiday meal
Some teens may avoid eating all day to just get through the big holiday meal. But skipping meals can increase anxiety, trigger disordered eating behaviors and make it harder for them to enjoy the celebration. It can help to:
- Plan ahead so your teen eats balanced meals and snacks throughout the day—breakfast, lunch and a light snack—before the family gathering begins.
- Agree on a plan in case they don't eat enough during the event. This proactive approach helps maintain nutrition and supports a positive relationship with food, rather than having meal-related holidays be a source of stress.
"I don't want to go."
When a child does not want to attend a family get-together, probe gently for reasons why and problem-solve to come up with solutions. Are they being bullied by cousins? Molested by a relative or otherwise traumatized? Are they afraid of the foods served? For some kids with obsessive-compulsive disorder (OCD), they may be distressed by the prospect of germs or how foods are prepared.
Plan in advance to leave the party early if your child feels overwhelmed. You can even come up with a "safe word" or signal they can use to tell you they need a break. This gives your child control and helps avoid drama, shame, or guilt.
If your child is germ phobic, bring a meal from home with "safe" utensils.. 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.
Remember
Talk with your child’s pediatrician or dietitian for extra support. They can help you sort out food myths, ease fear and plan for tricky situations. Together, you can figure out which foods or settings might be stressful and come up with ways to make them easier. This can help your child slowly build confidence and feel more comfortable challenging situations around food.
More information
About Dr. Rome
 Ellen Rome, MD, MPH, FAAP, is Head of the Center for Adolescent Medicine at Cleveland Clinic Children's and is a Professor of Pediatrics at the Cleveland Clinic Lerner College of Medicine at Case. She is a board certified pediatrician who was also among the first in the U.S. to be board certified in Adolescent Medicine. Dr. Rome is a past president of both the North American Society for Pediatric and Adolescent Gynecology and its umbrella organization, the International Federation for Pediatric and Adolescent Gynecology. She has served on the Committee on Adolescence as well as the Committee on Nutrition for the AAP, has chaired the Subcommittee on Eating Disorders for the Society for Adolescent Health and Medicine, has chaired the Public Health and the Media Committees for the Academy for Eating Disorders (AED). She currently serves on the Medical Care Task Force for the AED and on the NASPAG and FIGIJ Advocacy Committees.
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