The sibling factor

“Eating disorders don’t just affect those they inhabit; they can have knock-on effects too. I wish just once I had been asked how I was finding everything and how I felt – it doesn’t sound like a lot, but as the ‘other child’, I know it could mean the world. “

Anonymous (From: Sibling Solidarity article, BEAT Eating Disorders website)

OJ and M, Manobier beach, Pembrokeshire Wales, August 2021

My partner and I recently accompanied OJ to an appointment with a paediatric psychologist. During one part of the meeting, our first with her, she asked OJ whether he had any brothers or sisters. OJ spoke enthusiastically about M and told the psychologist several funny anecdotes. There’s exactly two years between OJ and his brother M. The boys enjoy each other’s company and have always got on really well.

The effect of ARFID on OJ’s brother is something my partner and I have wondered and worried about over the years. More recently we have been discussing the impact and effects that OJ’s eating struggles may have had on him. Going forward I hope that M might be able to be part of clinical discussions, although I’m not sure where siblings come into things within the treatment process for eating disorders.

Unlike OJ, his older brother M has always loved his food and has always been interested in trying a wide variety of different things.  M enjoys trying foods from other cultures (we have an international family!) and he generally has a really healthy relationship with food, comfortable trying different things, able to make good choices, and knowing when he’s had enough. I can’t ever remember having to think much about the food when dropping him at a friend’s birthday party, or for overnight stays with relatives, or excursions and trips with his Scout group. It’s simply been a case of asking what’s on offer, and the response from M is usually ‘yum!’

M certainly gets his fair share of attention and time from us too. For example, he does a lot more clubs and activities than OJ, mainly because OJ is far less interested and willing to engage in clubs. Hence, OJ accompanies his brother to three or four clubs per week, bringing a book along, or helping me do the supermarket shop or run errands to fill the time. As a family we recently attended a Scouts awards evening where M received a certificate. With OJ’s eating issues taking up so much time and attention, I feel this sort of evens things out for M a bit more…

But how does M really feel about OJ’s eating issues? And how has it affected him over the years?

When it comes to food and mealtimes, with so much focus on OJ, there are ways in which it has affected his older brother that I wish I’d been more aware of from the beginning. Here they are:

Attention for him. In a 2019 article on the F.E.A.S.T website titled A Seat at the Table: Supporting Siblings of Eating Disorder Patients, psychologist Sarah Ravin observes that ‘When a child is ill with an eating disorder, the siblings often receive less attention from their parents… Parents often feel worried, stressed, and irritable, and these emotions can easily spill over into their relationships with their other children.’ For our family I think that statement is definitely true when it comes to mealtimes, or visits to cafes and social events that involve food. I think it is subtler than that though; for example, when planning holidays or outings, my partner and I will discuss and plan how to manage OJ’s eating needs, and it is no secret that this takes priority and has an impact on what we do and where we go. We often ask OJ what he’d like to eat, and we have to remember to allow M that opportunity too. Sharing choices and opportunities out fairly is difficult when one child’s needs so profoundly affect given situations. Does M feel that he has been treated differently or unfairly over the years? I suspect that in some ways he does. As a family we are beginning to speak more openly together about OJ’s eating, and strangely enough this has become easier to do since we have had the term ARFID to hang conversations off. Needless to say, it is often on OJ’s terms, and he is not always willing or ready to speak about it when the rest of us are. I am learning that some conversations need to be with, and solely for M.

His food repertoire. Our family’s eating habits have been significantly shaped by OJ’s eating issues. Slowly but surely over the years we have relied on a weekly menu that caters largely for OJ, while trying to balance this with meals that the rest of us enjoy and like to eat. We often prepare two different meals so that the rest of us don’t ‘miss out’ on variety. This comes with extra expense and extra time pressure, which in a busy working week isn’t always feasible. As a result, M has probably had less variety in his diet and less opportunity to explore and enjoy food that he otherwise might have. He was always adventurous with trying new foods as a toddler, and we feel that his interest in food and willingness to try new things has waned somewhat over the years. Or that we perhaps haven’t devoted the same energy and attention to it. We eat a lot of the same things week in, week out, and we do wonder what M’s diet might look like had ARFID not been a feature in our house for so long.

Impact on mealtimes. The stress and tension of OJs food meltdowns mean that mealtimes in our house have often been tense, explosive times. When I think back to the worst periods when OJ would scream and tantrum and refuse to eat or even to come to the table, I remember M sitting quietly at his seat at the table, often starting his meal before the rest of us. A sensitive child, he would sometimes burst into tears, upset by his brother’s distress and anger, and most likely sensing the tension, worry and stress in us, his parents. Sometimes disruption at mealtimes would have a knock-on effect to M’s schedule; difficulty in helping OJ to eat would often make us late to drop M at nursery, or to school, or to an event. One of the aims of OJ’s treatment at GOSH was to make mealtimes calmer for the whole family. On the whole it is a lot better these days, but it can still be difficult on the odd occasion when we make a meal that OJ doesn’t like, or when we are eating elsewhere.

In her book ARFID: A Guide for Parents and Carers, Rachel Bryant-Waugh looks at some of the wider consequences of having ARFID and says that,

‘A common issue described by parents is the effect of the behaviour on other children in the family. They may complain that it is unfair that their brother or sister always gets certain foods they would like, such as chips…’ (page 66)

Further on she observes that ‘it can feel difficult to justify why one child can have the same foods every day, some of which parents may limit for their other children… balancing being fair and making exceptions can be difficult’. (page 77)

Effects on social events. Family trips have often been ruined or negatively affected by ‘food meltdowns’. Many times, we’ve had to alter plans because of the need to cater for OJ, meaning that we perhaps might not have gone to a venue that M would have preferred, or for a meal that would have been M’s choice. In the same way that we have found it difficult to try and explain OJ’s eating issues to other adults, M has found it tricky to explain it to friends who visit. We’ve worked hard to ensure that OJ is equipped with ‘safe food’ on the occasions that M has friends round, precisely because we don’t want M to worry that OJ might have an outburst.

The importance of giving him a voice too. We are only just beginning to talk about ARFID more as a family. This has included asking M how he feels about mealtimes, and how he feels about OJ’s struggles with food. Taking part in two news articles about ARFID in the past year has been a catalyst for this. M expresses worry for his brother – concern for his health and also his personal happiness. Does he feel angry or jealous about all the time and attention taken up at mealtimes? Does he feel that expectations for him are different? I think it is really important to allow M the opportunity to talk about it all, and for us to listen to him! If I had my time over, I’d like to have given M that voice sooner.

I’m hoping that within whatever treatment plan OJ is offered going forward, there is scope and opportunity for M to be included. Regardless of whether or not this happens, it is clear to me that acknowledging his feelings and experiences is important. And as parents we will make it a priority.

Published by dancinglottie

Mum, ballet teacher, sports massage therapist. I love the great outdoors and wildlife. Dabble in local politics now and then. Worry about environmental issues quite a lot. Miss NZ every day, but love living in Hertfordshire.

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