1. Conflicts during meals
Dietary forcing and conflicts during meals for children suffering cystic fibrosis: The psychologist’s point of view
Pilar LEGER1, Anne LE RHUN2, Valérie DAVID3, Dominique CHEVALIER4
1 psychologist, CRCM Nantes, France, 2 MD Public Health, Nantes, France, 3 paediatrician, CRCM Nantes, France, 4nurse CRCM Nantes, France
INTRODUCTION
The psychological repercussions of dietary constraints :
For parents
> Shock experienced when CF is diagnosed,
narcissistic wound, anxiety for the child’s life
(focusing on the diet)
> Impact of the medicalization: Loss of confidence in their parental abilities.
Intrusion of the medical into the family privacy.
They become caregivers and monitoring ++
For the patients
> Alteration of the emotional attachment during meals
For the child
> Realization of being different and questioning
> Conflicting behaviors
For the teenager
> Feeling different from others, self-image, self-esteem (+ delayed puberty)
> Compliance problems: raids against the parents/separation attempts
OBJECTIVES:
With CF, a good nutritional state is linked to a good breathing condition. In our Center, the chid’s weight must be carefully monitored.
This might lead to dietary forcing behaviours from parents.
It creates conflicts during the meals, resulting in eating disorders ans insufficent weight gains.
How to avoid this vicious circle ?
When the children and their parents come to
the CF service,the children get weighed and measured
Dietary forcing
- Natural and logic desire to have their child eat well, and even better than others because he’s suffering from Cystic Fibrosis.
- For fear of seeing their child’s state of health getting worse.
- For fear of the gastrostomy with a feeling of failure and a growth of the feeling of guilt.
- For wanting to do things right.
- Emphasizing weight loss 
- Absence of proven positive result
Weight loss
Weight gain
Parents stress…
and children stress
Conflicts during meals
METHODS:
Collective therapeutic education sessions are offered to parents having children aged 3-4 and 7-8
During those sessions , in presence of the doctor and the nutritionist, the psychologist leads a short role play called « A meal at home with shredded carrot salad ». One parent is acting as the father, one as the mother, and a third as the child. Each of them has conscious goals and hidden needs.
TO BE READ TO EVERYBODY
Situation :
Sara, Elsa’s mother: you began to diner with your daughter, Elsa, 2 years and half and your husband. You have shredded carrots with love and presented them to begin the diner.
THIS IS JUST FOR YOU :
Your conscious goals :
- « I want Elsa to eat this shredded carrots »
-At the CF service , I’ve heard that Elsa need to eat a varieted diet.
Your hidden need :
- « You want to affirm your mother authority . It’s very hard this time because your daughter doesn’t obey very often, she is testing limits »
Elsa, 2 years and a half: You are at diner with your mother and your father. You hate shredded carrots and your mother always insists with carrots.
Your conscious goal :
«I refuse to eat this carrots and nobody will make me change my mind !»
- « You want to show to your mother that you’re not a baby and to affirm your personnality »
Julien, Elsa’s father : Your are at diner with your daughter and your wife. You dont’t like shredded carrots so much.
-« It’s no matter to eat carrots or whatever else. The most important is to share a pleasant moment with my family,”  
Your hidden nead :
- « For you, it’s important to avoid conflicts during the meals and you need peace and the end of the day »
« Who wants to eat carrots ? »
RESULTS
Within a few minutes, complex factors come forward: - the operating rules of the family - the emotional attachments and the « pacts » - the power and authority relationships - the conflicts between parents regarding the upbringing attitude towards the child
These role plays are source of enriching discussions between parents,
advice and decision making between them
Parents practicing dietary forcing realize how much their child suffers from
the situation and change their attitude
CONCLUSIONS:
Nutrition is not just about calories. It is a complex action linked to hunger, aspiration and pleasure.
Affective, emotional, social and cultural factors also must be considered.
Role plays promote the emergency of those factors and enable parents to find suitable solutions for their
family by themselves.
38th european cystic fibrosis conference,10-13 june Brussels