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rolphdog

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Reply with quote  #1 

Hi,

I'm a Dad of a 10yo D who was diagnosed with Anorexia Nervosa last Monday 27 Feb (though we've been very concerned during January and went to the GP on 9th of Feb) and tomorrow will start the first session of Family Based Treatment at the London South West & St George Children and Young Person’s community eating disorders service. She was seen by the paediatrician on Wednesday who said she's medically stable, so able to be home with us (though the care plan we're on means she's off school until she gets back from 75% Weight for Height to 85% W4H). Our D initially said that she didn't have a problem, that she was eating fine, but she seems very slowly to be coming around to the idea that there's an issue.

After lots of books and internet searches we introduced a magic plate style, 3 meals / 2 snacks meal plan in mid-Feb, with a focus on refeeding, which highlighted the problem. Since last Tuesday our D has refused to eat any solid food outside of Dinner (and even then she seems to have a rule of not eating more than 2/3 of the solid food), so she's drinking full fat milk and fruit juice at breakfast and lunch, rejecting the afternoon home made banana milkshake snack (she keeps it until dinner time).

My wife and I are finding it very hard work. We've read Eva Musby's book and watched lots of videos, about creating a soothing environment and realising how anxious our D is likely be feeling, but haven't yet found any technique that has lead to our daughter eating more than she decides to.

We are all eating as a family (with D's 12 yo sister as well) for breakfast and dinner, as well as weekend lunches, and focus on creating a calm, caring and consistent approach. However, we seem to get stuck after 30 - 40 minutes of refusal into a (so far) unproductive "We care about you, you need to eat what's in front of you, the food is your medicine, pick up your fork and start" set of requests that aren't getting us anywhere. She often ends up shouting at us to stop, and recently has started sitting there with her arms crossed and eyes shut, refusing to eat any solids, or drink anything at snack time. She says that she has her own private reasons for not eating, but she wont tell us what they are - which I mainly put down to the semi-starved state her body and mind are in, and am aware that the first goal is just to get her refeeding.

I'm able to be calm for the majority of time, but find it upsetting and can sometimes get angry (at the illness, not my daughter, and in general away from the table). I'm noticing that a lot of it is fear on my part - being afraid that I or my wife aren't doing the correct thing, and that this means our D isn't eating, and then catastrophising that the only way forward is a 10 day in-patient visit (the treatment team have said this might be necessary if she's not increasing her weight each week). It's been helpful to read the stories here and see that for some sufferers, this step can be necessary and helpful and that it's not that we've failed as parents (I like the reframe that we've done great to help her stay alive this long).

We're trying hard not to use negative punishments ("if you don't eat then we won't have friends around") and to recognise that it's not her wilfully being difficult (so, if at the end of a long meal she hasn't eaten it's not helpful to blame her for not deciding to eat) but this is a struggle. The treatment team have said to exude confidence, and "fake it until you make it" but I'm finding that hard when she's not increasing the amounts she's eating, and particularly with her not eating any solids until dinner.

I was wondering if any others here could share their experiences (or point to useful posts) on helping get the refeeding process going with a young sufferer or anorexia who's refusing to eat solids for most meals and doesn't see that they've got a problem?


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10yo D diagnosed Mon 27 Feb 2017, now refeeding
iHateED

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Reply with quote  #2 
Welcome to the group, Rolphdog, though so sorry that you need to be here with us.  You will find so much valuable information on this forum so read around as much as you can.  But first, wow! just wow! you have done such an amazing job in such a short period of time.  Everything you say and have done in your first few weeks took me (any many others on here) months to figure out!  So pat yourself on the back for understanding this illness already.  You already know more than many professionals about how this illness works! 

As far as getting your D to eat, have you tried a boost drink or ensure?  Many people put a time limit on eating the meal or snack and then if it's not eaten in the required time, they take the food away and give the supplement drink.  It doesn't taste that good so it may be an incentive to eat the better tasting food.   SO SO Great that you have started with a milkshake so early in refeeding.  These will become your best weapon to fight this illness so don't stop offering them daily (even if she isn't drinking them yet).  You can up the calorie count in a milkshake without making it much bigger in volume.  Add heavy whipping cream and canola oil (I think it's called rapeseed oil in the UK) into the to the blender.  Just as important as calorie count each day, is the number of fats in her daily diet.  In my opinion, Fats are the key to brain healing!

Really great also that you know about reframing your thinking -- this took me quite a while!  And that negative punishments don't work well.  So what might work?  Are there any activities that your D likes to do that you could use to encourage eating?  If she has a laptop or ipad, you could take it away and frame it as a positive outcome -- "you can have your XXXX back when you have finished your lunch but eating is more important right now"   Try not to get into to much discussion about the illness or why she won't eat.  She probably doesn't know.   What other things can you use as a positive outcome?  Craft activities, watching a movie on TV, a back scratch (my D loved them), walk the dog -- anything she likes?  Is there any toy or game that she wants to buy?  Some of the best centers say it's ok to offer a monetary amount for each meal and snack eaten.   You just need to find an incentive that can be stronger than the ED hold.  It won't be easy and it won't happen all at once, but keep at it and over time it gets easier and the meals don't take as long.

Hang in there - you are doing a great job. 
rolphdog

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Reply with quote  #3 
Hi iHateED, thanks for your detailed and quick reply. It's very comforting to know that we're on the right track and that others have experienced the challenges too.

I'll chat with the treatment team tomorrow about a boost drink or ensure. Thanks for the encouragement about the milkshakes - I've been using this forum to research recipes, and my wife found almond butter recently and has been adding that. I'll focus more on the fats too (we've already switched from semi-skimmed to full-fat milk).

Good tips too on the searching for incentives for eating. A couple of weeks ago she did eat her breakfast because she wanted to go to school, so I've definitely seen that when she really wants something she'll eat (she even told me that "I'm going to eat even though it's hard because I want to go to school"). I'll talk more with my wife about other options (including financial rewards)

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10yo D diagnosed Mon 27 Feb 2017, now refeeding
Foodsupport_AUS

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Reply with quote  #4 
Welcome to the forum. Sorry that you have needed to find us. 

It sounds like you have already got yourself some help on the ground and you have some back up. Getting someone with anorexia to eat is hard, and if you are going to succeed at home, only you can do it. 

Working on what she finds easy is often a good way to start, so long as you can boost it up. Milk is a great food for re-feeding as it has plenty of phosphorous in it too (some with anorexia are deficient). Offering rewards immediately after did seem to be helpful for my D, but they needed not to seem to be something she felt she didn't deserve. 
Examples include, playing a game, watching a favourite movie, going out somewhere, and yes, going to school. The reward needed to be immediate, so no good when you have done  this we can do X tomorrow. 

It looks as though you have been doing some research. Have you found our young person's thread?

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D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
Ping_Pong

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Reply with quote  #5 
It's hard, so hard, Rolphdog, and I'm sorry you find yourself here. I too am impressed with how you and Mrs Rolphdog have got yourselves up to speed with all this. I feel it took me ages to get to that level of understanding.

The incentives are the things that turned everything round for our daughter. She didn't want to miss out, and as she gained weight and was allowed to take up her activities again, inc school, things improved pretty quickly. We always tried to make sure we had the next thing lined up for her to look forward to.

We tried to make meals look manageable, so didn't pile the plate too high. We did, though, add cream, butter, etc where we could. Thankfully, she never lost the taste for mashed potato! She was on Ensures for a while - drinking them chilled seems to make them less sickly. Would your D entertain smoothies? We keep a bag of frozen fruit in the freezer and whizz some up with a banana, loads of creme fraiche/ice cream and orange juice, and that's usually been well-received.

Also agree with the other advice given about not entering into the whys and wherefores of if all with your D. They're not really able to rationalise it all at this stage, but it looks as if you've worked that one out. Our consultant told us not to blame ourselves and to direct our energies into treating our D. Being released of the blame was really important to us and allowed us to focus on getting her better. With food. Lots of it.

How supportive is the school? Ours is fab. We had work sent home, and then a phased return (core subjects first, and then the rest). I was also signed off by the GP for the initial few weeks, which allowed me to focus fully on meal prep, support, post meal supervision, ready to start the cycle again, not to mention appointments with her treatment team. We found that my husband (shift worker, so around quit a bit during the working week) and I taking it in turns to do meals didn't really work. We never got a chance to handover/'debrief' as we went along. I also keep a journal, which I find useful to track how far we've come. I referred back to it quite a bit during a recent relapse to remind us what worked before.

Your D is lucky to have you and your wife on her team! It sounds like you've gripped it really well so far. It looks (I hope!) as if your treatment team are on the ball as well. Keep coming back to the forum for answers to any questions and for virtual hugs.

Chinstrap.
Torie

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Reply with quote  #6 
Quote:
Originally Posted by rolphdog
I'll chat with the treatment team tomorrow about a boost drink or ensure.


I think it's called Fortisip in the UK.

Quote:
Originally Posted by rolphdog
Thanks for the encouragement about the milkshakes - I've been using this forum to research recipes, and my wife found almond butter recently and has been adding that. I'll focus more on the fats too (we've already switched from semi-skimmed to full-fat milk).


Good job.  I was surprised to learn how much more caloric the premium ice creams are - in the beginning, I spent ages in the grocery store looking at all the labels to find the items with higher calories.  It's amazing what a difference it makes to buy full fat yogurt and cheese, calorie-dense bread, etc.

Quote:
Originally Posted by rolphdog
A couple of weeks ago she did eat her breakfast because she wanted to go to school, so I've definitely seen that when she really wants something she'll eat (she even told me that "I'm going to eat even though it's hard because I want to go to school"). I'll talk more with my wife about other options (including financial rewards)


School was a good motivator for my d, too.  I wonder if your team might permit her to attend school even though she is still 75% if that would result in her getting more nutrition due to the positive motivation?  Of course, her lunch would need to be supervised (preferably by a parent), with, again, the condition that she can return to class as soon as she has finished her meal.

Keep up the good work!  You're off to a great start! 

-Torie

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meadow

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Reply with quote  #7 
Hi, welcome to the forum but of course it's sad that you need to be here.

Our D is 8 and was diagnosed in November, and I can relate to a lot of what you've said.  Our D didn't accept at all that there was a problem for quite some time and had very little (if any) intrinsic motivation for change. 

It sounds as though you are doing an amazing job.  Everyone's different and for us sitting at the table as a family was the least calming way to get D to eat, so we let her sit at the sofa watching TV.  Occasionally we used the consequence of turning off the TV if we really had exhausted every other option for getting her to eat, but generally it was a useful distraction.

A lot of people here have successfully used a time limit and then given a supplement drink (yes it's Fortisip in the UK and it's on prescription).  For us, getting D to drink Fortisip was just as hard.  We didn't use a time limit but just carried on until D ate.  This could take up to 2.5 hours and was absolutely hideous, with a lot of physical aggression.  However, in the end, the ED did eventually give in and she ate what was required. This meant we had some late nights, and for a couple of weeks it seemed that all we did was get her to eat, because by the time one meal had finished it was just about snack time.  It was dreadful, but it was worth it to hit the ED hard at the start. 

We added calories to everything we could - double cream into her milk etc. Our D had an extremely restricted range of foods so it was hard, but we shopped around to find the highest-calorie everything, and as people on this site said, every calorie counts.  I personally wouldn't worry too much about the fact that she's hardly eating any solid food for now, and focus your energies into getting fats and calories in.  She will ease up on the rules and rigidity as she gets better. 

With the younger kids the thought processes can be very different to what you typically find with adolescents and adults. We've been seen in outpatients at Great Ormond St and they told us that often the young children are never able to articulate what's been going on in their minds.

I really feel for you - it's a terrible illness and an exhausting and painful thing to go through.  How is your other D managing?  We arranged lots of play dates for our other D (who is much younger).

You will manage this.  We are three months down the line and we have got our old D back.  Still a long way to go, but we're over the worst. 

Keep us posted and you're doing great.  
meadow

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Reply with quote  #8 
P.s. I've had so much great advice from this forum so you can look up my posts - they're all relatively recent.  Mamabear and Yoghurt Parfait have also had children diagnosed young and there's a wealth of info in their posts as well.
mjkz

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Reply with quote  #9 
I don't have much to add to all the awesome advice you have gotten.  My daughter started under the age of 10 so I can truly appreciate how difficult this is for you and your family.  Welcome and keep coming back.
Mamaroo

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Reply with quote  #10 
Hi Rolphdog, sorry to hear about your D. Mine was 9.5 when she first restricted and spend her 10th birthday at the hospital. She was refed mainly on Ensures. We started slowly with one ensure a day, increasing the amount until we reached 6 a day. Then we added snacks, one at a time until 3 was added. Then the hard work started, replacing the ensures with food. First lunch, then breakfast and so on.

During the ensure phase we still gave her proper breakfast, lunch and dinners. She just tasted them for 15 mins or so. Then I would take it away and give the ensure. This sounds pointless, but was crucial to keep her exposed to real food, since she was able to replace the ensures more easily with the tasting foods. So it was easier for her to eat meat again than fruit (which I never gave her to taste, because there is only so much I can feed the dogs or throw away).

We used incentives a lot. She didn't have an ipad, but could play games on mine when a meal was finished. Then she discovered games that needed real money to play with, so she ate for iTunes cards. I decided to place a monetary value on each day she completed her mealplan. Initially I rewarded her if she just ate more than the previous day. The only punishment was the lost of ipad playtime when a meal was not finished. The rest of the time we organised playdates as soon she was eating enough not to loose weight (at around 6 ensures a day).

After refeeding for 9 months like this, she was well into the habit of eating and I told her no more insentives and that she would instead get pocket money like her sister. She was fine with that and now would est without too much fuss.

I agree with ihateEd, fats are really good. I give my D an omega 3 oil capsule every day, the biggest one I could find, 1.5 gram. As well as fat, I found protein to be very important as well. I make sure she has protein at every snack and mealtime. I am currently reading Julia Ross' The Mood Cure' about how certain foods can influence your mood. Very good read.

Finally this is a marathon not a sprint. Take time to look after yourself and the mrs and any other siblings. My H used the take our other daughter to the movies or just for lunch every Sunday and I would take her to the shops one day after school. We also made a deal not to talk about ED in the evenings. Initially I found it very hard not to talk about ED, but it forced me to think about other, more pleasant things.
Best of luck!

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D became obsessed with exercise at age 9. Started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for a year and WR at age 11. Challenging fear foods now.
Playball40

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Reply with quote  #11 
My daughter had just passed her 11th birthday when she was hospitalized but had truly been restricting since the age of 6.  It became critical at 10 and she almost had a heart attack riding her bike (of course I didn't know this at the time).  The hospital mostly re-fed her on Ensure and Boost Plus.  When she wouldn't drink them, they gave her an NG tube.  Although it was only for about 6 hours, it was enough to get her to drink the Boost Plus (to this day, she still hates them and I have a hard time still, including them in her meals). 

So glad to hear you have good solid information and are moving on this so quickly.  I wasted a good 7 months until we found this site, and a PHP before she really started to move in the right direction.  She is 13 now and still re-feeding (she is at a safe weight, but not 'weight restored' or what I consider a healthy weight for her - but we keep plugging at it).  She is MUCH better at eating now and eats a variety of solid foods.

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rolphdog

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Reply with quote  #12 

Thanks to everyone who's replied Foodsupport_AUS, chinstrap, Torie, meadow, mjkz, mamaroo and playball40 - it's amazingly comforting to know that we're not alone.

We just came back from the first Family Based Treatment session with the whole family and the consultant psychiatrist at Springfield hospital. D had put on 0.25kg over the week (but her blood pressure, as judged by the sit up (?) test has dropped by 10 - not sure what the units are) and is still adamantly refusing solids or any food or drink at snack time (at lunch today she sat for 55 minutes at the table with her eyes shut to avoid having to look at her smoothie or us).

The psychiatrist told D she needs to start eating all of what we give her at afternoon snack, evening meal and night time snack, and that if the psychiatrist phones us tomorrow and finds this hasn't happened, D will be going to hospital before the weekend. D looked devastated, frozen, angry and sad and is now howling. I think this is the first time it's hit home to D how serious a situation this is.

Fast forward to now (end of the day) and she didn't finish her afternoon snack (she saved it and finished it for dinner), or dinner (she left 1/3 on her plate) and night time snack (she drank 1/2 her milk) so I think tomorrow will mean the psychiatrist will be working with the paediatrician to organise a hospital stay starting before the weekend. Now to research how to provide the best help when our D is in hospital ...

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10yo D diagnosed Mon 27 Feb 2017, now refeeding
meadow

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Reply with quote  #13 
Hi Rolphdog,

Oh I'm so sorry to hear that. 0.25kg is actually an achievement given the circumstances, but she is very ill and hospital is not in any way a failure. My D only just avoided it (at a considerably higher weight-for-height than yours). Is it likely to be somewhere close to you?

I remember asking for opinions here about hospital admission for little ones and being generally very reassured by other people's experience.

Thinking of you and your family.
Torie

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Reply with quote  #14 
Quote:
Originally Posted by rolphdog
D looked devastated, frozen, angry and sad and is now howling. I think this is the first time it's hit home to D how serious a situation this is.


Maybe.

It's kind of a double whammy - your real d is surely aghast at the idea of leaving home for hospital, AND, the disordered part of her is reeling with the realization that the eating disorder (ED) has more than met its match.  Unfortunately, it's very standard for them to freak out when it becomes apparent that full nutrition is going to happen, whether at home or elsewhere.  

But it's entirely possible that your d will maintain that she is fine, she isn't ill, everyone is overreacting about, well, nothing really.  Just crazy how their brains are hijacked by this vile illness.

In the end, though, it doesn't matter what she thinks.  It just matters that she eats.

Stay strong.  It really does get better.  (But it might get worse first.) 

-Torie





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Foodsupport_AUS

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Reply with quote  #15 
Sorry that it looks as though she may need admission. In some ways it is easier that she has struggled afterwards, rather than pushing her self to eat while there is an immediate risk of admission but finding herself unable to follow through two days later. (A common ED ploy). It is great that you seem to be getting good support. If she does go in, it is not because you didn't try hard enough, rather her illness at the moment is too strong for feeding at home (more tools needed).
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D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
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Reply with quote  #16 
Rolphdog, it was different for us, but I want you to know that d's stay in hospital was the turning point in her treatment. We really needed that to get us going.

You're doing great. Just keep going.

xoOTM

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D in and out of EDNOS since age 8. dx RAN 2013. WR Aug '14. Graduated FBT June 2015 at 18 yrs old. [thumb]
rolphdog

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Reply with quote  #17 

@torie - thanks for the reminder not to get too bogged down in what she's thinking right now. As you say "it doesn't matter what she thinks.  It just matters that she eats."

@Foodsupport_AUS - you're right - it's probably better that we saw how strong the ED was right away, rather than her struggling to eat but without the ability to carry it on for days at home.

D was calm all morning, but still refused to eat solids at breakfast. 

We took her into A&E at St George's Hospital at requested by the psychiatrist today. 

The team there were great (particularly a woman who worked with D on her fear of having blood tests, by doing a dry run of the procedure slowly so that D could understand what was going to happen, why and test for herself that the anasthetic cream would work).

I had to leave Mrs Rolphdog with D. We're both feeling pleased D is getting the help she needs right now to fight the ED and are proud of the efforts we've put in to date.

Mrs Rolphdog tells me that she's done the same "start eating dinner, then stall" we've seen for the last 10 days at home, but will have to drink whatever calories she fails to eat.

Thanks again for this forum - it's such a solace to be able to share my experience and receive encouragement, support and suggestions from people that have experienced similar situations.


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10yo D diagnosed Mon 27 Feb 2017, now refeeding
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Reply with quote  #18 
Welcome Rolphdog, and greetings to Mrs Rolphdog too.

You've got some good advice here and it sounds as if your team are supportive and have the resources needed to help you. It's sad that your d needs to be in hospital at the moment but she does and I hope that the time she spends there will help to challenge her Eating Disorder and provide you both, and your older d, with just a little bit of respite time to rest and take care of yourselves.

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Reply with quote  #19 
Rolphdog and Mrs. Rolphdog, I'm so glad you have a team who is on the ball and willing to do whatever is needed to help your daughter. Take the time she is inpatient to recharge your own batteries.  She is in a safe place and will be getting nutrition no matter what which is THE most important thing at this point.  Regroup and get ready for when she comes home because she will still need a lot of support. 
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Reply with quote  #20 
Hi Rophdog. I  can also say that agreeing to IP admission for our D was the best (though hardest) decision we ever made.  Once we got over our sadness and guilt that she'd been hospitalised, we learnt to make the most of the respite from the relentless illness, and 3 months later she was discharged in a far better place than she could possibly have been if we'd have kept her at home.   Best of luck
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Reply with quote  #21 
Rophdog - I know how hard this is for you...it was similar for my daughter but it was her pediatrician, not a psychiatrist.  We had to go straight from pediatrician to pediatric emergency room and my daughter (all 54 lbs of her) cried the whole way.  She looked so tiny, helpless and defeated with the NG tube up her nose and the sorrow I felt was unimaginable.  But, like so many have said it was the catalyst that started our journey to healing.  After the hospital we tried re-feeding at home but weren't making the progress we needed.  5 months later she entered a PHP program that REALLY taught us so much and completely kicked her weight gain into gear.  Since then, it's been slow and steady...some setbacks but nothing like it was that December in 2014.  We are not weight restored but we are almost at 100 lbs now and 5'.05" from 54lbs 4'9".

Hang in there my friend.  Thinking of your family and your baby.

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rolphdog

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Reply with quote  #22 

@mkjz - yes, the team have been great, and we are relieved to be able to recharge our batteries a bit (we luxuriated and slept in through what's become a standard family breakfast at 7:30a,)

@hertsmum - great to hear about the benefits that hospitalisation brought in your scenario.

@playball40 - thanks for sharing your experience, and also reminding me that there can be steps forward and 'backward'

We spent most of the day at IP with D, and overall it was very positive.

She is still refusing solids (bar a forkful of chicken at lunch) but has (so far, often just at the last moment) replaced all uneaten food calories with fortisip drinks. The staff were very supportive and willing to let us run the feeding session and to be there as backups or for handovers when we needed it.

She was distraught about having had so many calories today, and for the first time I heard her mention weight, saying "I'm so fat, you're making me fat". This was interesting, as we originally found it hard to see D had an ED because prior to today she never mentioned weight or body image concerns, so her AN didn't fit our stereotype, or the NICE definition of AN an illness that "is caused by an anxiety about body shape and weight that originates from a fear of being fat or from wanting to be thin"

Some things I noticed that were helpful in terms of demonstrating improvements we could make at home:

  • The staff were very calm and patient, which was great to see modelled.
  • The use of time limits (30 mins for main meals, 20 for snacks) with the consequence that anything not eaten had to be drunk via fortisip (within 15 mins) or else a tube would need to be fitted (which wasn't quite true; the tube comes in if there is no calorie intake for 24 hours) seemed to be a major motivator for D. Other than "you'll have to go back to hospital" I'm not sure how we could replicate this at home.
  • One of the nurses was firm but didn't spend any time addressing D when she was sobbing into her bed pillow, instead she just set the timer and spoke with us about a range of general topics. It was useful to help us think about whether our engagement with D when she's distraught is useful or not.
Tomorrow MrsRD and I are going to split the meals (me on breakfast and dinner, her on snacks/lunch/snack with a cross-over for dinner) at the IP unit. She's also going to come home for some of Saturday, and then longer on Sunday, which will be interesting.

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10yo D diagnosed Mon 27 Feb 2017, now refeeding
mjkz

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Reply with quote  #23 
I've found when my daughter is sobbing and distraught, nothing really is going in or out (in her head).  I do something similar as the nurse because nothing I say or do is going to relieve that distress.  All I can do is ignore it and address things when she calms down.
Blommie

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Reply with quote  #24 
It is so hard... seeing our beautiful child is so much distress is heart breaking and our natural response is to want to comfort and talk it through. But we found with our d that this just fed into the anxiety and made it worse. We would acknowledge her feelings, tell her we loved her and then stayed physically close to her (could not touch her or get too close as she hated touch when very ill) and then once she calmed enough we would try distraction- funny you tube videos, tv program, puzzles...anything we could think of.
This illness is very counter intuitive!

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D officially diagnosed April 2014 at age 13 after being hospitalised on a medical ward due to severe restriction. Been refeeding at home, doing FBT through CAMHS. Living life moment by moment
rolphdog

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Reply with quote  #25 
At the end of the day today, D achieved the target 1600 calories (up from 1400 yesterday), (a bit sadly to my mind) all with fortisip, having not touched any food (though she did spend time looking at afternoon snack and dinner), and drank enough water (a challenge for some reason).

Combined, this was a major step forward and probably the first time since we started tracking meals at the start of Feb that she's had that many calories.

I think there was an obvious lift in her mood as a result; she smiled, started conversations, asked questions about others and in general was a delight to be with.  We saw no melt-downs, yelling or persistent sobbing.  She was also able to attend the school and play areas within the ward.

So today was a good day, and tomorrow we do it all again and, as always, maintain our sense of hope.

If anyone reading this knowns of posts covering encouraging EDi's to move from fortisip/supplements back to solid foods, I'd love it if they could point me at them (I spent 30 minutes searching the archives but didn't see anything) so I can build my knowledge (given our main goal at present is stabilising eating and getting the calories / nutrients, I'll be OK with fortisip if that's what it takes for now)

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10yo D diagnosed Mon 27 Feb 2017, now refeeding
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