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chulaw

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Reply with quote  #1 
My 13-year old daughter has recently been diagnosed with anorexia and has had one appointment with CAMHS. She has been told to stop her exercising at home and to eat what I give her. I have had no advice on how to get her to "eat what I give her", although I hope to get help with this during the next appointment.

In the meantime - what words of encouragement can I give her, or what things can I do or put in place, to help my daughter eat her meals? She had previously stopped eating dairy and carbohydrates, preferring to just eat fruit and salads, with a small amount of protein, mostly in the form of quorn chicken fillets or vegetarian sausages. She became vegetarian several months ago. I'm trying to very very gradually get some dairy and carbohydrates back into her diet, by re-introducing a little something each day i.e. a couple of spoons of rice or pasta, a slice of cheese, a low-fat yoghurt etc. Am I right to do this so gradually?! I'm worried that if I increase these things too quickly, it will have an adverse affect.

She always asks way ahead of a meal what she is going to have, and I tell her. She then has a massive meltdown about it. I tell her I'm not discussing it or negotiating with her about it. She screams and shouts and cries A LOT. When the mealtime arrives, she sits with me and her sister to eat, but she takes a very long time to eat, complains a lot, but eventually eats it. I try to talk about day-to-day things, or put the TV on as a distraction. Does anyone please have any other tips on what I could do or some things I could say to help her through her mealtimes? I tell her regularly why she needs to give her body the nutrients it needs, particularly at this stage in her development. I empathise and tell her I can see how hard it is, and that we will get her through this. But I'm not sure if there's anything else I can be saying or doing?
mjkz

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Reply with quote  #2 
Welcome.  Glad you found us.  Even more glad your CAMHS told your daughter to stop exercising at home and eat what you give her!!

Quote:
She always asks way ahead of a meal what she is going to have, and I tell her. She then has a massive meltdown about it. I tell her I'm not discussing it or negotiating with her about it. She screams and shouts and cries A LOT.


I wouldn't tell her.  What I found with my daughter was that telling her ahead of time just gave her time to obsess and worry about it.  One of the important things is to get things back to as close to normal as possible.  Is it normal for a 13 year old to be asking about dinner before breakfast and then having a meltdown about it? No, not at all.  I think you are prolonging the meltdown by talking to her about it.  When my daughter would ask things like that, I'd just say something like "I'll give you what you need to eat" and that is all I would say.  I never gave specifics and if she kept asking, I would tell her I wasn't going to talk to her ED.  It really helped shorten the meltdowns and the endless obsessing over what was coming later in the day.

Quote:
Am I right to do this so gradually?! I'm worried that if I increase these things too quickly, it will have an adverse affect.


What more adverse effect are you worried about?  It sounds like she is having long, loud meltdowns that are emotionally and physically exhausting for all involved.  One thing I learned was that I was going to get the same meltdown over one spoonful of rice as an entire serving of rice so I would just go with the entire serving.  I think you have got the right idea and are doing wonderfully but if you are going to get the same reaction then push for more normal foods and normal amounts.  I wouldn't serve anything low fat.  You need the fat and calories so no more low fat yogurt or skim milk.  Go for the full fat varieties and start adding oil and cream to whatever you can. The faster the weight gain and faster you get to a normal weight, the better.  My daughter is lactose intolerant so we had to do smoothies but she would do at least one smoothie a day that was over 1000 calories in just that smoothie.  We had to get up to 4500-5500 calories a day for her to gain and keep gaining so you will need to add calories to every thing you cook.  I never let my daughter in the kitchen when cooking and I never told her what was in things.  It just made the anxiety worse and increased the chances she wouldn't eat it.

It sounds like you have learned that distraction is key.  We did whatever it took to distract my daughter when eating.  We watched TV, played movies, played games, read stories, anything to help the anxiety pass.  You are saying all the right things and it may take her more time.  My daughter would drag out meals until we were sitting at the table 24/7 for her 3 meals and 3 snacks.  For my own sanity, I had to start setting a time limit on meals and snacks. We did an hour for meals and half an hour for snacks.  She either ate what I gave her or drank a supplement.  If you have the time and can handle sitting at the table longer, by all means do it.  As long as you are getting food in and down, that's awesome!!  It all depends on what you can handle.

My daughter loved to negotiate.  That girl could sell ice cubes to Eskimos!!  She complained endlessly about the food and did she have to eat it, etc.  I did not negotiate and when she complained, I'd simply tell her it was what she needed to eat and left it at that.  I learned to tune out the complaints after that.  I also learned that she was going to be distressed and there was nothing I could do about it.  In fact, saying things like I know this is hard, you need to do this to be healthy after awhile just fed into the meltdowns.  I'd tell her once I was sorry this was hard for her and then let her eat.  If she complained instead of ate, I'd remind her to keep eating.  We came down hard on every ED habit all at once.  My daughter loved to rip things into tiny pieces, etc. etc.  We just tackled things as they came up.

I'm sure others will join in and tell you what worked for them.  Another key is finding what works for you and using that. For not knowing how to get her to eat what you give her, you are doing a great job!!!
Torie

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Reply with quote  #3 
Hi chulaw - So sorry you needed to join us here.

Mjkz has already given you good advice - I just have a couple things to add.  You asked what words of encouragement you can give her, and the best answer I have found is the video made by forum member Eva Musby.  It took me a long time to understand that the normal kind of encouragement isn't what our kids need - reasoning with them about food doesn't usually work, and as mjkz said, negotiating with them usually backfires.  I think Eva gets it exactly right, here:  



I tried to imitate her.

Please feel free to ask all the questions you like. xx

-Torie

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"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
tina72

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Reply with quote  #4 
Hi chulaw,
you have found the right place to answer all your questions and you will get a lot of help here.
First of all I will recommend the book by Eva Musby: Anorexia and other eating disorders. How to help your child eat well and be well. You will find a lot of practical advices in there for every situation you will meet in the next time. It is very helpful.
Then I would agree with the other members: don´t tell her what she will have to eat. It just increases anxiety. Don´t try to start with little amounts. You will have stress anyway, so let´s have stress about something which is bringing you further. She will not gain weight with low fat products. And its very difficult with vegetarian food. Try to stop this until she has gained enough weight.
What is great is that you try to re-introduce food again every day. That´s helpful. Try to stop every behaviour which is "not normal" and which she didn´t have before. The target is that she eats everything she ate before.
What helped us a lot was to present smoothies. We made them of fruit and vegetable only (no milk or cream added) so they looked and smelled very healthy and low caloric. But we added oil (best worked canola oil because it doesn´t taste), a lot of oil, you can add up to 100 ml to a 600 ml Smoothie so you get a lot of calories in there and she doesn´t expect. My daughter took 3 of them free willingly a day...[wink] I told her its important for her metabolism to eat a lot of fruit and vegetable. The fat is very important because the brain needs a lot of fat to recover.

You are doing a great job. You have found the best therapie for her. Read the book quickly, you will find a lot of helpfu tips in there. It´s not so important what you do and say during mealtimes. The most important thing is to stay calm and constant and give the ED no chance to break through a hole in the net. You don´t need to explain so much, just play a broken record: This is the food you need. You have to eat whats on this plate. I will help you. You are not alone.

Ask a lot of questions. There are so many helpful people in here and you will get a lot of practical tips.
The beginning is hard. But you will see progress in every week. My daughter was diagnosed 6 months ago and she is back to school, with her friends again, able to care for 2 meals a day on her own and eating nearly everything she ate before. She is snacking from our plates, but doesn´t take a second plate up to now. She has gained 9 kg weigt in 6 months. Her brain is recovered up to 80-90%. We are just controlling a bit whats she eats and have to keep an eye on relapses.
There is hope. You just have to go on. Get some help if you can because thats a marathon and not a sprint. You will need to have some time out to stand this.

We will help you!
Tina72
chulaw

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Reply with quote  #5 
Thank you, guys, for all your helpful tips and advice. I'll give it all a go.
seaglass

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Reply with quote  #6 
My d is 13 and we started this journey about nine months ago.

From my experience the first bit is the hardest. You're all scared and desperate for help and clear guidance but the system of CAHMS doesn't give that right away. You want guidance NOW and have to wait for your next appointment to ask more questions and get more support. In the meantime six days and nights can feel like you're all at sea without a paddle.

The way forward is simple in one respect (more food, less exercise) but so so hard to implement.

You have got and will continue to get amazing support and advice here. I found that at the beginning we had to slowly find a way to get my d to eat and increase calories. It's hard. You have to find your way to stay strong and be brave and find ways to support and require her to eat the meals you serve.

Eva musby's books and videos offer great practical advice and also a variety of strategies if one doesn't work or suit you and your family.

We started small with a meal plan (not at all detailed but a plan of three meals and three snacks). At the beginning lunches were hardest so they were the smallest meal. We made it clear that we were going to help her but she needed to eat what we gave her. We made each meal as easy as possible with distraction and support and hot water bottles/ baths afterwards. We started with 'safe foods' but tried to make sure each bite counted by adding raoeseed oil where possible and cream (without her seeing the prepRation). We even stirred rapeseed oil into ketchup. At the stage you are at every bite was a bonus. There's time to build up and increase variety and calories and find your way.

I think that this beginning stage is so scary and bewildering that I would say do your best, ask lots of questions and vent away here and take it day by day. Hell - take it half hour by half hour if you have to.

Phone CAHMS and ask for more help or more immediate meetings if you are struggling. Don't be fobbed off.

And finding this place is a lifeline.

We all get it.

Keep posting and ask away and the lovely people here will help.

Mamaroo

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Reply with quote  #7 
Hi Chulaw

There is a very good post on super resistors (not that your child sound like one, but you might get additional tips): https://www.aroundthedinnertable.org/post/the-super-resistors-when-lsuye-and-magic-plate-cause-total-shut-down-8122350?pid=1295094434

In addition to the other comments I can add just one tip. When the weight goes up, it usually sits on the face and tummy before it redistributes to the rest of the body. Typically my D would say that she is fat. There is only one answer to this, which you must say over and over until she can hear your voice in her head: "You are not fat" and nothing else. Eva Musby promotes this phrase and was a lifer saver for us.

If your D still gets anxious over the menu, I can suggest the following as an interim measure: Print out a weekly menu with all her meals and snacks on it. Make is fairly consistent eg. Monday - lamb with rice and veg, Tue - spag & meatballs and veg, Wed - fish and chips and salad etc. I had the same menu on the fridge for months. After a while I would change one item, replacing spag and meatballs with a hamburger and so on. Now she has anything I give her without asking about it.

It takes a long time to beat this illness, this is a marathon, not a sprint. Take care of yourself as well.
Best wishes 


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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 in March 2017. Challenging fear foods and behaviours now.
evamusby_UK

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Reply with quote  #8 
Hi Chulaw, sounds like you've only had one CAMHS session so far, so the next one, you can get into all this "how do I do it" stuff. Ask them for a "family meal" i.e. where they can observe you in action and give you feedback. It's part of FBT but a lot of English CAMHS have been trained differently, so they don't do it, but then they are supposed to offer this practical guidance through multifamily sessions. 

Mamaroo, I'm touched that a phrase in my book was a life saver in your family. That is so precious. At the same time, for others reading and new to this, be aware saying "you are not fat" over and over again may not be helpful. Some of it depends how deep in the eating disorder they are (the deeper they are, the less effective are your reassuring words as they seem to just activate the opposite). For some of our kids (including mine) it can help to try the "you're not fat" just once when asked, as sometimes it seems to help our child shut down their eating disorder voice. But if that doesn't work, leave it at that. It also sometimes helped mine to hear empathy around the fat thing along the lines of "I can see it's really freaking you out to have your mind tormenting you and telling you this or that. I'm sorry you're going through all this, it must be horrible. I love you...  and then, distraction... 
As usual, experiment and see what works for your child.

Back to you, Chulaw, sending you good wishes - hope you find what works for you very soon.

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Eva Musby, mother, author, produces lots of resources for parents at http://anorexiafamily.com and on YouTube https://www.youtube.com/user/EvaMusby/playlists
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hope21

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Reply with quote  #9 
My daughter is also vegetarian, when she was very ill at points was only eating smoothies and since her IP can't face a smoothie. The hospital view was that she should be fed with normal food. What a normal teenager would eat. When at crisis point and she was loosing weight daily and the hospital said 'your her mother' you know what to feed her so just feed her. I could have punched them! No matter what was presented it was not eaten. I sat there! 5 hours over a milk smoothie, both of us exhausted till after midnight!

Magic plate - again we sat there. Then we were advised to introduce timings. We were both exhausted and nothing eaten or sometimes a few mouthfuls. An hour for main meals and half an hour for snacks. My big mistake was to listen to the hospital, they won't give you supplement drinks and highly recommend you DONT use them. So even after sitting for hours and then with new time structure most food was not eaten and without supplement drinks the weight fell off.

She wad admitted and put on a meal plan through the hospital where they showed her what she would get i.e. Protein/carbs on each meal. Started off on 750 calories as she was in danger of re feeding syndrome. This increased every 2-3 days until she was on 2500 calories a day. The introduction of milk was a big factor as dairy had been stripped from her diet.

She still has three main meals and three snacks.

Her lowest was 33kg height 157 cm. She is now 159.5 cm and 50 kg.

She is still a vegetarian. So for us it was a slow and steady increase of foods she previously liked. We watched tv while eating... no chatting. Focus on something else and I always sit beside her. So she knows I'm there. She must eat everything on the plate, always.
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