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claretre

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Reply with quote  #1 
Hi, my 10 yr old has been treated by FBT over the last year. She had regained weight but recently her anxiety has got totally out of control. She will not sit down during the day & this is causing a big problem at school. Today her Consultant Psychiatrist suggested a low dose of Prozac (Flouroxetine), but we are unsure whether this is the right thing to do for such a young child. Your advice is appreciated.
Colleen

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Reply with quote  #2 
Welcome, claretre.  I'm sorry about your little girl.  So young.  I hate ED, but I really hate when it preys on our babies.

My first question is:  are you sure she is at a good weight FOR HER?  Capping those words because weight is an individualized thing, not a one-size-fits-all.  Also, their physical health (heartrate, bp, labs, etc, periods if she's having them) can all be normal or in the normal range but she can still exhibit a lot of emotional instability if she is under her personal healthy weight.  There's nothing to be gained by setting the target weight too low, especially for kids who are about to enter their pubertal growth spurt.

Question your providers on how they set that goal weight.  Setting it too low is the #1 mistake that professionals make.  This is one area where we parents have to really advocate for our kids.  There have been so many parents here who've found that they needed to bring their child up to a much higher weight than their professionals recommended before they saw a return of the happy child they used to know.  We had to go twenty pounds higher than our highly experienced team recommended--granted, my d was a 6' teenager, not a young girl, but you get the idea.  And no, she is nowhere near overweight!  Docs and therapists fear weight gain as much as anyone and it's ridiculous.  Do you have any data on her age/weight at different times as she was growing up?  You can plot those points at sites like mygrowthcharts to project where she might be at this age had she not gotten sick.  That's a good starting point.

A lot of co-morbid conditions are linked to being underweight--anxiety being a biggie.  I can't second-guess your on-the-ground professionals, but for kids with ED, FOOD IS MEDICINE.  And if she's even a little underweight, the best thing is to keep gaining, keep nutrition high, use lots of fats and oils (her brain needs them).  Food and weight gain have a lot fewer side effects than Prozac.  Anxiety often spikes as true w/r approaches, so you might just be seeing what we call here the Dreaded Last Ten Pounds.  You don't want to leave her in this uncomfortable zone.

I got to meet Dr. Lock of Lock and LeGrange fame at a FEAST conference a few years ago.  He said that treating co-morbids should wait till at least six months after w/r because many of them will remit with continued nutrition.  YMMV.

I would discuss my concerns with her psych.  SSRIs are not only unstudied in the young, they don't often work as expected in ED because the mechanism that they are 'correcting' is not the mechanism that ED has messed up.  See this thread for a more thorough explanation:  EDs and co-morbidities  Maybe you can print IrishUp's brilliant post there to share with him, see what he/she thinks.

And welcome.  I'm glad you've found us.  The help I found here ATDT was invaluable in helping my d recover.  Lots of things are the same no matter how old the sufferer is.  But rest assured, there are other parents with little ones here too.  This is a place of great hope.  Your d can recover!

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Colleen in the great Pacific Northwest, USA

"What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease."
Alexander Pope, 1688-1744
claretre

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Reply with quote  #3 
Hi Colleen, thank you for your reply. I have exactly the same concerns regarding the use of Prozac. My d was diagnosed & treated relatively quickly because her starting weight was low. She has always been small anyway but her descent into full blown starvation was super fast. Refeeding was total hell but we got her to her 'first target' weight within 3 months. Things improved for 3 months after but since November 2015, her anxiety was getting worse. During this time she did continue to eat but (if I'm honest) we were a bit more relaxed about snacks & portion control. So by Christmas she became very morose, spending more time in her room, often doing exercises. Recounting this to you makes it sound pretty obvious that lack of food (or too much exercise) is the culprit. It's interesting you talk about target weight; our clinician has not advised a target weight since August; the view is that she is where she should be on the growth curve (although her height has stalled). So with all this in mind I am not convinced that medication is the answer right now, though I wouldn't rule it out if her anxiety worsens.

Thank you again for your reply. It's good to know there are other carers out there & we're not alone...
mamabear

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Reply with quote  #4 

Hi- below is a previous post from me on another thread of a parent with a younger kid. It applies to you as well.
I am the mom of a daughter who was diagnosed at ten. JUST LIKE YOU- my daughter would not sit down, was exercising all of the time.was anxious, having panic attacks etc. And just like you- the psychiatrist wanted us to put her on Prozac. We said- NO. We would not consider meds in a ten year old kid until she had put on significant weight and we had given her time to see if the behaviors would settle down/disappear. 

I am happy to report that she never needed meds. ALL of the behaviors disappeared with weight and time. We also gave 3 warnings for movement and then gave ensure as a replacement for burned calories.

Your daughter is entering the greatest period of growth in her entire life since that first year of life. SHE WILL NEED ONGOING WEIGHT GAIN INCLUDING A DIET VERY HIGH IN FAT FOR THE NEXT SEVERAL YEARS. 

NOW IS NOT WHEN YOU BACK DOWN. You CANNOT back off. Now is the time when you PUSH and get more weight on. She will grow and make up for lost time and PLEASE listen to me from 5 years of experience- she will use up so much energy and lose weight with growth. You have to keep on top of it. Her exercise compulsion and inability to sit is a SYMPTOM of a brain that is NOT getting the nutrition that it needs. I hope what is written below will help you. These are all of the things that we did to save my daughter from ED. I am happy to report to you that she is 15.5 years old now, a sophomore in high school. She has a boyfriend and a few solid friends. She is content with her body. She eats freely and intuitively and is in a 100% solid ED recovery (for well over 2 years now), but it took 3 HARDCORE years of battling puberty and growth to get here. 8 inches in height, full puberty, and went from 68 to 130 pounds. We battled lunch ditching and restriction and all sorts of ED trickery evERY SINGLE TIME there was a growth spurt. I have a very long thread titled  "Unbelievable Progress"that chronicles our story. The following I wrote for a mom of a 14 year old boy and it equally applies to you.






I am going to give you the advice that I wish ALL treatment facilities would give upon discharge to home.

Make your home into an inpatient treatment facility. 
3 meals and 3 snacks every day. High calories and specifically high in FATS, 
Your son is 14 and will be making up for lost time. He is in the biggest time of growth and change since infancy. Right now his weight is a moving target. There is no magic number that you can really aim for right now. You will have to tweak things as he grows and changes. You may find that his caloric needs INCREASE as time goes on right now. His body once it knows that it is going to be fed will start to rev up metabolism and use the energy for growth. Weight restoration is only the first step towards recovery. Once a solid weight is reached the weight must be maintained and added too with as few losses as possible. Use the scale as your gauge for what he needs. 

INTERRUPT ALL BEHAVIORS

What this means is do NOT give ED the opportunity for purging through vomiting or exercise. What this means is that you need to be with him. Do not allow bathroom use within at least 90 minutes of eating and then I would have him leave the door open a bit and I would sit outside of the door. Same thing with showering. Some people take doors off of hinges, remove locks etc. 

Sleep with him. Put a mattress on his floor or your floor. Do not give ed an opportunity to torture him during the night. 

Eat lunch with him at school or arrange for him to eat with someone one on one. Many people pull their kids out of school for a time during this phase. My daughter was able to go to school but many cannot. 

These are all things that we did with our daughter, who was 10.5 when diagnosed. She had a very very severe exercise compulsion. She was hospitalized for a month. We took her out against medical advice as we felt we were not getting what we wanted out of her treatment. She was left alone too much. If left alone for 30 seconds she could do 15 burpees. 

It took us a solid 3 years to get her into a solid recovery. 3 years of 8 inches in height and FULL puberty. Period, hips, breasts, the whole nine yards. She needed VERY high calories and very high FATS for those first 3 years. She holds the record here on FEAST at 6000 a day for about 2.5 years. Most do not need that much, but many parents of kids your sons age have found that they hit the 4000-5000 mark. Aim for 2 pounds a week of gain. 

Add canola oil to things like applesauce and pudding and orange juice and soups. Add butter and heavy whipping cream anywhere you can. We didn't give any choices. It was too stressful to give my daughter any choices. It was like "Do you want spiders or snakes?" Some people have found that choice helps. But the choices must be equal. 

We gave Ensure as a replacement for any unnecessary activity. We gave 3 warnings. After the third warning she got a shot of ensure to replace those calories. 

Search his room regularly. This is not a trust thing- this is saving his life. I found bags of milkshakes and food in monopoly boxes and baby doll boxes and jewelry boxes and in plants. This is especially important once he gets back any independent eating. 

Sounds overwhelming and like a ton of work….yes it is. It is the hardest thing I have ever had to do in my life….but it worked. My daughter is now 15.5 and has been in a very solid recovery eating normally and intuitively on her own now for well over 2 years now. 

We did not do things perfectly. This list I have compiled for you are all things that we did but in the very beginning we had a very steep learning curve. I wish I would have had this list myself in the very beginning. I wish they would have sent me home with this list. It didn't take long at home to realize that we would be headed back to hospitalization in a heartbeat if we did not do everything I have listed above. 

This is a marathon, not a sprint. It is way too easy to get ahead of ourselves. It is really really really hard to do, but try to stay in the moment. One bite at a time. One meal at a time. One day at a time. It will get better as time goes on, weight goes up, and nutrition is consistent. 

I hope this helps. Love to you!
 
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Persistent, consistent vigilance!
Torie

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Reply with quote  #5 
Hi claretre - One thing I somehow didn't realize is that kids need to gain weight in advance before they grow in height. They all do - Ed and non-Ed alike. They need the additional weight in advance, to fuel the growth. For my d, that was 5th grade, but of course it depends on the kid. Maybe your d is at the point she needs to pack on some "extra" pounds as she prepares for puberty?

Keep swimming.

xx

-Torie

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

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Reply with quote  #6 
Hi 

My d fell ill at 10 and a few months after we started refeeding-- I think she would have been WR by then but it's hard to say when they are so young as growth is ongoing-- we put our daughter on zoloft as she was desperately depressed, agitated and emotionally devastated at night, as well as very anxious all the time.  I was very resistant to putting her on the medicine but she was in desperate trouble and the med helped. You can look up my earlier posts for details.

She did have a few weeks with some suicidal expression when she was going on it, which scared the tar out of me and I had to be very careful with watching her but even then you could see quickly that it was helping her. We took her off the med after a year as I didn't like her being on it.  The psych wanted to keep her on it.  She had no problems going off it.  However, we have debated putting her back on and each time I find a reason to say "not yet "  as I am suspicious of whether there could be side effects long term for meds for young kids.  I have NO info on this, it is just my fear.

I think it would be quite reasonable to say that you are first going to push up her weight and see if that does it, but if it does not then look at a medication. The thing that rather stumps me is why one 10 yo with anxiety would be put on zoloft and another on prozac. I might want to discuss that. One hopes it isn't random.

Please don't feel like a failure if your child ultimately needs medication.  It seems that WR and pushing up weight helps some kids but doesn't do it for all.  The longer I am on this forum the more I see EDs don't have one size fits all cures.  


PuddleduckNZ

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Reply with quote  #7 
This is so tough.

I was heavily anti meds for my 10yo and put off trying them too long, in hindsight.

No one path is right. Don't feel badly if you decide to trial meds. At the end of the day ED kills, I worry about side effects too but ED is here and now.

Olanzapine really helped my S at his worst and he is also on fluoxetine which I am not so sure helps as it coincided with him turning a corner anyway.


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Son 9yrs when he became unwell 2013, ED slide from April 2014, dx at 10yrs July 2014, 2 hospitalisations - dx so many times Behavioural Anorexia, EDNOS, ARFID. FBT from August 2014. Anxiety, Emetophobia. 12yrs old now! Reaching for recovery, we're so close....
mjlinc

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Reply with quote  #8 
Medication is something we went back and forth on for a couple of months. My d is 10 also and we didn't want to rush into medication. In fact, our doctor told us it was an option, but doesn't push them. The weight restoration really is the key from what I understand. However, we ended up trying a low dose of Fluoxetine and olanzapine. It really made a difference for her. She was having suicidal thoughts before the meds. No more. She was also having extreme running down the road screaming fits and those have stopped. The weight didn't change during this time, so we know it was the medicine helping. Just our experience with it. This is definitely not an "one size fits all" illness.
Playball40

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Reply with quote  #9 
So I was of the understanding the Prozac was actually tested and utilized for children but it was the only one.  That said, I was scared and resisted with my 11 year old (especially considering she wasn't "fully" weight restored).  However, she has taken it with very positive results.  It seems to take just enough 'edge' off of her to make it easier to eat.  She takes one pill at night right before bed and she has had no ill side effects.  That said, she decided one day not to take it (she was hiding them) and I saw a rapid and noticeable decline in her behavior - and her anxiety shot up.  I realize now that until she is fully weight restored, she will need to continue with the Prozac and probably even for a time after.  She is 12 now and her weight is truly a moving target as her body is trying to catch up to itself. 
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Caroline
mnmomUSA

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Reply with quote  #10 
Wanted to mention another possibility, and that is hydroxyzine.  It is primarily for treating allergies, but it also has a mild sedative effect.  In early days (and in difficult times, such as now for us), my D took this 20-30 minutes before every major meal (10 mg....very low dose).  It took the edge off "just enough" so that she was able to complete her meals.  As she got better, she took it less frequently, and then not at all.  She has started it again because for whatever reason, her anxiety is spiking and eating was becoming very difficult for her.  It is once again helping to "take the edge off" and allowing her to complete her meals.
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D, age 16, first diagnosed March 20, 2013, RAN, at age 13 Hospitalized 3 weeks for medical stability. FBT at home since.  UCSD Multi-family Intensive June 2015. We've arrived on the other side.  :-)
HateEDwithApassion

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Reply with quote  #11 
Hi,

I am so sorry you are struggling with your D. Our experience is that Prozac did help our D with the anxiety around food, but did not help much with depression. It has a very long half life, so it's actually a pretty easy one to take and easy to stop taking. 

That being said, we had to take my D off the Prozac because it made her super sleepy. I still like it the best of the ones we've tried. My H and I were very against medication, but she has needed it. We haven't found a perfect fit yet, and still are trying.

Of course, being fully WR is always the first and most preferable means of dealing with anxiety and depression, but in the meantime, can you give her some relief while also helping her get closer to WR by taking away some of that anxiety around eating? It may be worth it. It does not have to be forever. It may have to be forever. There's no shame in either scenario. 

We came to the place that if the medication helps her make it through another day and relieves some of her crippling sadness and anxiety, we'll do it. Damn ED.

__________________
17 yo D. Diagnosed in July 2013. W/R in Sept. 2013 and has remained so. Roller coaster on and off since, mainly with ED under control but co-morbid depression and other negative coping mechanisms making our life hell. Trusting in God for daily strength and wisdom.
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