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hangry

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Reply with quote  #1 
daughter just went from residential (after hospital) to php day program on Weds. It's Friday and she refused afternoon snack and then dinner and then evening snack. What to do? Trying to remain calm, non-confrontational, pushing a bit, etc. just tucked her into bed and told her tomorrow is a new day. How many meals can she skip without me freaking out and taking her to the ER? 24 hours? 48? Wait until Monday? I know I'm getting ahead of myself but I just am TERRIFIED. 
Friends of hers are supposed to come over tomorrow afternoon at her request. Do I cancel them if she won't eat anything beforehand? I don't know what to do. 
Kali

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Reply with quote  #2 
Hi Hangry,

First: Take a deep breath!!!! And another!!!!! You can do this!!!!

Unfortunately, it may still be early days in the illness. You have already done a herculean job helping your d. You came back from China, got her into treatment and learned about the disorder. 

Like you said, tomorrow is a new day and another chance. Do you have a copy of the menu of what she was eating in residential? Perhaps serve some of those foods. Familiar is good right now.

Tomorrow morning you can make her breakfast. Perhaps keep the menu very simple; cheerios with milk, and a banana, and orange juice. Wake her up and be cheery and calm and compassionate, and talk about the fun plans she has for the day and anything else you might be doing together this weekend. See what happens. Then for lunch, perhaps give her some grilled cheese, and juice and fruit for dessert. I'm just suggesting these foods because they worked for us when things were difficult. As she gets more accustomed to eating at home, you can branch out to a wider repertoire.  

Try to frame things in a positive sense: "After you eat, your friends are going to come over", (a reward) instead of "if you don't eat your friends can't come over". (a punishment) Then change the subject and sit down with her for breakfast. 

In our house, 24 hours of no food was the cut off for a theoretical emergency room visit. But you know what, I never had to actually take her there. We did get to 18 or 19 hours of no food a few times and then I let her know that if she couldn't eat that I would have to take her in to keep her safe. She ate.

Your daughter is still in treatment at the PHP, right? So if things do not go well this weekend, you can call them and then go in with her on Monday and discuss the options with her team. Perhaps they can give you some guidance about how to approach mealtimes at home. Perhaps she will benefit from going back to a higher level of care.

I'm thinking that this is new for you at home, the routine of eating with your d. after she has been away. Distractions can also help. Can you try eating with her in front of the tv while watching something she likes? 

Have you read Eva Musby's Anorexia and Other Eating Disorders? She has some good ideas about how to handle meal times and I believe her daughter was also your daughter's age when she became ill.

There is also the UCSD program which some families have found helpful for managing at home and are specifically for teenagers.
http://eatingdisorders.ucsd.edu/treatment/oneweek-intensive-treatment-programs.html

You could also try reading some of Deenl's posts and see if anything resonates. Her son was around your daughter's age when he became ill and she has some excellent practical advice about how to handle meals at home.

warmly,

Kali




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hangry

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Reply with quote  #3 
Thank you so much! Your words are so appreciated! xoxo
mjkz

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Reply with quote  #4 
hangry, I'd definitely make her friends visiting conditional her on eating all meals and snacks for the day (have them visit after dinner so she can do at least 3 meals and 2 snacks).  Also I'd take her to the ER after 24 hours of no fluids and food too since she just got out of the hospital.  Can you let her team know what is happening and get some guidance from them?

I would go in with her on Monday and get things clarified with the team what to do if she continues like she is on the weekends or even after PHP.  It is always good to have a plan in place and for everyone to know what needs to happen.  I don't know about you but nonconfrontational didn't work well for us.  I really had to confront my daughter and point out the road she was going down.  I had to make it very clear what she was doing was not okay and it would lead to her going right back into the hospital.

I also had to really pull out the stops on making sure not eating was less pleasant than eating because mine was a super resistor.  If she skipped a meal or snack, she laid on her bed until the next one came around.  She needed bed rest to conserve calories and that meant no TV, no reading, no phone, no internet, etc.  If she ate, then she got all those things until the next meal or snack.  If she refused, she was right back on full bed rest.

You can do this!!!  You already moved half way across the earth and changed your entire life to help your daughter.  There always seems to be a blip (at least for us) in moving from one level of care to another.  Get your plan in place.
kazi67

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Reply with quote  #5 
I used behaviour modification techniques that I learnt workingnitba school for special needs children with inappropriate beaviours to help modify my d eating behaviours
If I was you I would not let the friends over unless she eats her meal
When my d is cryingnor sulking or simply refusing to eat her meal I will say ok go and get me your phone, or computer, or we take away use of the car
If she eats she gets these things
So you r rewarding the desired behaviours
I also ignore the crying etc, and by no means get involved with the arguing I will just say well that's the anerexia or demon talking in your head and I'm not interested in what they have to say
Followed by u need to eat your meal to get strong and healthy and you will not be able to use phone etc etc if you don't
This is working very well for us
Hope this helps
Kali

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Reply with quote  #6 
Hi Hangry,

Thinking of you and your daughter.
How did it go this weekend?

warmly,

Kali

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hangry

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Reply with quote  #7 
Hey Kali! 
thanks for asking. After no Friday afternoon snack/dinner/after dinner snack, she ate breakfast lunch and dinner both saturday and sunday. would not eat the three snacks either day or this morning (her day treatment center does a late breakfast at like 9:30 so she's supposed to have one snack before she leaves home in the am.
So am i supposed to feel good about this or bad? I'm trying to detach but it's so hard. I feel like on the one hand this is to be expected, but i don't want it to become the way things are. Does this make sense? 
Kali

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Reply with quote  #8 
Hi Hangry

I think that is great news! She was able to eat three meals each day!!!! These are early days and it is her first weekend home eating with you!!! You nailed it. 

We served many of the same foods over and over, so once you see there are certain menus that she eats, my advice is to write down what she had and then rotate the meals. Then try adding additional new ones as you go along.

We did not do 3 snacks a day, we did 2. So the schedule looked something like this: bkfast 9:30 or so, lunch 12:30 or so, snack 1 at 3:30 or so, dinner around 6ish and then another snack at 9pm. Or if she had an early bkfast say at 8, snack at 11 and then lunch at 1:30, for example.I think the purpose of the snacks is to keep blood sugar up and not go too long between meals. Snacks were simple: yoghurt, fruit, popcorn, pita and hummus, nuts, granola bars, juice, etc. Can you find out what type of snacks they are serving at the treatment center and try some of them at home also? 

If she is supposed to eat something in the morning before going in, can you first try to give her something to drink, perhaps a glass of milk and see how that goes? Or a banana? It is very much about the routine of getting used to eating over and over again. I found that keeping to the same schedule as in the treatment center was also helpful because she had become used to that.

You are doing a great job.

warmly,


Kali

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mjkz

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Reply with quote  #9 
I would be happy with that!!!  Progress.  Did you get a chance to talk to the PHP team and find out what they recommend?  It would be really great to have a plan in place so you and she know exactly what to do if this happens again.
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