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coarfiddad

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New here, composing my intro.

I've seen a couple of references to not making a big deal when someone recovering from ED does something new. Is that specifically for AN? I've been complimenting my ARFID d when she tries something new or eats better on her own in a positive reinforcement model.

Tali97

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Every child is different and when you have something that works for your child continue until you find that you need Plan B. With ARFID are you entering new territory with foods or are you hoping to return to old eating habits? Is your daughter a teenager? 
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18 year old boy (Gluten Free/Dairy Free 2005)
 IP - March/April 2014.  ARFID.
 2015 - Gastroparisis
coarfiddad

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She is 13. Still appreciates hugs and kisses. She's never eaten large amounts. Efforts right now are on increasing her diet and getting her weight up. Disorder has been driven associating being full with vomiting caused by abdominal migraines that she's had her whole life. Positive reinforcement is usually for completing a meal without fighting. Kazdin model inspired for laying on positive reinforcement and thanking her when she eats and drinks without putting up a fuss. I heaped on the praise after a meal this week when I pointed out to her that she got a full serving down quickly without her ED sticking his head out even though I could see it was hard for her.
Tali97

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I would suggest you read honey_badger thread new here... 13 YO son, possible ARFID she made amazing progress with her son. 

When praise is working use it to her advantage. It looks like it is helping her for you to acknowledge how difficult it is for her. 

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18 year old boy (Gluten Free/Dairy Free 2005)
 IP - March/April 2014.  ARFID.
 2015 - Gastroparisis
coarfiddad

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Quote:
Originally Posted by Tali97
I would suggest you read honey_badger thread new here... 13 YO son, possible ARFID she made amazing progress with her son. 


Working my way through honey_badger's thread, thanks. 😉

This AM is an example. She ate her double waffle with syrup (~500 cals) plus an oatmeal sandwich cookie (200 cals) and her 12 oz Gatorade in her time limit without me needing to remind her. I gave her a hug and pointed out how well she did. (Didn't talk calories on advice from her therapist). 

It just feels like these baby steps can be so far in between, I really want to celebrate them when they get us forward.
Foodsupport_AUS

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There really isn't a right way to look at managing this. Some kids with AN for example feel terribly guilty about any and all meals. Others when more engaged in the process of recovery may actually want acknowledgement of their hard work. The difference can be having them distraught and self harming or a kid who is happy that their hard work is acknowledged. 
It is much more likely that a child with ARFID is engaged in their own recovery and wants that acknowledgement, but the dividing lines between ARFID and AN can be very blurry at times, with many kids being diagnosed as one rather than the other. You know your own child much better than anyone else. If it is working go for it. If you feel it is making it harder for her to eat then work on another strategy. 

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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.
coarfiddad

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Quote:
Originally Posted by Foodsupport_AUS
There really isn't a right way to look at managing this. Some kids with AN for example feel terribly guilty about any and all meals. Others when more engaged in the process of recovery may actually want acknowledgement of their hard work.


Thanks, saw that guilt reference digging through old threads. Her ED doesn't talk to her that way (I hope). He more tells her she's going to throw up and has every excuse in the book to pick a fight about why she shouldn't "have to" eat. Generally, when the meal is over, he's gone and he doesn't have any drive to make her continue conflict over food. No point. Meal's over.

Particularly when she's able to stave him off, I definitely want to give her a positive feedback loop to realize on her own how she may have gotten herself to eat. A huge part of her recovery is going to be her fighting him off without me there coaxing/coaching or reminding her to have another drink/bite. At this point, she doesn't know how to fight him off, and she doesn't always recognize when she has. I can point out to her how all the ridiculous excuses and negotiating are evidence that he's getting in control, but when he's there, she can't see it. Reason has left the building. Hopefully, the positive feedback from me will help her associate with fighting him off and the reward.

I have also found that right after a meal is the wrong time to start discussing another one. Just keys up the anxiety that she just got over. It can be tricky to time planning breakfast. If she finished dinner/evening snack and I give her a hug and congratulate her, the next words out of my mouth can't be to jump into the next meal. That gets hard when her evening snack is right up against bedtime and I either try to get some agreement to breakfast planning while trying to get her to bed or I end up getting a half-answer when she's struggling to wake up. That has a coin flip of anxiety triggered by not wanting to get up on top of not wanting to think about food first thing. Shoving anxiety in there will override any positive feedback.

I have to laugh at my own anxiety. If breakfast on a weekend starts late, or afternoon milkshake takes too long on school days, all I can see is the snowball effect it's going to have on the next meals. Breakfast is late, then morning snack cuts into lunch, lunch cuts into milkshake, milkshake is right up against dinner, dinner is a fight, evening snack is hopeless, and anything she agrees to about breakfast the next day is going to be out the window and the snowball starts all over.
Mamaroo

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Hi, you're doing a great job with your D [thumb]

You are right, the treatment for ARFID and AN is different, especially where it comes to positive reinforcements. These children have a fear of food textures and tastes, but not the fear for gaining weight and neither do they have the negative bullying voice. My d has/had AN, but I grew up as a 'picky' eater, but looking now at ARFID, I tick all the boxes. Now, I can eat anything, even if I dislike it. I taught myself to expand my food palette and can give you the following pointers:

Have a weekly mealplan and stick it on the fridge. This way, you don't need to discuss the next meal and your D can refer to it whenever she feels she needs to prepare herself mentally for the next meal. I know it's hard to squeeze in all the meals. Over the weekend I have a big breakfast and lunch to absorb morning tea's calories; I have a large afternoon tea and late dinner and maybe a small supper just before bed. Kartini clinic's mealplan only has 4 meals a day (breakfast, lunch, afternoon tea and dinner), so you can see what works for you.

Let her cook. I know this is a big no-no with AN children, but preparing the meals with Mum’s help, reduced my anxiety. I thought, if I could eat all the individual ingredients, I could eat the whole dish (lasagna, bacaon & cheese omelet for example). As I got used to a certain dish, I was able to eat a similar dish outside of home (family, restaurant)

Give her multi-vitamin and calcium tablets. I used to get back pain as a teenager and x-rays showed it was due to low bone density, because I didn’t get all the nutrition I needed (I was also always very tired). I wished my Mum just placed a calcium tablet in front of me. These days I still give my 2 daughters multi-vitamin, calcium, magnesium tablets as well as an omega 3 oil capsule. I used to add a zinc tablet, so that’s worth looking at as well.

Be confident that your child will like the dish. My mum used to say that I would like this or that and when I tried it, she was right! I do think now, it was her confidence that gave me courage to try it.

Aloe vera juice will help with tummy discomfort. Sometimes my d feels very nauseous while eating and would often not finish her plate. Just a glass a day of aloe vera juice for a week, strengthened her stomach and the nausea went away.

Keep it bland. I believe ARFID children have very sensitive taste buds and things just taste stronger for them. When adding spices, just add a small amount and gradually increase it until she can tolerate a normal amount. Just as a side note, it is still difficult for me to eat spicy food and drink juice or strong coffee or tea (I eat/drink it very slowly).

Continual exposure will help to reduce the anxiety, initially I only ate a little bit of a scary dish, but as the dish got presented every time I was able to eat more of it until I could finish it.

Here is a good video on ARFID: The cases that don't fit the box Pt 4: ARFID. Dr. Amy Talbot:

 Best wishes!


__________________
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. She is back to her old happy self and can eat anything put in front of her. Now working on intuitive eating.
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