F.E.A.S.T's Around The Dinner Table forum

Welcome to F.E.A.S.T's Around The Dinner Table forum. This is a free service provided for parents of those suffering from eating disorders. It is moderated by kind, experienced, parent caregivers trained to guide you in how to use the forum and how to find resources to help you support your family member. This forum is for parents of patients with all eating disorder diagnoses, all ages, around the world.

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50wattplexi
My 12 year old (soon to be 13) daughter was diagnosed with anorexia on May 17th....spent 2.5 weeks in an in-patient facility and did a remarkably great job of eating her meals/snacks.  It was determined that FBT is the preferred treatment option and she's ben home since early June.  In general, she's done really well but over the past week or so she is now starting to not finish lunch/dinner and is trying to narrow choices on snacks.  She has continued to add weight but this recent development is so demoralizing to us.  We sit with her, offer encouragement/support, tell her we love her and while she says she wants to get better, the ED always seems to get in the way.  We are taking privileges away when meals are not complete, but the past few days have been maddening.

Our current therapist as well as the doctor from the in-patient keep telling us we're doing a great job but it feels so overwhelming.  We constantly ask ourselves what could we have done differently?  I know this is going to be a journey and there are no easy answers but it is nice to have a place where other parents KNOW how you feel...all of the pain/anguish and hopefully happiness one day.

Does anyone have any suggestions on how to get my daughter to eat when she is resolute in NOT finishing?  Any other words of wisdom?

Apologies for rambling....I feel like I'm boxing a ghost...so lost.

Thanks for listening.
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mtkmbc4
I’m sorry that you need to be here. It is not an easy journey.

My best suggestion to deal with your daughters refusals/incompletion of meals is to have a privilege that can immediately be revoked if she does not finish meals. Conversely, you can make the same privilege something that can be earned only after meal completion. (Same net effect but two different ways to word it and approach things.) Some kids do better with the thought of earning something while others are “reward insensitive” (because the eating disorder is giving them a bigger “reward”), so with those kids, you need a consequence to deliver.

You’ll have to be creative and use your own judgement as to which approach might work better with your daughter and don’t be afraid to change up your approach, either. You do what works to get the food in.

Ultimately, with my daughter, no reward and no consequence would leverage her to be compliant. She ended up needing a higher level of care. Even in a partial program, we only gained her cooperation and full compliance with meals by writing a behavior contract stating that losing X lbs for 2 consecutive weeks means she will leave partial and go to residential treatment. She had to know that we were stopping at nothing to insist on her health.

I hope your daughter will cooperate before that becomes necessary.

Feel free to ask specific questions. You’ve come to a great place for support.
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BebraveMummy
My 11 yr old was diagnosed in Jan and had a 9 wk stay in hospital where she very rarely ate but drank meal replacements. She had the option to eat all plated food or have to drink all replacement. Im not sure if it stopped her trying to eat solid food because she seemed to decide as soon as the meal arrived to eat or to wait for the suppliment. If she didn't have the suppliments in 20 min she was to be NG tubed. This very nearly happened but she always managed to drink eventually.  Weight was restored relatively quickly. 
She did not respond to any consequences or rewards ever. Loss of privelages made her more miserable but would not affect eating, so we eventually agreed with her team to stop trying this approach for what little joy she found was needed.  I think for some it is very effective but not for us. 
She left hospital almost entirely on drink suppliments.  Always  offered meals for 20 min then swapped for suppliments. She was discharged with instructions to return to hospital for NG at any time  if all suppliment was not consumed.  It was a written letter for the ED so no discussion needed just the proceedure then home.So we had a "power" that no matter what the nourishment would go in. There were many times that we were ready to go to hospital with babysitters arrived for other kids before she hysterically drank her suppliments. It worked. It was a strong enough and totally logical explainable outcome to not completing her meal so we could be strong and consistent  she learned we would never back down. Thankfully those days have passed for now and she eats what is plated 90 % of time. There have been no meltdowns for 6ish weeks.  
This may or may not be useful for your situation but it worked well for us.
Sending you loads of love and support.  
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mtkmbc4
BeBraveMummy, you are most fortunate that you had a team and a hospital willing to place an NG tube in the ER. Our daughter refused both solid food and supplements at home and would repeatedly be sent home from the ER (at the very same hospital with a well respected ED service!) after having eaten nothing but a package of graham crackers! She quickly learned that unless she was admitted (and she wouldn’t be unless severely bradycardic or with electrolyte disturbance) we had no power to make her eat.

It truly is a gift to have a compliant child or at least a treatment team that is willing to place an NG every single time a patient presents to the ER with serial meal refusals.
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tina72
Hi and a very warm welcome from Germany. Sorry that you need to be here with us.

It is quite normal that fights are more and less in that state. It is a rollercoaster. Some times they are compliant and then they fight you like hell again.
Can you please give us some ideas what she does when she refuses and how you react then?

You write that she is trying to narrow choices on snack. What does that mean? Do you already have started phase 2? Does she have already choices for snacks? Maybe she is overwelmed by that. Normally at that early state a few weeks into refeeding there should be no choices at all.

What did you already try for distraction during meals? Do you need ideas for that?
Keep feeding. There is light at the end of the tunnel.
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50wattplexi
tina72 wrote:
Hi and a very warm welcome from Germany. Sorry that you need to be here with us.

It is quite normal that fights are more and less in that state. It is a rollercoaster. Some times they are compliant and then they fight you like hell again.
Can you please give us some ideas what she does when she refuses and how you react then?

You write that she is trying to narrow choices on snack. What does that mean? Do you already have started phase 2? Does she have already choices for snacks? Maybe she is overwelmed by that. Normally at that early state a few weeks into refeeding there should be no choices at all.

What did you already try for distraction during meals? Do you need ideas for that?


Hi Tina.  She is typically quite anxious at meal times (e.g. how much longer until it's ready?, etc.).  She usually starts pretty strong (albeit she eats sequentially) at some point she just states she's done and will try and leave table.  She will go into our den and pace or make a friendship bracelet....clearly the anxiety manifesting itself.  My wife and I will emphasize that her meal is her medicine and she needs to have everything presented but she is resolute.  We try to disengage from the ED, tell her e love her/support her, acknowledge her fear/pain but it hasn't worked the past few days.  We are simply heartbroken and overwhelmed....I never imagined an ED could be this kind of nightmare.  We see pediatrician tomorrow and psychologist on Tuesday...hope they can provide some guidance.

With regard to snack she was eating peanut butter/graham crackers and is now pushing for yogurt.  Last night when she refused I told her she needed to go to bed...the ED was pissed but we're at wits end.

Thank goodness for a site like this....it is so helpful to talk to people who actually understand this horror....thank you all!
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Foodsupport_AUS
Welcome to the forum. Parenting your daughter back to health is going to be one of the hardest things you ever do. There is no specific recipe that works in terms of getting your daughter to eat. Resistsnce is normal and expected. Behaviour thst they have never done before is expected. It is truly challenging. You have done a great job to get her starting to gain. It is common for residtance to sometimes increase. The trick is for you as parents to plan howmyou will attack this.

A few ideas. If possible try and keep to fairly specific meal times. They are often anxious about meals and serving at an expected time is useful. At the same time don’t become a slave to this. It is worth hemming her in during meals so she can’t get up from the table. Settimg expectstions that meals will be completed no matter what, and that there are consequences for not finishing can be helpful. Please ask your questions. 
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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50wattplexi
Thank you.  The really frustrating part is that while we are in FBT Phase 1, the therapist doesn't really feel like any type of individual therapy for my daughter would be helpful but I KNOW she's in pain and can't but help thinking talking to someone might be helpful.  The therapist is very highly regarded so we're putting our trust in her but it is SO HARD....
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Ellesmum
Great job so far, 
distraction at meal times can be useful like eating on the sofa in front of a film, I agree with aiming for regular mealtimes, I found incentives worked better ‘finish up then we’ll order you a X’   Right now telling her food is medication may be futile  as it’s normal for them to not want to recover early on, luckily we don’t need their buy in at this stage.   
If you can get that yoghurt in, double cream mixes well, it’s vital to get lots of fats in by any means possible. 

Its hell on earth, I’ve spoonfed my teenager before, whatever gets it in is fine by me.   Try hard to stand firm each refusal but you can give yourself a break too when you get to the end of your tether like a breezy ‘oh, ok you don’t want snack just now, no problem but it needs to be eaten by 7pm’ or whatever, this way you get a chance to regroup and take a breath while not actually giving in to the ED, it sets an expectation and sometimes worked well. 
Ellesmum
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scaredmom

Welcome to the forum. 
I do hope you find the information and support you need to help your child. 
As you can see from the replies above, that there is no one way to do this. It is common for there to be resistance that is so overwhelming. My d to was super compliant in hospital and no one prepared me that things would go very differently at home. (Just an aside here- that information would be helpful for all IP teams to convey to families!! That is part of the Education the families need- it is mandatory in my opinion. Would have saved a lot people some grief).
You are doing all the "Right things" so please don't take it as a failure. It is "ED in her head" that is making this happen.

Some have found distraction helpful, some have not (ME), some have found that gentle coaxing helpful, some have not (ME). We found that saying absolutely nothing and not even looking at her was the best. She would stare daggers at me and I would have to avert my eyes and the other kids could not speak to her either. She sat next to her dad who quietly insisted with no emotion she would finish and she would. Even after throwing food around too. I will post deenl's thread about super-resisters too. We have to figure out how to manipulate the ED in our homes. Although they quite similar, some ED's "personalities" need creative solutions. And unfortunately, our child is unable to tell us how to manage their particular version of ED.

Also a word of caution: no eating for 24 hrs (some say 48 I just get too  anxious for that to happen) and no drinks in 24 hr - get her to the emergency department.
When you see the team, please ask them for contingency plans. They should be able to give ideas of what others have done in similar situations that you may try too. 

My d too was anxious about when the food would be available. They do like their schedules and at the beginning we kept to the hospital schedule, it made her feel safe and over time we mixed it up, but not until she was less fearful. 

It does get better, it just takes time and a lot of it.

When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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scaredmom
Here is the thread that I referred to above. 
There may be some ideas here that click for your situation 
https://www.aroundthedinnertable.org/post/the-super-resistors-when-lsuye-and-magic-plate-cause-total-shut-down-8122350?highlight=super&pid=1308670048

Please note, it gets worse before it gets better. I am sorry about that. Also you mention getting someone to talk to for her. She is so ill in her mind she cannot get out of her mind.. I hope that makes sense. That is like talking to an alcoholic while drunk. Right now the food has to take effect and help her brain. I thought too if we talked to her and got her to see the light, she would eat. It does not work that way. Her behaviours and moods are a manifestation of her malnutrition over time they may get better or not and then other mental health support may be required. My d has anxiety and although it was there with ED, it did get better  with food and time, but she is also on meds and gets some support for her anxiety in the last 6 months or so.
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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sk8r31
Chiming in with a welcome as well, and sending warm support.  You have already had some really great suggestions on how to move forward.  We have a saying here, "Feedback not failure", so try some of the ideas above if they resonate with you, and tweak as needed. 
When our d was first dx with AN at age 14, I desperately wanted someone to tell me exactly how to help her.  I thought if I found someone's situation that was 'exactly' like ours, I would know how to eradicate the ED.  It was a steep learning curve, trying to get a handle on the illness, and it took ages to realize that our kids and our families are all 'snowflakes'...similar but unique.  Similar techniques may work with one kid, but not another.  Strategies around meals and snacks may work for a while, and then not.  So read and ask questions and adjust your 'tool kit' as needed.

And a quick word about self-care.  It is essential for you and your partner to be in the best physical and mental shape possible...so take time daily, even if just for a few minutes, to do whatever you are able to recharge your batteries.
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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tina72
50wattplexi wrote:

She is typically quite anxious at meal times (e.g. how much longer until it's ready?, etc.).  She usually starts pretty strong (albeit she eats sequentially) at some point she just states she's done and will try and leave table.


That is quite normal for that state. The secret is distraction, distraction, distraction and making leaving the table impossible. Put her between you and your wife, lock the door if needed. Make escaping and not eating impossible.
We ate a lot in front of TV watching funny shows. Some do card games or crosswords. You need to try what makes her "forget" a bit that she must eat.
Keep feeding. There is light at the end of the tunnel.
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tina72
50wattplexi wrote:
Thank you.  The really frustrating part is that while we are in FBT Phase 1, the therapist doesn't really feel like any type of individual therapy for my daughter would be helpful but I KNOW she's in pain and can't but help thinking talking to someone might be helpful.  The therapist is very highly regarded so we're putting our trust in her but it is SO HARD....


To be honest: the therapist is right with that. In most cases individual therapy like CBT does not work at all as long as they are malnurished and often is not needed any more once they are weight restorated and brain recovery has started. So at the moment she needs nothing but food, love, and food. And more food. 🙂 No talking at all helps her with that pain, only practice and seeing that nothing bad happens when she eats a cookie. It is mostly exposure therapy. Did you already watch the great bungee jump video by Eva Musby (you can find it on youtube)? She describes very good why talking and explaining with logic that this cookie is safe does not help at all.

"We are taking privileges away when meals are not complete, but the past few days have been maddening."

Did you already try to work with incentives? Is there something she is keen on that you could use as leverage? It must be a short time leverage, such as "when you have finished lunch we can go to the neighbor so see their puppy". Some parents "payed" their kids for eating, with money for extras or with video games or we for example payed my d with driving lessons 🙂.

In addition to the book mentioned above I would suggest you read Eva Musbys book "Anorexia and Other Eating Disorders: How to Help Your Child Eat Well and be Well". You will find help with nearly every situation you will get into in the next weeks/months there.

"With regard to snack she was eating peanut butter/graham crackers and is now pushing for yogurt.  Last night when she refused I told her she needed to go to bed...the ED was pissed but we're at wits end."

If she refuses the crackers and wants yoghurt make the yoghurt portion equal in calories to the crackers and then it would be o.k. in my eyes. I think she just asked for yoghurt because it seemed to be less calories to her but it is also possible that she had liked to have yoghurt. It is o.k. to want something different but it must be clear that it is same amount of calories.

About sending her to bed: that is no good idea. What did she learn from that? She learned if I refuse to eat I am send to bed without eating and can avoid eating that way. Better signal would be to sit down besides her and say very calm "I can take all time that it needs. I have the whole night if needed to get you to eat that snack." Not eating must be impossible.
Keep feeding. There is light at the end of the tunnel.
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50wattplexi
tina72 wrote:


If she refuses the crackers and wants yoghurt make the yoghurt portion equal in calories to the crackers and then it would be o.k. in my eyes. I think she just asked for yoghurt because it seemed to be less calories to her but it is also possible that she had liked to have yoghurt. It is o.k. to want something different but it must be clear that it is same amount of calories.

About sending her to bed: that is no good idea. What did she learn from that? She learned if I refuse to eat I am send to bed without eating and can avoid eating that way. Better signal would be to sit down besides her and say very calm "I can take all time that it needs. I have the whole night if needed to get you to eat that snack." Not eating must be impossible.


Thanks Tina....some great advice.  Agree that sending her to bed early is not ideal but even if we calmly tell her we'll spend the whole night supporting her to finish, she's steadfast.  Not sure she'll listen to reason (and understand that at this stage it's virtually impossible) but will try and continue to disengage the ED and just keep telling her we love her and this is necessary to restore her health.  She actually gets nastier with me versus my wife as I think the ED knows I will never back down from it.  I can live with her (or I should say the ED) not liking me for however long it takes...was just hoping it would be related to normal teen stuff!
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tina72
No, that is no normal teen stuff, that is ED.
It is also normal that they are nastier to the part of the parents that sets the rules and boundaries and fights ED more.

"Agree that sending her to bed early is not ideal but even if we calmly tell her we'll spend the whole night supporting her to finish, she's steadfast."

Have you ever tried it? I think she does not believe that you mean business. It is one thing to say it and one thing to actually DO it. My d was very surprised when we started to exactly do what we announce. She did not think we will be that hard. One day we were sitting at the table for about 21 hours in total. It was the last day she refused anything. She was very tired when I woke her up after 3 hours sleep because it was breakfast time....she never wanted to do that again 🙂.
Keep feeding. There is light at the end of the tunnel.
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scaredmom
hi 50wattplexi,
Just checking in and hope all is well on your end.
All the best,
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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50wattplexi
Thanks for checking in scaredmom.  Week has been fair....she continues to eat but won't finish certain meals and will try and negotiate less nutrient dense snacks.  My daughter actually shared with our lead psychologist that she realizes she needs help, feels she would focus better in a dedicated facility (to continue restoration) and feels badly she's causing us pain.  After consulting with our team, we considered both UCSD and ERC Denver and looks like we're going to go with Denver (in speaking with both programs, they both seemed great).  It will be tough having her away for a time, but we have time over the summer to really focus on getting better and will devote time out there as a family during step-down.  I hate this disease and we will do everything in our power to help her beat this...

I'll keep everyone posted.....
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scaredmom
I understand how hard it will be not to have her at home. You are correct to say you have time in the summer to really focus on getting her better.

wishing you continued strength,
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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