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

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meadow
Hi

Another problem we're having with D (8) is very rigid ways of wanting things done.

I've written quite a lot already about her extremely restricted range of foods. There are currently about 6 items she's happy to eat without a major fight. This week we have started plating up meals that she previously ate, and she's eaten most/all (with a lot of physical aggression), but the biggest problem is that what we gives her looks bigger to her than her 'usual', which was ham sandwich.

She will eat the new foods if we physically pack them to look like a sandwich!

On one hand I believe she needs to increase her range of foods and if this is the way to do it then so be it. On the other, this feels like getting into negotiations with ED, which we don't want to do.

Meanwhile, it's a lot easier to get the calories in when she has her safe foods (and it's still not at all easy).

She had a thing about only drinking out of shot glasses. We got partly on top of that, but again she drinks a lot more if we allow them. She is terrified of bigger mugs. I know this is a thing.

I imagine these behaviours are fairly common. Would again very much value any thoughts,
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AUSSIEedfamily
Dear meadow,

ED has the ridgid ways.

ED likes the shot glasses & things that are equal to a ham sandwich. The important thing is to challenge ed & help your D to challenge ed.

However if you can vary the times where/when you challenge ed and go with the easy to eat things at other times might be an idea.
ED Dad
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Dobbin
Dear Meadow, I don't know if this approach would work for an 8 year old but it worked for my then 15 yo. I worked tactically (for maximum calories) from what she would eat and always kept in mind what was "normal" (the concept of "normal" is recommended by someone on this forum and it worked really well for us). So if the fillings you are adding to the sandwich are things which you might find in a sandwich in an adventurous deli, then go with it but only for one meal a day because normally, we wouldn't eat sandwiches for both lunch and dinner in a day. After a few days of more adventurous fillings, you can allow some of the filling to spill out, eg tomatoes become a side item...
It sounds like you got her eating spaghetti? I'd now work on that. Provide spaghetti again for a few days and then add another pasta to the spaghetti so that it's a mix of shapes. Go for sauces which mix in well and then gradually up the quantity over a few days. The following week, maybe add some small pieces of potato and work on increasing the potato ratio - basic macaroni chees/tuna pasta bake recipes are excellent for sliding in small varieties, and you can do wonders with calories once you have a basic cheese sauce on everything!
From my experience, if the flooding approach is just too much for your family to cope with (it was for us), then I'd go for a rapid ladder and a lot of tactical food games (games on your part of which your daughter should be totally unaware) to get the variety in and to shake up the rigidity - so for example, I remember playing about and having "dinner" at lunch time and a sandwich for tea...then also breakfast out, meaning porridge at tea time, but only after I'd got some variety going which differentiated the different meals.
And as recommended on here, shakes of almost any sort can be a really good tool in your box. These can start small and be initially just fruit so long as you move on fairly quickly with the variety.
Sorry, I can't help with the shot glasses problem. It sounds really difficult and definitely like one you need to get her away from. Can you accidentally break them all in a washing up catastrophe?
I wish you all the best...
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Psycho_Mom
Hi,

Yes, when our d was really ill and underweight she was terrified of things "looking big". She also had lots of fear foods (she ate only about 10 things comfortably, mostly veggies and tofu, but thankfully also granola and nuts). She also tore her sandwich into little bits, ate all but the corners of crackers, hid food under lettuce leaves, pushed soup on the sides of plates, only drank half a drink....yikes.

What I did was put fast weight gain as the first priority. I wanted her to gain 2 lbs a week, and I didn't care how we had to do it. I insisted on smoothies right from the start, which she resisted A GOOD DEAL at first. Then I served her a lot of her "safe" foods which was mostly granola and nuts. Then, I modified as well as I could her other "safe" foods. I sauteed the tofu in oil and covered it with macadamia nuts (quite yummy actually). I put cheese sauce on the broccoli (no it wasn't easy but it was easier by far than trying to feed her cheese sandwich).

Meals took a long time and there were sometimes panic attacks and lots of behaviors. I let everything go because it was all we could do to get the food in, and that was victory enough. 

She started to gain, and the panic attacks started to lessen. Other behaviors didn't. I started with what I thought was the worst behavior, the most problematic or the one most likely to actually keep her from eating enough.

At a calm time with no food in sight I said to her, hey, you WILL soon be able to eat like a normal person again. We're going to start working at behavior x. (I don't remember what we worked on first. Let's say it was sandwich ripping.)

And then I reminded her that other kids don't rip up their sandwich in tiny bits, it isn't normal, and didn't she want to be able to have lunch with her friends and not have them stare at her? So there was motivation.

And then I asked her for her ideas on what would help her to eat a sandwich in a normal way. She woulnd't be able to suggest anything, usually, until she was much more recovered, but I think it empowered her for me to ask. Reminded her that we were on the same side.

Then, I told her I would serve her a small sandwich with lunch (to make it nt seem so daunting at first), and she would eat it in a normal way, by picking it up with her hands, and that if she didn't, I would serve her more sandwich.

She was not happy with this plan, but it worked. 

But no, I wouln'dt have added the additional stress early on, when I just wanted to get the sandwich in in any way possible.

You'll figure out what works, and it's different for different sufferers. But put weight gain first, and keep steadily and incrementally pushing against ed, and you'll get there.

best wishes,


ps.

"On one hand I believe she needs to increase her range of foods and if this is the way to do it then so be it. On the other, this feels like getting into negotiations with ED, which we don't want to do. "

You can make it clear that you are in charge and making the decisions, and then make decisions that make it as easy as possible for her to get the nutrition she needs. Ie just serve her a plate of food and require that she finish all of it. But on the plate is mostly what you know is comfortable for her. Then gradually serve her more challenging things.

As for shot glasses, you say she drinks more when she uses them? And that at present you are having a great deal of trouble jut to get the food in? As I said, I'd do whatever works to get the most food in at present. But if shot glasses are the most problematic behavior, I'd let her know that soon, you will start helping her to be able to drink from a regular glass.

pss. If you haven't already, do look up some of the old posts of YogurtParfait. Her daughter was 6 when diagnosed and she has a lot of great ideas about refeeding a young one.
D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
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meadow
Hi,

Thanks for the really helpful suggestions. I've also just found Eva Musby's chapter on desensitisation, which has reassured me that it's ok not to try to tackle everything at once.

Extremely helpful to hear what has worked for you guys.  We had a mammoth 'flooding' session with the shot glasses before Christmas and it was hideous, but worked.  Then they started creeping back in when D went to stay away over the holiday.  We've completely stopped giving them to her again over the last 48 hours, and she is coping with a variety of mugs, as long as they're not full to the top.

Good idea to try to vary the times and we've started doing that this weekend. We will also definitely build on the spaghetti.  

We have a referral for a dietician (not in CAMHS though), but don't have an appointment yet.  We have a meal plan but to be honest there's not one thing on it that she would eat. AAgh, if only she would have her bread toasted! Maybe I could start by just warming it up?!  She won't have any sauces at all yet. 

We had a bit of success when a friend came over this week (although she just kicked and scratched me from under the table instead of in full view).  Yesterday we had an adult friend over and D kicked and hit me for a good 15 mins or so in front of him :-(.

Also had some success today with choosing between two feared foods - hurray. 

We don't have a problem with baby utensils, but come to think of it she hasn't used any cutlery for at least a month, because she has only eaten finger foods.  Also, I tend to get anything sharp out of the vicinity at mealtimes for her safety and mine! 

Thank you for those tips on breaking some of the behaviours. Psycho-mum - definitely some similarities between our Ds.  I feel better getting it clear in my head that getting the weight on needs to be priority. I'm so tuned in to ED's horrible ways and behaviours now that I've probably been getting myself too worked up about changing everything at once. 


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Torie
meadow wrote:
She had a thing about only drinking out of shot glasses. We got partly on top of that, but again she drinks a lot more if we allow them.


I'm sorry, but I can't remember what she is drinking.  Full fat milk, I hope.  If so, can you / are you adding cream to it?  I agree that what matters most right now - by far - is getting the weight on.  

Please remember that it does get better.  Really. xx

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

Yes, full fat milk Torie. Sometimes I add cream but she can tell.

Haha, I think this illness is trying to mess with my head. This morning I told her we were increasing from one and a half pancakes to one and three quarters (mentally preparing for a battle, removing a pair of scissors from the area, working out how to get other D to school etc)...She said 'ok', and just ate it!
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Torie
meadow wrote:
Haha, I think this illness is trying to mess with my head.  


It sure did a number on mine!

So glad to hear the happy surprise about the pancakes.  There's just no way of guessing what tomorrow will bring with this vile illness. Keep up the good work! xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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meadow
The most heart-warming thing about it was that our 5 year-old beckoned me over and whispered, "she's getting better". So astute x
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meadow
Aw Toothfairy, you're such a love. Who knows what horrors tomorrow may bring, but I will be treasuring this morning's beautiful surprise x
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mjkz
This illness screws with our heads just as much as their head but you are doing so well Meadow.  Keep kicking ED butt.
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30BT
HI Meadow,
I think you are better to increase the food and types before tackling all the ED behaviours. It took me over 6 mths to stop my D from eating with a teaspoon, once she started to eat and be refed I picked my battles. I would much rather her eat but with a teaspoon than not eat at all. Still battling some of the ED behaviours, one at a time!

Mum to 17yr old girl with AN. Fighting hard for recovery since she was 13.
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meadow
Hi, thank you. I'm impatient! But learning to accept this will take longer than I want. We seem to be making a bit of progress every day every day at the moment at least x
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