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.

Join these conversations already in progress:
• Road To Recovery - Stories of Hope
• Events for Parents and Caregivers Around the World
• Free F.E.A.S.T Conference Videos

Visit the F.E.A.S.T website for information and support.

If you need help using the forum please reach out to one of the moderators (listed below), or email us at bronwen@feast-ed.org.

Need to talk with another parent? F.E.A.S.T. parents offer peer support via:

Blue
Our D 15yrs RAN is coming home from 3-4 weeks IP soon.  What now?

Understand this is a great opportunity to reset a number of habits, would love to get some ideas from this group of what we should consider- for example:

- do we remove the full-length mirror in her room? others in the house?
- what should we do re clothes she would have outgrown esp jeans?
- should we explicitly explain expectations/ consequences ie contract?
- considering moving from general therapist (had 4 sessions so far) to ED/ FBT specialist, any thoughts on how to manage that transition?
- as she will be WR (or close to), is some team exercise/ school sports ok to start?
- anything else we need to be aware of and/or consider?  

Really appreciate the collective and hard-earned knowledge and experience of this forum.  A Big Thank you to all of those who take the time to post.

Blue

Quote
Foodsupport_AUS
 Great that your D is coming home. Transitions are very tricky with ED and I would be very wary of trying to take things "back to normal" , such as school and sports.

 My D had numerous hospitalisations, even when close to weight restored she was not at a place on discharge that she could just carry on. She required full supervision all meals, meals needed to be on a similar schedule to her inpatient care and I also made snacks very similar to inpatient. The only thing that was different was the location.

 Only once she had settled in did we start to change things.

I would definitely start with clear expectations of what is to happen at home. All meals completed, bathroom before meals. Have a plan for meals that are not completed and how you are going to follow through on things. It doesn't need to be a contract.
Lots of people buy bigger clothes in several sizes to work out what fits, but working out how to move to large sizes depends a lot on the kid. Same goes with the mirrors. We had physical body checking, not so much mirror checking.
No to sport at school, not until you are clear how she is going, eating well and fully weight restored.
D diagnosed restrictive AN June 2010 age 13. Mostly recovered 10 years later.  Treatment: multiple hospitalisations and individual and family therapy.
Quote
Hibiscus
Hi Blue, glad your d is coming home soon.
It will mean a lot if diligence and work on your behalf. We removed old skinny clothes ( that she used to measure herself on) befote she came home and also scales. I didn’t initially cover mirrors in house but have done so lately, it seems to help my d . I suggest starting as u want to go on. That is, following eating plan established by dietician, no exceptions or breaking rules on d side of things. I would be really clear on what u expect but as she will test it, you need to be prepared to follow through on consequences.
Let us know if we can help
Xx
Quote
Hibiscus
P.s no dropping or spilling of food allowed. If u can stop the crumbling of food or breaking it apart ( if hasn’t already started) that would be awesome. Or try to stop on return home would also be great. 🤗
Quote
Kali

Hi Blue,

I hope that things will go well with the transition.
Here are a few things I did when my daughter transitioned home from being in residential for 3 months:

I had a meeting with her and the dietician of the program before she came home. The dietician asked my daughter to identify some meals she wanted to eat and had enough calories and nutrition to support her weight maintenance plan. (2800 calories a day, she is 5'3.5") I then went to the meeting, and was given the list. It had 7 breakfasts, lunches and dinners that she was "agreeing" to eat.

In the beginning for a few months we followed the time schedule of the unit as far as meal and snack times. 

I didn't let her sleep in and miss any breakfasts, I woke her up, had her come down to eat, and then let her go back to bed if she wanted to.

She attended a step down program for 6 weeks and had some of her meals there. She had to pack one meal a day to bring with her and the dieticians at the program checked what she brought and if it wasn't enough, gave her more food.

After the step down she started working with an outpatient team.
I kept a cookbook in a binder with recipes for the meals she would eat and we repeated a lot of them for months before being able to broaden the range of what she would eat and start on some fear foods.

I'll answer your questions:

- do we remove the full-length mirror in her room? others in the house?

We did not do this. 


- what should we do re clothes she would have outgrown esp jeans?

My daughter was older when she came home (18) and she had a friend come over and together they cleaned out all the small clothes and donated them. If she was 15, like your daughter, I might have taken this into my own hands and just donated the small clothes. 


- should we explicitly explain expectations/ consequences ie contract?

We did not have a contract until she went off to college. We did have a meeting with the social worker before she came home where we discussed a letter I wrote which mentioned some of the things we would want to see her working on to continue trying to get well. For example we would want her to continue in treatment as long as she needed to and we would want to be able to communicate with her team in event of any issues we might see at home. We also discussed what we would need to see her being able to do if she were to return to college. (completing meals, maintaining weight)

- considering moving from general therapist (had 4 sessions so far) to ED/ FBT specialist, any thoughts on how to manage that transition?

Sounds like a good idea. Can you meet with the FBT therapist and determine whether he/she is a good fit?

- as she will be WR (or close to), is some team exercise/ school sports ok to start?

My d. came home weight restored. The trick now is to keep the weight on. There were no sports for almost a year after she came home because she did have an exercise compulsion at her worst and that is why the doctor told her no sports. She had to be cleared by the dr. and therapist and we discussed making up the calories, before she started sports/exercise again.

- anything else we need to be aware of and/or consider? 

If your daughter was purging before she went in, no bathroom right after meals, do an activity with her if possible or watch TV and keep a close eye on her to make sure there are no signs of vomiting.

I ate as many meals with her as possible and changed up the place where we ate. We had previously battled it out at the kitchen table and when she came home we ate at the dining room table. I tried to really up my food game and make things that tasted good and presented well. There were flowers on the table, a playlist of songs she liked in the background, no unpleasant conversation during the actual meal. If she faltered she got a gentle reminder to finish up. Sometimes meals took a long time but as long as she was eating I just sat and made conversation. I ate the exact same thing she was eating with the same portions. I didn't stare at her plate or her chewing. I did have to take up some battles about caloric beverages, she was not allowed to drink water with her meal. Only full fat products at home, no diet products. I left snacky things around the kitchen on the counters. (cookies, chips, etc) and would take one and then offer her one and eventually she started taking them on her own. I added heavy cream to her smoothies and was generous with fats and butter and oil wherever possible even though she was weight restored.

warmly,

Kali
Food=Love
Quote
Enn

Hi Blue, 
I am so glad you are asking these questions. You will be really prepared!
Everyone has given you such amazing advice and mine will echo all the above. I want you to know that WR does NOT mean recovery. Usually too, the WR goal is set too low by many professionals, so I suggest keep feeding for weight gain. 

Some have removed all the mirrors in the home that could show the whole body. I think it depends if your child checked herself in the mirror a lot or not. Mine never discussed her body and  did not have dysmorphia. We did nothing to the existing mirrors in the home. 

The clothes can be a big issue for some but not all. My D was happy to buy more clothes. Some parents had to buy the exact same clothes and take out labels so that the child did not know that they were bigger. It depends how she feels about her size. Please look up "magic wardrobe"I think that is what some called it, when they exchanged the clothes without the child knowing. 

As for exercise: My D stood all the time so we could not allow any exercise at all and for sure no gym, no physical play at school or home or other extracurricular sport for about 4 months after discharge. MD had to tell D she had to eat extra if she wanted to play soccer (limited time on the field) and because D loves soccer, she would eat extra with no fuss.

Watch for "ED tricks" as I call them. As the others said above, purging, hiding food etc.. My D saw stuff in hospital that she could have learned so much from the other girls . Thankfully she did not(ie spitting out food into clothes, purging,) She did however,  hide food a few times. I did not find out until 6 months after the fact! AAAH
So keep a watchful eye.
XXX


 

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)
Quote
birdwatcher
Congratulations that your daughter is coming home!. I have read your previous posts and have noticed that some of the advice you have been given is not necessarily true.. 
- Your D at some point will have to make her own desicions regarding portions and food choices and so in my case, it was better for my D (EDNOS) to make her meals and I simply checked it. 
- Weight shouldn’t be measured in BMI or SCALES. For girls, it should be when their periods came back and all the blood work is good. Doctors gave my D the wrong estimated weight thinking she would “mentally heal” when in reality she healed through therapy not gaining WEIGHT.
And the most important piece of advice.. 
Grow your daughters trust. This disease will not last but your daughter will. If she were to find this, I am sure she wouldn’t be glad. Taking away information and ridding of her privacy isn’t fair on her. I choose to hide my D info simply because her story shouldn’t be plastered all over the internet.....
Quote
ValentinaGermania
Blue wrote:

- do we remove the full-length mirror in her room? others in the house?


If possible I would remove all mirrors and leave only one in bathroom that shows face to brush teeth.

Blue wrote:

- what should we do re clothes she would have outgrown esp jeans?


Take away all clothes that you think will not fit any more and replace them with same brand same yeans in a bigger size and remove labels if possible. If you do not find same brand same yeans take another similar one in a bigger size (and remove labels and size informations). If she asks for a special item say "must be in the laundry" or "sorry, I damaged it in the laundry, we can buy another one soon".
Do not take her to shops at the start. I ordered all by internet in different sizes and gave her the bigger size to try on first. To try on clothes that are too tight would have produced a meltdown here immidiately.

Blue wrote:

- should we explicitly explain expectations/ consequences ie contract?


I would think about that. We did have a contract but my d was much older when coming home (17). And we had that magical date being 18 coming in some months. I would at least tell her in words that you will do everything exactly the same as in IP (and I think there were special consequences, I would take them home 1:1). So I would tell her that you expect her to eat what you serve, to have 3 meals and 2-3 snacks (what you prefer) and that refusing will lead to consequences (ensure or back to IP to get tube fed). Discuss that with her team without your d what possibilties they offer for consequences.
We tried to offer some incentives in the contract and not only consequences. I have no idea what your d is keen on but our d wanted to do her driving licence so we offered 1 driving lesson for each day without arguing about meals. We offered paying for the licence at WR and buying a car when maintaining weight for 6 months (she did all that). Think about what you can offer as short time incentives (that works best at the start) and as long term incentives.

Blue wrote:

- considering moving from general therapist (had 4 sessions so far) to ED/ FBT specialist, any thoughts on how to manage that transition?


Just tell her. You are the captain of that ship, you decide what to do. If you have an FBT specialist you will see after some lessons that this help is more needed for you than for your d at the moment. She only has to eat. Nothing else. More therapy is not needed for her during refeeding and after that it is in most cases not needed any more.

Blue wrote:

- as she will be WR (or close to), is some team exercise/ school sports ok to start?


Is she already back to school? If not, I would start with half days and have lunch at home about 3-4 weeks after coming home. You will need that first weeks to find out how to manage her meal plan at home and what she needs to eat and how you get her to eat. When that works she can start school again. We had half days for 2 weeks and then went to full days but took her home for lunch every day. No tests in the first months. No school sports. She will need extra energy just to be able to go to school and not loose weight with that and you need to find out how much. My d needed about 500 calories a day extra just to go to school (brain needs more, they walk around much more etc.)
After you found out how much she needs to be able to go to school she can start school sport very slowly. No extra exercising in the afternoon at that state. Normal school sport, but no exhausting things. Talk to her sports teacher and ask for some therotical work for her while they are doing exhausting sports.
We allowed 1 hour school sports and 1,5 hours dancing (standard/latin dance in a group) after WR but my d was NEVER exercising while ill. So this depends on wether she did that or not. If she ever exercised to lose weight I would not allow exercising and sports for a very long time until you see real change in state.

Blue wrote:

- anything else we need to be aware of and/or consider?  


Be aware that transition at home is a very difficult situation and will not work from day 1. We needed about 4-6 weeks to get into a regular routine. Be aware that you will do "mistakes" and that this is no failure but learning. You will learn what to do and how to react every single day and you will not be perfect with that from the start.
Be aware that situations can get out of control and that you need a plan b for that. Be aware that you take away all things that can be used to hurt someone (scissors, knifes etc). Take away things that can be thrown and damaged. Buy plastic plates and glasses.
Lock windows and take away door keys so she cannot lock herself in. Have front door key in your poket so you can lock the front door if she tries to escape. Lock car doors while driving. I do not want to scare you but some kids do really strange things in these exciting situations and some did try to jump out of a rolling car here.
Safety is most important. Do everything that is needed to keep her safe, even if it might be strange for you at the moment. Strange situations need strange solutions. Sleep with her if needed. Join her in bathroom if needed. Eat under the table or in the basement if needed.

It is great that she is coming home. I hope I did not scare you with the things I wrote but that are the things I wished to know before my d came home. She once had a knife in her hand while screaming at me and decided to throw the apple just by luck. She once locked herself in in her bedroom and we could nor get in for 2 hours because I forgot to take away the key. So this is all just to help you to learn from the mistakes I made and not to need to re-invent the wheel.

Keep us updated how it goes and come here to vent and if you need help! We are here 24/7.
Keep feeding. There is light at the end of the tunnel.
Quote
ValentinaGermania
What I forgot:
- fill your fridge/freezer
- have your own appointments done before she comes home (dentist, hairdresser...) because you may not find time to do this for some weeks or months
- get leave from work as long as possible
- sleep as much as you can
- take the time to check and prepare her PC if you have not done that up to now (block negative sides, have the chronic seen so you can check what sites she has visited), same for smartphone
Keep feeding. There is light at the end of the tunnel.
Quote

        

WTadmin