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

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tassie_star_5
After making some progress, my D, 13 has started restricting and refusing food again.

She has settled very well into a new school and being teachers at the same school, we were able to supervise lunch in the school yard where she could eat and connect socially. This can no longer happen as she has now slowed down her eating to avoid having to finish food before the lunch bell.

She now has to eat in our classrooms at lunch, we share the load. She can't go to her own class until she finishes eating - this can take an hour. This means she needs to sit at the back of our classes and eat while other grades learn. I thought she'd be devastated/self-conscious about this but she doesn't seem to care at all. At the moment, this seems to be the only option.

She is raging at home during dinner, breakfast and snacks - fighting, trying to compromise or flat out refusing. If she does eat, meals can last up to 3 hours.

I don't feel this is an extinction burst but that possibly with a new routine she's lost a small amount of weight and this is all it's taken for the ED thoughts to escalate. But now she's fighting us more than she ever has. It's worse than it's ever been. Far worse than the early days of re-feeding.

CAMHS feels like a waste of time as it's simply talk and she's not at all in a rational enough place to engage or accept she needs help (only been 3 times). The hospital clinic will only help if she becomes medically unstable. It's terrifying to think we'll only get help if she's near death's door again.

I get that we need to increase calories, fats etc. and aim for a higher weight but when she is now scrutinising everything, challenging, wanting to compromise, restricting or flat out refusing, how are we supposed to do this?

Any words of advice, encouragement or wisdom would be appreciated.
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Foodsupport_AUS
I am sorry to hear that she seems to be going backwards. 

Unfortunately some kids get a lot worse before they get better, mine did. 

I assume that you have some form of medical supervision for her? Is she getting weighed regularly and getting orthostatic measurements done? Do you think it is possible she has added in other ED behaviours so that she is restricting even more or perhaps purging? All of which can sometimes make things seem worse. 

In general in Australia yes the only indication for hospitalisation is medical instability. A few of the private hospitals have some eating disorder units but mostly not for adolescents. Not sure if there is one in Tasmania. Otherwise yes it is down to us to get that weight on with the most intensive program that can be managed. 

If she refuses breakfast does she still go to school? Are you able to sit with her until each meal is done? Essentially the only options that we have as parents is to make sure that every meal is sufficient and every meal goes in. 

As for CAMHS remember at present this is as much for you as it is for her. It is not for them to convince her she needs treatment or even to help her feel better. It is to support you to make sure that things are moving forward. 

Perhaps assessment first as to what else is going on may be a good next step? It may be she is not well enough to be at school. 
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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tina72
"fighting, trying to compromise or flat out refusing. If she does eat, meals can last up to 3 hours"

What are you doing when she refuses to eat? What consequence does that have at the moment? Same question with meals lasting 3 hours, did you already try to have the rule that when meals are not finished within an acceptable time she needs to have a supplement?

It is very possible that you see this behaviour because she has lost weight. Can you add more fat to the amounts she is eating to get that lost weight back soon?
Keep feeding. There is light at the end of the tunnel.
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tassie_star_5
Thank you, Foodsupport, really appreciate your input.

Yes, breakfast is always finished before school day starts, even if she has to bring it to school and finish with us in our classrooms. Every meal/snack is supervised, as is bathroom use as I feel that the ED is so strong at the moment that anything could start happening.

Yes, medical supervision is happening. Because she'd made such great progress - rapid weight gain in a short amount of time - she is having weigh-ins every three weeks. Because over the last couple of weeks we seem to be back down the rabbit hole, I will need to change this so that they can regularly check her orthostatic readings more regularly.

I'm thinking CAMHS might be a bit of a lottery?

Will definitely get her assessed asap. Unfortunately our appointment was cancelled on us today. I was devastated. Could be a long and difficult weekend....
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tina72
Is there anything she likes to do you can use as incentive to make her eat faster? Getting smartphone back or playing games on Ipad?
I would also think you might need to take her out of school for some time to get back on path...
Keep feeding. There is light at the end of the tunnel.
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tassie_star_5
Thanks Tina. When she flat out refuses, we explain we are in it for the long haul, stay compassionate and calm (easier said than done), weather the storm and sit it out. Exhausting but the only thing that seems to work.  Eventually the food goes down. For some reason, supplements have never worked for her. She's less likely to consume them than food.

Likewise, consequences or incentives have never worked.  Removing devices, social outings, or anything else makes no difference I'm afraid. All that matters is not eating and she'll sacrifice anything....

But thank you Tina, we'll keep pushing those fats.
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mimi321
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I get that we need to increase calories, fats etc. and aim for a higher weight but when she is now scrutinising everything, challenging, wanting to compromise, restricting or flat out refusing, how are we supposed to do this?


Sorry things are so tough right now. It sounds like that little bit of weight loss kicked ED into high gear again, and you know what needs to be done, it is just the doing is not easy.

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When she flat out refuses, we explain we are in it for the long haul, stay compassionate and calm (easier said than done), weather the storm and sit it out. Exhausting but the only thing that seems to work.  Eventually the food goes down. For some reason, supplements have never worked for her. She's less likely to consume them than food.


It sounds like you've figured out what works for you. This is exactly the approach that worked for us. It sounds like it may be just a matter of time to weather out the storm, as tough as that is. You are right to give her supervision at this time, I felt the same way, she could develop a new behaviour when feeling this desperate.

It sounds like you are on top of it. Hopefully it won't last too long and once she regains the lost weight she will get back on a better track. 
Promise me you'll always remember: You're braver than you believe, and stronger than you seem, and smarter than you think. - A. A. Milne
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scaredmom

Hi,
I am sorry it is so difficult right now. 
"Eventually the food goes down."
That is the statement that tells me you are doing well! She may tire of this resistance soon, I hope. 
Yes, to medical assessment. I found I needed our team more regularly even when d was stable. Kept her and me on our toes. 
Is there something happening at school that you do not know about? Friends etc.?
Just wondering if she is anxious too about something and is worried about telling you? When my d was anxious about friends or school work she would fight me more. 


XXX

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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mimi321
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Just wondering if she is anxious too about something and is worried about telling you? When my d was anxious about friends or school work she would fight me more. 


True with my D, and it often took a couple of weeks for her to tell me about it so we could work it out. Having said that, she was better able to cope with these stresses with more weight. Sometimes "issues" became "non-issues."
Promise me you'll always remember: You're braver than you believe, and stronger than you seem, and smarter than you think. - A. A. Milne
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tina72
"She can't go to her own class until she finishes eating - this can take an hour. This means she needs to sit at the back of our classes and eat while other grades learn. I thought she'd be devastated/self-conscious about this but she doesn't seem to care at all."

Maybe someone of her class said something negative about that to her and she just fakes that she does not care...
Kids at that age can be really cruel if someone is a bit different.
Keep feeding. There is light at the end of the tunnel.
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tassie_star_5
Thanks Mimi, Scaredmom and Tina. Yes, I'd considered the fact that something might have happened at school that's not helped.

I have some strong relationships with the kids in her grade (I'm the Head of Pastoral Care). I've subtly checked this out with a few students I trust who are mature, sensitive souls and they haven't seen or heard a thing. Likewise with her teachers and a couple of parents who are close friends of mine whose kids are in her grade who I've given permission to pull me up if they observe anything that I'm missing or overlooking. Of course this doesn't mean nothing has been said or that she's not experiencing stress but I've tried to cover all bases. We've also made it clear that there is no expectation to do homework, assignments, tests etc 

I know the whole school package could just be too much at the moment but she says she's enjoying it and is really engaged there. I do believe this awful regression is purely down to the ED and it's hold on her. We'll keep pushing the fats and calories. Just difficult when nothing seems to be working and her resistance is increasing daily.

Thanks once again.
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mimi321
Yes, seems likely. Just wanted to note that with my D the thing that was bothering her was a misperception or misunderstanding, no one would have noticed, having to do with her perfectionist trait I'm guessing. My D didn't do well on an assignment and the teacher told the class no one in the class should be getting marks in the 60's or 70's. My D got a 65. My D felt singled out and took it quite personally, and discouraged that she wasn't living up to her teacher's expectations (and likely disappointed in herself that the assignment didn't come as easily to her). She said the teacher hates her and is afraid she will yell at her if she asks for help. The teacher is somewhat stern and the class probably does get chatty, and I'm sure she raises her voice. I had to unpackage this with my D (her perceptions) but also had to speak to her teacher to let her know why her current assignment wasn't passed in (she lost the sheet as she is having organizational issues and was afraid she'd be yelled at in front of class if she asked for a new one). It was a little awkward but I think the teacher got it, as apparently the next time the class got too rambunctious she had them do a relaxation activity. But all of this was brewing internally for two weeks before my D finally told me, so you just never know! I can't say for sure but this extra sensitivity seemed to coincide with an overall dip (trouble sleeping, food pickiness) that seemed to improve with upping fats. They are just so sensitive at this stage aren't they, a little setback seems like it can really set them back. Best wishes!
Promise me you'll always remember: You're braver than you believe, and stronger than you seem, and smarter than you think. - A. A. Milne
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