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

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OK - First question post.....

D, 14, has a professionally designed refeeding diet.   She is generally compliant, but extremely anxious (constant shaking) about all the food.     She accepts some foods, but flat out refuses to eat some things on her plan if she thinks they are "too sweet" or "too fatty".   There are enough choices on the plan that we can work around some of the objections, but SHOULD we be doing this?   A big part of me says that if she is getting her nutrition and necessary calories for restoration, I should not add to her anxiety by forcing  her to eat the things causing the most fear.  (Actually - everything causes fear these days....I'm talking about the 9's and  10's on the 1-10 scale of fear).

A big part of her fear right now is that she is convinced that since she has visibly put on a few pounds, that she is 'OK' now and that we are all trying to "make her fat".   She has been caught doing some food hiding, attempting exercise and is monitored very closely (no bathroom time by herself, mom sleeping in the room with her) to prevent her from sabotaging these early stages of recovery.   Is this a normal reaction from the young ED patient?   She has all the facts, but is in deep denial.   

Another regular "battle" is the "anorexic behaviors" while eating.  We have been told to correct nibbling and breaking food into tiny bites.   She does both at times and we are all annoyed with having to continually remind her "no nibbling" and "take normal bites".   Could use some encouragement that we are on the right course with this one. (or correction if that is necessary!)
----    "Parenting is not for cowards."
That's a really common question and you'll get different opinions.   Some parents plow full-bore through all kinds of foods from the get-go.   Others are more cautious and decide that eating something (and enough of that something) is more important at the moment and put off the fear food thing with plans to come back to it later after some weight goes on.

I think a lot of it depends on what kind of support you have and need to get through it.   Also, are you emotionally equipped to fight the battles?    It would probably be worse to try to feed fear foods and wind up negotiating away from them because you were just too exhausted emotionally to follow through.   

If you decide not to push fear foods it does not mean you're failing - it could mean that you have made an honest assessment of your situation and realize what you're realistically capable of doing.   That's huge right there.

So far I haven't seen a role model that would work for every family in every situation.   There's a lot of trial and error involved - because our kids are like snowflakes.  
A dad.
Good job Stubby at helping your D by refeeding her.  And your question is a good one.  I agree with Jangled that this is individual for each of our children in their readiness for fear foods.

And that getting calories in is really important.  We did, however, want to ensure that my D got enough fats and proteins since they are most needed for brain healing.  One way to do that is with fats that are hidden in your D's food.  The other is to give her a Boost Plus in addition to the meals if they are not enough.  

All the ED behaviors  you are describing are what most of our children go through.  They are to be expected and mostly just acknowledge your D's distress but you will help her get through this.

The more she eats and gets back to her accurate WR range, the closer she is to brain healing.
As for the fear foods, we introduced ones she always liked, one at a time, when she was ready.

Not the first month but certainly after that.  Boy, was my D happy to be able to eat a  hamburger again.
And pizza.

Sending you hope and strength
WenWinning (formerly wenlow) - a Mom who has learned patience, determination, empathy, and inner strength to help her young adult daughter gain full remission after over a decade of illness and clinician set inaccurate weights
Thanks for those responses.  We have considered hidden fats, but we really want to be honest with her throughout this process.  

Just had a very difficult passive-aggressive breakfast.   Tiny nibbles.   1 tsp of yogurt taking 3 "bites".   Constant reminders.   Icy glares.   Silence - even when a response is requested.  

----    "Parenting is not for cowards."

How long have you been refeeding your D?  What does your clinical help say?  What type of meal plan is she on?  I probably should have asked you that first, since it really depends on where you are in the refeeding process and how much weight your D needs to gain.

We didn't use magic plate because our FBT required we work with a nutritionist.
And she met with all of us to discuss some options for breakfasts, snacks, lunch and dinner with some flexibility on our part.  Of course, she was just talking to my D's ED who didn't want to agree to any of the food choices.

I know that when my Ex fed our D he added more oils, peanut butter, etc to the meals rather than strict measuring because he knew that it would help our D get her weight up quicker.

The nutritionist added the Boost Plus in for possible snack because my D always chose things that had less fat.  After awhile, she actually preferred to drink the Boost Plus over other choices.

As for wanting to be honest, I found it really helpful to realize that it was not my D I was dealing with but really it was a monster in her brain disordered mind.  My main goal was to refeed my D and get her the nutrition she needed and not prolong her torture.

The tiny nibbles with 3 bites is ED and will get her nowhere.

Sending you strength and hope

WenWinning (formerly wenlow) - a Mom who has learned patience, determination, empathy, and inner strength to help her young adult daughter gain full remission after over a decade of illness and clinician set inaccurate weights
Stubby, we found the best thing for us was to just basically ignore anything our D had to say about food, because it was ED talking. Later on in FBT (and I mean a year down the road) the therapist talked to our D about how she felt ignored and treated like a child. BUT, our D said to us, whatever you did, worked. 
If you keep her out of the kitchen you can prepare foods whichever way you need. Do you know about magic plate? When ED asks what is in the food, you can say that we will talk about the food after the meal is over (and the anxiety has subsided). I would say I have prepared what your body needs to heal and work properly. End of conversation-change topic to something trivial and non food related.
You are not dealing with common sense or a brain that is working properly. At this stage of the game you have to just step in and take charge. It is strange parenting, but it will help your D get better.
5 years in active recovery; With many, many days of full nutrition and closed loopholes, insight, life experiences and brain maturity we are slowly loosening the safety net
D returned from inpatient hospitalization 2 weeks ago after a rapid onset restrictive ED.  We've been refeeding since.  We have a team that includes FBT, nutritionist, psychiatrist and physician.     She has bounced back from low weight, but  needs to still add 20+ lbs to get to "healthy".   She thinks she is "healthy" now, so every bite is a battle sometimes.   I know we must win and cannot tire of doing what is right, and I know that weight restoration is just a first step.           We do give supplements as snacks sometimes.   When she sees it you'd think we had given her a glass of raw sewage.   She drinks, but the (repressed) anger and anxiety are off the scale.     

[edited - I looked up "Magic Plate"]    
We are, essentially, doing a form of magic plate.    I think we may be giving her a few too many choices as part of the process.   She has no part in prep.  
----    "Parenting is not for cowards."
I remember all of this.

Here is what we did (with expert support); good solid meal plan; 3 meals 1 snack per day. Always fat at each meal; whole milk, or whole milk yogurt, peanut butter, cream cheese, 1 TBS butter, olive oil/balsamic vinegar for salad (while re-feeding we added benecalorie to yogurt and Boost+ at night in a shake). At the beginning of his recovery my son liked 3 dinners so we had them in rotation. His food choices were limited - but over time he healed slowly and added choices (with my suggestion) to the plan. By 9 months he had 12 dinners he liked so we had those in rotation. We didn't challenge fear foods and on the meal plan no hyper-palatable food for one year. That suited him and honestly me too  - since we almost lost him to this disorder.   

We set a timer on the table; 30 min for meals and 20 min for snack. All meals were compensated by boost+ if not eaten (1 boost+ if half the meal was consumed and 2 boost+ if less or none was consumed). I would say "food is your medicine" no napkin, not eating alone, I sat across the table from him for every meal and snack for months and months and months. And of course distractions galore...trivia, card games that make you choose a scenario  jokes, riddles, and always an activity right after meals...puzzle, card game, a drive, a short walk, visit a pet store, walk a dog, see a movie, go to a park etc etc etc. He had huge issues with exercise compulsion. 

Just this past 2 weeks he has really challenged himself with food choices sweets, french fries, Chick filet with friends.
It has been an extremely long journey but I think I we may be standing in the light at the end of this dark dark tunnel.

I hope some of that helps. Hang in there you're doing a great job!

Son diagnosed @ 12.5 yrs old with Severe RAN 2/11. Co-morbids - anxiety, Active restriction for 3 months. He stopped eating completely 2x. He needed immediate, aggressive treatment from a provider who specialized in eating disorders, adolescents and males. We got that at Kartini Clinic. WR since 5/11. 2017 getting ready to graduate slipping lost 8lbs. Fighting our way back.
Stubby - I don't think of the hidden fats as being dishonest, but rather a way to reach the needed calorie intake without putting an overwhelming amount of food on my daughter's plate. Without the hidden oils, HWC and butter, my daughter's serving size would be enormous. Even without ED, I would feel anxiety if someone expected me to eat that much food in one sitting. I feel like the hidden fats are a way of normalizing eating. Normal serving sizes (with an abnormally high number of calories) are one way of bringing my daughter back to healthy eating.
Daughter dx at age 14 with AN and depression. Currently 19 and experiencing a relapse.
Thanks for clarifying Stubby.  It is early in your refeeding, so what you are experiencing is to be expected.  After they leave IP and have gained a significant amount, the ED beats up on them to try to undo that weight.

So, staying the course with your consistency, confidence, calm and caring will carry her through this phase.

If you think she has too many choices, maybe start with a couple choices for each meal or snack and keep giving her the message that this food is her medicine and what will get her better.  You can acknowledge her distress and let her know you understand her discomfort.  But the only way to get rid of that feeling is to keep eating.

Trusttheprocess has some good suggestions for how to stand firm to your D's ED.
We used a lot of incentives of what we could do once my D finished eating her full meal.  
We also used a lot of distractions.  Sometimes she needed to watch a show while eating in order to not hear her ED beating her up.

She also sometimes took a nap after the meal to avoid the ED thoughts.  She would wake up feeling better.

I found that my confidence and consistency was key to help my D overcome the ED rages.  We became a team to battle her ED until she was able to do it alone.

She felt safe with me -  knowing I would not listen to her ED.

sending more strength and hope
WenWinning (formerly wenlow) - a Mom who has learned patience, determination, empathy, and inner strength to help her young adult daughter gain full remission after over a decade of illness and clinician set inaccurate weights
Proceeding with renewed sense of resolve and determination. 
----    "Parenting is not for cowards."
I found this video on how to manage an ed at home very helpful
- three teens and hubby all with special needs; blended family - D18 is Ladybug; fed at home for three months, then inpatient far away for three months. We lost nine family members in that same year including her step-mom,both grandfathers,four uncles - She now insists on living on own - family falling apart.
You're awesome, Stubby.

You're describing my house back in 2008!

Endure the silence (you might get the "I hate yous" and "F#$%^^ b#$%^" soon enough).  Same with the disgust they show at the delicious food you provide.  (That used to really bother me! but she really was repulsed--a symptom, not her real reaction).  Decide if you want to challenge the food rituals at this stage.  Sometimes these things melt away on their own with continued nutrition.  Sometimes they are easier to address once the brain is better nourished.  Sometimes you wish you'd just tackled every single symptom all at once.  YOU know what you can handle right now.  There's only one important thing right now:  FOOD goes in and stays in.

My d couldn't stand having choices.  Or I should say, she demanded choices but they were torture for her.  They were easy if there was a caloric or fat gram difference between the two--then she could appease ED (and anything that appeases ED reinforces ED).  But even seemingly innocent choices like between two flavors of yogurt was torture.  Choose the flavor she likes and risk enjoying her food?  Choose the flavor she didn't want?  There was no right answer.  It was easier on her if I made the choice.  She could hate me for choosing the wrong one or be glad she was 'forced' to eat the one she wanted.  Of course I didn't know all this at the time--it was all in her head and she couldn't talk to me.  I kind of intuited it.  She didn't remember any of it after she was w/r.

We were also 'honest' with her about not hiding fats in her food.  She freaked out about butter on her vegetables and the 2% milk (should have just gone with the whole milk in retrospect).  H has a lot of heart disease in his family so we've always had a fairly low-fat diet.  We continued to feed her her historic likes and avoid her dislikes, but they were pretty low fat so it was a LOT of food.  Enormous amounts of food.  Lumberjack portions.  She told me years later how hungry she was all the time--that the volume of food was never enough (you would never have guessed this by her behavior at the time!).  I wonder if I had loaded her food with more fats she would have felt more satisfied.  Also--those fats are very needed for brain recovery.  I wonder if she would have had a shorter recovery time with more fats.  Hindsight stuff, but I can tell you one thing:  the honesty didn't matter one way or the other.  She didn't trust us anyway.

Our experience.

You are really on the right track and doing well!!  Whatever you decide works for your family, works.
Colleen in the great Pacific Northwest, USA

"What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease."
Alexander Pope, 1688-1744