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

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lberyan
My 15 year old was diagnosed a year ago with AN at 67 pounds. We practiced FBT with a well known eating disorder program with some higher care (6 hospitalizations) and stabilized her after 7 months (reached 86 pounds with last hospital stay). We continued FBT till about March and then it go spotty - my husband "quit" FBT and I was working too many hours to take on the full care. We mildly monitored our girl had she managed to stay at 86 till June/July when she had a weight loss of 10 pounds over about 4 weeks. We're now looking at the options -- back to FBT with mostly me, the mom, taking it on or residential. I welcome any thoughts on the best way to go. Our girl is significantly better than last year (not violent, not hiding food, not throwing or hitting) and I'd of course, like to keep her close. Docs are mixed in opinion. Thanks for your help.
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ValentinaGermania
I think I would make a lost of pros and cons of both options in your situation.
Can you stay at home with her 24/7 and afford that? Do you have help if hubby cannot help you?
What would happen after residential? She will not come home cured and recovered for sure...so you might need to do FBT then again anyway...
You know what to do and how to make her gain and that is means you are better prepared for that than most of us were at the first start.
But if it would ly all on your shoulders, can you do that?
Keep feeding. There is light at the end of the tunnel.
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lberyan
Thanks for the thoughts. My hubby will help a bit but my village will the doc, therapist, nutritionist. You're right - I'm broken in on what to do with FBT. Can't be 24 X 7 but I can handle after 5 everyday. If residential is a stepping stone, I'd rather just go right to the permanent work of FBT. 
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Enn
Hello and welcome. I do hope you find the information you seek and support.
A couple of things I note your d’s weight is very low for a 15 year old. Ie 76 pounds ? 
I do hope she has proper medical follow up. My first course of action would be to ensure she is medically stable (orthostatic vitals heart rate and Blood pressure lying and standing). It depends where you are geographically to see if residential would be viable. If it is a reputable place,  then maybe residential may be the first  step to get a lot more weight one her with more supervision of her eating. But currently what you write about her weight is sending me some red flags about her acute  health.
You say she does not hide food or throw. May I ask what she is eating and how can we help to get the weight up? Are you under a specialized ED team? 
No matter what you choose, unfortunately your d will need a lot of 24/7 supervision of all meals for a long time. It is the reality of ED. Are there other family members that can share some of the responsibility with you and your h?

My main worry right now is her very low weight.
 
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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Kali

Dear Lberyan,

It is a big decision and each family must come to their own way through this. However if your daughter is 15 and weighs 76lbs that is very low, although you do not say how tall she is. Is she being carefully monitored by an MD? 

There are some reasons to choose residential over home care. 
Low weight
Suicidality
Food refusal
Purging needs to be interrupted
The parents are working and cannot supervise and serve all meals.
Self harm is part of the constellation of symptoms and needs to be interrupted
The family is under a great deal of stress or have been doing FBT for awhile and not making adequate progress with weight gain.

There is no right or wrong way to help a child get well. What is important is that the weight goes on; whether it is at home or at a treatment center or hospital it doesn't matter. For us, a residential stay of 3 months was important and was the start of remission although our d. did not come home cured by any means she was weight restored but it was a long road afterwards to get her to keep that weight on. I would say that if your daughter has effectively only gone from 67 to 76 lbs in a year, then something needs to change. IMO only being able to help after 5pm would not be sufficient in this situation. 

Some other things to consider:

Could you get a leave of absence from work to supervise all meals for an extended period of time?
Which treatment centers could you consider for weight restoration?

warmly,

Kali




Food=Love
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Foodsupport_AUS
As others have said there is no right answer to this, but her weight sounds very low and if she is currently losing weight she will be at high risk of medical instability and re-feeding syndrome. Her medical oversight is really important. 

FBT does not usually use a nutritionist/ dietitian - is there a reason you have been using one with FBT to date? Was your therapist FBT trained or were they just supporting you in re-feeding at home?

 I think if  you are going to go down the FBT route, there needs to be someone there 24/7 for all meals and snacks as well as to supervise activity, purging etc.. If you can't manage that it may be better to consider a full time program or one that can support those meals that you can't supervise. Getting her fully nourished is the number one priority at present, given her weight it is likely that full weight restoration could take 6 months or so - so there has to be room for full supervision for all of that time plus afterwards to support her. 
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
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Mamaroo
Is it possibloe to take off some time at work? I dramatically reduced my working hours and honestly I can't see how you can do FBT if you're still working full time. Meals and snacks took forever and then you have do deal with the emotional fall out from it. On the other hand, like Tina said, you can send her to residential, but they don't come home cured. Do you have family that can help out with supervision during the day?
D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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lberyan
Thank you all for the caring thoughts. I did take off work for many months during the past year but unfortunately, I support the family and can't go on leave or reduce to part time because we need the med benefits and income. Thinking I will adjust my hours as best as possible to supervise all meals but lunch and will lean on my hubby to step in when I can't be there. May also look into a caregiver to assist. Feels like a long road ahead...
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ValentinaGermania
Can lunch be supervised by a school nurse? It would be no good idea to leave lunch unsupervised...
Keep feeding. There is light at the end of the tunnel.
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Enn
lberyan, 
Just thinking about your situation. I do hope all is well on your end and that you were able to get a medical assessment for your d. 
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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