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Our daughter is 14 and has anorexia

We started FBT around 4 weeks ago

Her heart is back to good resting levels but still too much variance between resting and standing. We hope that will get within normal range soon.   Her weight has been roughly flat over the last 4 weeks and we think she needs another 10 kg to get to healthy weight

We are following Eva Musby as well as our psychiatrist/counsellor in terms of approach but appear stuck.   I would say last week she had maybe 2,200-2,300 calories if I start with our goal of 2,500 less what she left on the plate and refused to eat.  (I must say this ED is so terrible and awful and we are so proud she got from what was 1000 cals a month ago to this level!) This calorie count includes a very heavy dinner (we add lots of butter, cream, oils) but we know we can add more to breakfast and snacks. She has many 'fear foods' (candy, chocolate, ice cream, and so on) and we read that this pretty typical.  

This week we told her we need to add more and we agreed to one additional thing - a smoothie which we think will add another 300-400 cals if we can get some yogurt in there.  We are trying to ladder things in vs go too fast with things like ice cream just yet. But it's going slower than we'd like

Ideas and inputs appreciated.  

Hi there, 
Most of our kids need so many more calories than we ever thought. My d needed 4500 cal per day to gain properly. I know you are adding in the extra calories. How many meals/snacks per day is she getting? We needed 3 meals and 3 snacks and one of them was a 800-1000 cal smoothie/shake whatever you want to call it. 
Juice, frozen fruit, hagen Dazs or Ben and jerry's ice cream (they have more cal per cup than the other ones generally speaking), heavy whipping cream and yogurt and canola oil and sugar!! 
We found that it was not helpful to discuss changes in plans with d. It added too much anxiety and then she would fight with me.
What we did discuss with her was adding in the fear foods. So for example once she was used to having her 3 meals and snack, then the team would suggest a new snack like a donut. (this was done through me calling the team first). The team presented any new food item I wanted to tackle that week to d so that they took the heat. I then could say to d :"well it is time for a donut this week. The team said so." 
What is she eating and drinking? high calories drinks are a great way to get the weight up. 

Remember it is only a few weeks at this point. You are still learning what your d should eat and how you will make it happen. Does she over exercise? Is she hiding food or purging? 

Please ask all the questions you have. 

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)
We put a tablespoon of heavy/double cream every time she has a full fat glass of milk which is four times a day  (got this idea on this site). I thought my daughter would notice but she didn’t! We also added 40g of Brazil and cashew nuts at supper which upped the calorie count for us. We have to keep a close eye on disappearing nuts mind you!
15 year old D. Started to feel low summer 2019. Fall out with friends October 2019. Depressed, self-harming and suicidal from January 2020. Diagnosed with AN July 2020. Slowly coming out of it and feeling hopeful for the future.
If you make your smoothie with full fat milk, a little cream, bananas, a handful of oats and add in something like ground flaxseed then you can easily pack the calories in without adding too much bulk
In the beginning the veggies were seen a "good" so we put a lot more olive oil over steamed courgettes, green beans, silverbeet, bak choi...

Towards the end we left out mooreish things like almonds, dried apricots or peanut butter to tempt her every time she passed. And little by little these snacks won, without us prompting.
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
Our main focus this week is a smoothie which we like for all the reasons mentioned above - we can start small (fruit, OJ, yogurt) but then start to add in extra items to help our D gain weight.
Our main battle is she struggles from very mean and loud thoughts that are angry at her (probably not different than many children with AN).  We try to slowly bring on these fear foods when we see a window to try it.  Yesterday was her first day of a bowl of full fat yogurt so that's a good sign (although after she bawled her eyes out because the voices were so mad at her... :-(....
Thanks for the suggestions

This week we told her we need to add more and we agreed to one additional thing - a smoothie which we think will add another 300-400 cals if we can get some yogurt in there.  We are trying to ladder things in vs go too fast with things like ice cream just yet. But it's going slower than we'd like
Ideas and inputs appreciated.  

Do not discuss that with her, just do it. She does not need to agree to add more. One thing will not be enough to gain 10 kg.
You can add melted ice cream to a milkshake as well as cream. Add the cream after mixing it or it will get too thick.
You can add up to 100 ml canola oil to 400 g fruit and juice, it disappears in the blender. Start with 30 ml and add 10 more every day. This will give you two 500 calorie drinks you can add to the main meals.
Keep feeding. There is light at the end of the tunnel.
I agree with Valentina.  This is one time that honesty is not a good thing.  When I stopped telling my daughter what was in her smoothies (and other foods) and no longer allowed her in the kitchen when I was preparing meals, things got tremendously better, and she started gaining weight.  In addition to cream and canola oil, I also found a high calorie protein powder that I added to her smoothies. 
Thank you so much eveyone!!!  We aren’t ignoring you. We are reading it all and trying to incorporate all the suggestions🙂
i add butter, cream and golden syrup to porridge. makes it taste delicious.
My magic milkshake has on it HWC, carnation milk, full fat milk and yogurt, canola oil (1 or 2 TBS), banana, nuts or peanut butter, sometimes Nutella, granola and honey. I also make a "latte" fortified with HWC and canola oil, butter and cream in scrambled eggs and everything else really, I fry eggs in the bacon fat. Mashed potato also with lots of butter and milk. Even cereal with milk is fortified with carnation milk. I have cut a very little bit and we are almost 9 months WR, my D needs loads of very rich food just to mantain.
13 yo d started to eat "healthy" September 2018, she had a growth spurt a bit later, followed by tummy bug. She started restricting breakfast and school lunch in January 2019 (that we know). We succesfully refed at home.
I have found inner strenght, patience and compassion that I did not know I had.
Never retreat, never surrender
keep feeding
I danced around fear foods and making things my D would eat for a few weeks, but in the end found it best to serve everything she ate before AN all at once. I wish I had done this from the beginning! She was terrified of dairy and fats, and I had milkshakes and chocolate milk thrown at me and dumped on the floor, but she knew that meant I would make another even bigger one so eventually she gave in. After a few weeks, and a lot of hidden anxiety and frustration on my part, she accepted it and even relaxed and I think found relief in me forcing her to eat everything. Without adding fear foods I was unable to get her calorie count high enough to gain weight, and faster weight gain means faster recovery. My favorite milkshake recipe was Tilamook ice cream (highest calorie count I could find - especially the peanut butter one), a couple tablespoons of cream and whole milk. It tasted great so no excuses about weird tastes. Muffins are also a great place to sneak in lots of calories for snacks - Kodiak Cakes makes some good high calorie ones. And definitely keep her out of the kitchen when cooking! Have snacks ready when she gets home. AN is looking for any excuse as to why she can’t eat what you’re making. Good luck!
I really piled in the calories wherever I could, knowing that the more calories in each bite, the fewer bites would be needed.  Not many veggies or fruits because that fills them up with empty non-calories.  Weight restoration causes so much misery - I really think the kindest approach is to push through asap.  

Canola oil (rapeseed in UK) became my best friend.  I was amazed to learn that it disappears without changing the flavor or texture if you stir it briskly and don't go overboard (but you can add a surprising amount).  Soups, yogurt, rice, pasta, smoothies, are all good candidates for that fortification.  Some here have even added oil to juice.  (Grape juice has the most calories.)

In the early days, I spent forever in the grocery store reading labels to find the highest calorie bread, granola bars, ice cream, etc.  That makes a huge difference.  Many people make adjustments in the grocery store parking lot, for example drinking a cupful of the full-fat milk and replacing with heavy whipping cream (double cream in UK).  You can grind nuts to a powder and add them to shakes, smoothies, pancakes, baked goods.

I learned (here) not to discuss calories, ingredients, etc. and if asked, I would just say that I don't discuss ingredients (or, "It isn't normal to discuss ingredients.")

Most find it best to keep ED-kid out of the kitchen during meal preparation.  A few people with open floor plans have put down a line of blue tape as a "Do not cross this line" signal.  Amazingly, that worked.

Refeeding was the hardest thing I have ever done.  But I did do it, and so can you.  Please feel free to ask all the questions you like. xx

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