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

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Hendrixt
Hi all,
 
I know there are lots of really good threads about this subject and I have read quite a lot and picked up some really good ideas. Having been refeeding since May we now feel a little more confident that our D is accepting virtually all meals, the melt downs are much fewer and farer between, she is gaining weight and now may be the time to try some fear foods. We’ve put a list together in order of difficulty and are about to take a deep breath and try introducing some. Most of the foods on the list are of the type which can be introduced at snack times, such as biscuits, muffins, cakes ect

The question I have is; at the moment we always have the clear the plate rule with all meals and snacks so that, if she tries to leave anything we alway override any resistance and insist on her continuing and finishing the entire meal. Is it recommended that when trying fear foods, the clear the plate rule can be relaxed a little? So for example, if we offered a muffin (or maybe half a muffin in the beginning), something which she would be incredibly anxious about, is it fair to just accept that she tries to eat some of it and if she can’t eat it all after prompting and encouragement we then try to get her to eat more on future attempts. 
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workingthrough
I think it depends on you and you daughter. 

For s, if we had ever given the option of “trying” something - he definitely would have only “tried” vs. eating more.

With things we knew he ate before, we expected him to eat them again - entirely. We didn’t throw everything at him at once, but had challenges every day. Perhaps, for example, we’d have foods he was fairly comfortable with throughout one day, but have a muffin and milk for snack. We’d require him to finish it. The next day we might have a more challenging dinner, but a more familiar snack. The following day, we’d bring the muffin back. For s, it took about 3-6 times (depending on food) eating things and he was fairly okay. 

In the beginning when s was struggling we had a point system where he earned points with challenge foods. We also used distraction. As time went on, we added more challenges and just expected them vs. rewards, etc. 

One of our team members suggested s “try” something one time and sure enough, he had a nibble and left it at that. From then on, we just served fear foods as regular foods (as they are) and expected him to finish. It was rough to start each one, but got better with time. They still aren’t all his favorite foods just yet, but he eats them just fine and we continue serving them. 
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ValentinaGermania
We had the rule that fear foods must not be finished the first time we introduced them but missed calories must be filled with safe food then.
Next time it was served it was normally finished so no "rules" needed about that.

It is hard work to make them try it the first time but normally when my d knew what was introduced next she could eat it. It must be clear that trying fear food does not allow to eat less, so have some safe food in back to fill up with if needed.
Keep feeding. There is light at the end of the tunnel.
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HopeNZ
It has been our experience that, as the saying goes, 'ED lives in the last bite'.  Throughout refeeding and beyond, we learnt that we had to insist that the last bite / sip / crumbs really did need to be eaten.  And today, 18 months+ after wr, in times of stress or on particularly bad days, we know that this is the last place ED lurks for my d.  Very rarely, when my d is doing particularly well, she does just simply get full and we feel it's ok for her to leave that last potato.  But if we have an inkling that her request not to finish smacks even remotely of ED, we still insist it gets eaten.

We didn't really have to deal with fear foods per se, as my d was just terrified of all food, so I can't comment on that aspect of it.  Good luck.
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Enn
I can share what happened here.  For d at  the beginning everything was a fear food. We were fighting on a lot of things so I just pushed things like the cakes sweets and other similar things. One thing that did make it easier for us was that my d listens to others in authority better than me. So if the doctor or dietitian said that she had to have ice cream that week twice, she did it. D did not know it was because  I called the team first and said ‘ we need to do ice cream this week’ then they pretended that it was their idea so if there was  stress at home we could blame the team. Here we said she had to eat all of it and she did.

one thing that was really important for me to learn was that once you introduce that food serve it often. I know that makes sense but it is hard to do that when trying to get other fear foods in too with timing it all.  
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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Ellesmum
I ate everything with d at first, so I would also have a cake at the coffee shop for example.  I’m not keen on ice cream but I insisted we both have one on a very hot day last year when we were on a day out, same with maccies etc, I ate the same as back in the bad days she’d have the carrot bag and a diet cola, we progressed to flurries and then burgers. As above just about everything was a fear food so I dived right in but certainly it helped to eat with her. I also gave a little bit of warning ‘when we get home we’ll have a drink and a doughnut and watch X on tv’ 
Ellesmum
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Hendrixt
[QUOTE username=workingthrough userid=6371886 postid=1309047811]I think it depends on you and you daughter. 

For s, if we had ever given the option of “trying” something - he definitely would have only “tried” vs. eating more.

So if he didn’t want to finish a fear food how far would you go for a clear – would you push through massive melt-downs etc. as you would when you start initial re-feeding from the beginning?

The points system sounds interesting?


 


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Hendrixt
[QUOTE username=tina72 userid=4964560 postid=1309048176]We had the rule that fear foods must not be finished the first time we introduced them but missed calories must be filled with safe food then.
Next time it was served it was normally finished so no "rules" needed about that.

Hi Tina72 - so did you always have the clear the plate rule before you started on fear foods? But did you then you had a slightly different approach on fear foods?

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Hendrixt
[QUOTE username=scaredmom userid=4930637 postid=1309049046]I can share what happened here.  For d at  the beginning everything was a fear food. We were fighting on a lot of things so I just pushed things like the cakes sweets and other similar things. One thing that did make it easier for us was that my d listens to others in authority better than me. So if the doctor or dietitian said that she had to have ice cream that week twice, she did it. D did not know it was because  I called the team first and said ‘ we need to do ice cream this week’ then they pretended that it was their idea so if there was  stress at home we could blame the team. Here we said she had to eat all of it and she did.

Hi Scaredmom - this approach sounds great but I’m not sure if using the team as authoritative back up would work in our D’s case. Although she is only 13yrs, she is pretty dismissive of the therapist and the therapist isn’t using an assertive approach. At CAHMs today D rejected all the therapists’ suggestions to try fear foods on our list and she gave up and suggested D should ‘discuss it with your mum and dad’. Even if the therapist had insisted that she should try a fear food I think she would have probably ignored this. She probably sees us as having more authority, probably because we were already succesfully re-feeding our D on our own without any support before we got into CAHMS.  To be fair to the therapist she managed to get a very tentative agreement that D MAY try a couple of the foods but I’m not holding my breath.


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Hendrixt
HopeNZ wrote:
It has been our experience that, as the saying goes, 'ED lives in the last bite'.  Throughout refeeding and beyond, we learnt that we had to insist that the last bite / sip / crumbs really did need to be eaten.  And today, 18 months+ after wr, in times of stress or on particularly bad days, we know that this is the last place ED lurks for my d.  Very rarely, when my d is doing particularly well, she does just simply get full and we feel it's ok for her to leave that last potato.  But if we have an inkling that her request not to finish smacks even remotely of ED, we still insist it gets eaten.

We didn't really have to deal with fear foods per se, as my d was just terrified of all food, so I can't comment on that aspect of it.  Good luck.


'ED lives in the last bite'.  – that’s what worries me as we have never done anything other than clear the plate

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Hendrixt
Thanks to everybody for your very valuble advice. So reassuring to have people with experience to turn to. 
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workingthrough
Hendrixt wrote:
I think it depends on you and you daughter. 

For s, if we had ever given the option of “trying” something - he definitely would have only “tried” vs. eating more.

So if he didn’t want to finish a fear food how far would you go for a clear – would you push through massive melt-downs etc. as you would when you start initial re-feeding from the beginning?

The points system sounds interesting?




We did push through massive meltdowns. It was awful. Like pp, everything was a fear food in the beginning - we tried to give s “safer foods” as he was WR’ing and beginning, but honestly, everything was a fear food.

We started with pasta, rice, breads and required serving sizes he needed. As he was eating those things and gaining (with the help of Ensure Plus between each meal), we added pizza, hamburgers, hot dogs, foods that a normal 13 yo would eat + desserts each night.

Massive meltdowns before, during, and after . . . it was awful, but he did it. He still won’t “choose” dessert or fear foods per se, but for example, will now tell us that “since he has to have it, so and so type of ice cream or food sounds best.” We’re about 10 months in now. Again, that isn’t daily. Some days he still pushes back and tells us he’s too full, too tired, etc. We always serve and expect his full meal plan + fear foods, thankfully very few meltdowns at this point. We do still need to watch closely and plate everything. 

Like scaredmom, we had/have the full support of s’s team. We’d meet together and decide what fear foods to add each week. If s couldn’t comply, eat, meet challenges, + gain, higher level of care remained on the table. S really didn’t want to go to PHP. 

The point system was something we implemented at home. I don’t know if it’s recommended, but it worked well for us. 

For each day of full meals met s earned 10 points (or something similar). When he had a true fear food, he earned an addl. 5 points. When he didn’t exercise at all in the day, he earned 5 points. When he completed clothing challenges (t’s vs. sweatshirts), showered, etc.  he earned points. I don’t remember numbers or amounts, but we paid him a ~quarter or so for each point. In turn, we’d let him use that money to buy different things. 

At the time, he was so sick. He had no desire to actually follow through with buying/shopping, but it did help him follow through with eating/not exercising. Being held accountable and seeing he was making progress was good.

I wish we had a magical, easy answer. My biggest advice would be to decide what you’re going to do and stay strong with that plan. ED’s are good at working around and through things, just remember you can do this - stay strong! (and make sure you’re getting in as much self care as absolutely possible!!) 
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Hendrixt
[QUOTE username=workingthrough userid=6371886 postid=1309052058]

We did push through massive meltdowns. It was awful. Like pp, everything was a fear food in the beginning - we tried to give s “safer foods” as he was WR’ing and beginning, but honestly, everything was a fear food......................

Thanks workthrough. Sounds like you did an amazing job - it's quite inspiring to see how people like yourself have pushed through these horrendous situations. It's given me a lot to think about. 

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Enn
You know, the only way to figure it out is to try something and see. Then reevaluate as needed. We found sometimes telling her days in advance worked well and that my expectations were that she would finish it all. We sometimes had  a choice, ‘ do you want ice cream today or tomorrow?’ But she knew it would be done that week. Or a choice of two fear foods at the same time. Sometimes she was able to choose and other times she could not. I really could not predict what would work. When she knew she had to have a fear food, she said it helped her to know it was coming that week for certain foods but not all. I never knew which foods were her worst fears, So I could not do the hierarchy that some were able to.  Sometimes she asked to have it on a certain day. I think she felt it gave her some control over a situation she truly had no control over. It helped her psyche.
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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Hendrixt
Thanks for the insight scaredmom there’s always lots to be learned from your posts. Suppose it’s going to be a case of trial and error. The school holidays start next week and we’re going to use the time to work in a few fear foods 
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Mamaroo
We transitioned to food very slowly, but steadily, requiring her to just taste the food initially. I made sure she always ate more than previously. Exposure to fear food has a snowball effect and as we introduced more fear food, it became easier to eat it. The main aim is to always move forward.
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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ValentinaGermania
Hendrixt wrote:
We had the rule that fear foods must not be finished the first time we introduced them but missed calories must be filled with safe food then.
Next time it was served it was normally finished so no "rules" needed about that.

Hi Tina72 - so did you always have the clear the plate rule before you started on fear foods? But did you then you had a slightly different approach on fear foods?


My d always cleared plates with safe food and knew she had to eat xy amount. So when we introduced a fear food I for example plated half portion of fear food and some save food in addition to fill up. Did I get your question right?
Keep feeding. There is light at the end of the tunnel.
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deenl
Hi Hendrixt,

We refed on safe foods, only re-introducing meat along the way. I would sometimes "forget" or "run out of" a safe food so as to test the waters. It usually meant that he missed those calories because he would not eat alternatives. After a number of months with this restricted diet I guess he got sick of the safe foods and he had put on some weight and this technique started working. We gradually just started introducing more and more variety without any issues. He now eats absolutely everything.

We always allowed him to leave the last bite. For various reasons, we could not sustain major meltdowns over a long period and this allowed an element of saving face. One of the reasons we did not fight it is because the amount remained the same, he did not use it as an excuse to leave more and more each night. It made life easier during refeeding but he still, almost 4 years later, leaves a bite of dinner. I continue to work on eliminating that habit.

Warm wishes

D
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal.
  • We cannot control the wind but we can direct the sail.
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TouchandGo
deenl wrote:

We always allowed him to leave the last bite. For various reasons, we could not sustain major meltdowns over a long period and this allowed an element of saving face. One of the reasons we did not fight it is because the amount remained the same, he did not use it as an excuse to leave more and more each night. It made life easier during refeeding but he still, almost 4 years later, leaves a bite of dinner. I continue to work on eliminating that habit.


It's interesting that leaving the last bite is so common. My D also always leaves at least 3 mouthfuls behind with pretty much any meal, but it's something she's done since a small child so we haven't been so rigid about it. Obviously, if she's trying to leave a quarter of the meal behind we try and get her to eat the rest but we don't bother trying to get her to scrape her plate clean. I'm not sure if at this point it's an ED behaviour that just continued on during her periods of recovery or if it's just a deeply ingrained habit from when she was young.
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Hendrixt
tina72 wrote:


My d always cleared plates with safe food and knew she had to eat xy amount. So when we introduced a fear food I for example plated half portion of fear food and some save food in addition to fill up. Did I get your question right?


Yes it does answer my question. It's interesting how some people require the plate to be cleared and will push through the melt-downs etc when offering fear foods whereas others, like yourself will allow some food to be left uneaten - although I understand you make up for any lost calories
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Hendrixt
deenl wrote:
Hi Hendrixt,

We refed on safe foods, only re-introducing meat along the way. I would sometimes "forget" or "run out of" a safe food so as to test the waters. It usually meant that he missed those calories because he would not eat alternatives. After a number of months with this restricted diet I guess he got sick of the safe foods and he had put on some weight and this technique started working. We gradually just started introducing more and more variety without any issues. He now eats absolutely everything.

Hi Deenl - thanks so much for your advice. We have also used this technique of manufacturing opportunities - only today my wife was clearing the fridge out. She gave our D a sausage roll which is on her list of difficult foods and told her that we have to eat up food from the fridge which was about to go off. She ate it no problem. It comes in useful sometimes to do that 

We always allowed him to leave the last bite. For various reasons, we could not sustain major meltdowns over a long period and this allowed an element of saving face. One of the reasons we did not fight it is because the amount remained the same, he did not use it as an excuse to leave more and more each night. It made life easier during refeeding but he still, almost 4 years later, leaves a bite of dinner. I continue to work on eliminating that habit.

Warm wishes

I totally understand you not wanting to withstand constant melt-downs. The 'leaving the last bite' habit is interesting. As you say, if your S is leaving the same amount and it is not increasing I suppose it's not an urgent problem to solve. Pre AN our D often left a bit of food, as does my wife. Maybe your S uses this to try to placate ED whilst still ensuring that he doesn't restrict - eg "See - I'm still leaving a little bit so I'm not totally giving in to the enemy [my parents]"

D
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debra18
Have the same problem with the last bite. When my daughter was hiding food in napkins and pockets i told her to leave something over instead of hiding it. I didn't know at the time I was creating another ED behavior but it is more normal to leave food over than hide it. Still dealing with the spitting that pops up sometimes than I will see about the last bite. Yes very strange that these behaviors are universal. All of the other behaviors did end up stopping on their own. My daughter was standing for over a year all the time and than one day she started sitting like it was never a problem.
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