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

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My daughter is 14 , anorexic, we are first phase BFT/Maudsley.   I'm the only caregiver. She was 101 lbs after 2nd discharge. 4 weeks later she is 106lbs. resting heart rate is now 50 to 60 pretty steady. I'm using the plate method. eating 6 times a day. 3 meals 3 snacks.  I really worked around the ED by going with cream , butter , oils , nuts in potatoes, yams, eggs, rice etc. Real change came after my daughter hit bottom ( I hope ) . Would not eat and not take replacement. Therapist gave me good advice to just go for it , not activity, nothing everything stops until replacement is taken or food is eaten.  It took hours of patients, anger, crying and laughing to get through it. She had a big change , no longer hiding food much ( trust but verify ). No throwing up ( she did it a couple times a week she told me about. ) and spitting food out. It was scary and her HR was high 48 and 47 on two visits to pediatrician. In the span of 4 days it was up at 60 at pediatrician. She was confident but I wasn't . No activity those 4 days.

My biggest current challenge. At the last visit, Therapist told us replacement is really only an inpatient crutch. You need to confront ED straight on with fear foods. I was managing fear food by letting her replace, or replace with real food of equivalent calories. I don't know how hard to go a the fear foods at this point. Every meal, just at snacks, once a day? The therapist just said confronting them now leads to better results long term. My daughter rebelled today when I said no replacement, eat the 300 cal yogurt instead of 200 she had eaten every morning, no replacement. She equated the extra fat as more fear. I really got pissed at the ED . Its hard to manage all this while trying to conf in at work.   How frequently should I hit the fear foods ? Can I take a break when I need an easy meal ? How can I motivate her in positive ways?  Funny thing, this was this morning and now its kumbaya this evening , off to the pumpkin patch tomorrow,. She even ate dinner like a normal person, no squashing on plate, or lips, picking through the food. It was mashed potatoes with 1 cup sour cream fish fried in butter and carrots , OJ and pumpkin puree with spices for desert.  All commiseration and insights welcome.
There is no ONE right way to tackle fear food. Only important thing is that you DO tackle it. You can rip the band aid off and serve it all together from day one again (this is recommended with young children) or you can make a list and work that down in a laddered aproach. There is no right or wrong. You need to find out what works in your family. You will see more resistance and more fear and more fights again but that is normal and you need to go through that. Fear food must be worked on. But HOW is your decision.
We had a list and once a week fear food day and reintroduced all slowly. It took us a year to work that down and looking back I would do 2 fear food days to get through it more quick. We offered incentives after she has eaten that fear food and that worked very good here.
Keep feeding. There is light at the end of the tunnel.
Welcome to the forum, sorry that you have had to find your way here. It sounds like you are making some good headway. 
 You need to confront ED straight on with fear foods. I was managing fear food by letting her replace, or replace with real food of equivalent calories. I don't know how hard to go a the fear foods at this point. Every meal, just at snacks, once a day? The therapist just said confronting them now leads to better results long term.

I am not sure that there is evidence that very early exposure to fear foods leads to better results long term. There is evidence that faster weight restoration leads to good results in the long term. As for supplements I think the biggest issue is that it implies a degree of negotiation and that often gets in the way of fast enough weight restoration. Magic plate and LSUYE (life stops until you eat) techniques work very well for many parents. They don't  lead to universal success and there are plenty who have used their own variants and changes to get what they need. 

Fear foods do need to be addressed, however if every calorie is a fear - trying to increase that fear will get in the way of eating. The most important thing is regular eating and progressive weight gain, with gradual expansion of what is being eaten.
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.

Dear Ruoka,

We have just been having a discussion about fear foods this week on this thread:


If you would like to take a look. You can also try searching for fear foods to see how other parents have handled it. Like Tina says, there is not right or wrong way to approach. It sounds as though the most important things right now are to keep her heart rate at a healthy level and for her to keep gaining weight. 

If you search for fear foods, you will also find many discussions and perhaps you can get some ideas about how to proceed. You might also want to take a look at some of the topics in the ATDT hall of fame:


and here is an amazing thread, started way back in 2005, which has some high calorie suggestions for meals since you are refeeding. There is some evidence that with patients who have anorexia, eating a broader range of different foods has a higher correlation with recovery and that has been studied. 


I'm not sure how you are serving the yogurt that caused the pushback by her: is it in the container and can she see the calories so she knows it has 300 instead of 200? If that is the case, I could suggest serving yogurt in a bowl and not in the container so that she doesn't know exactly how much is in there. Then try increasing the portion slowly. When she is able to eat more of the yogurt, you could then try adding some granola or nuts and raisins for an additional caloric increase. In our house I never announced: Now we are tackling fear foods. I needed to be more subtle than that. 



Thanks for the replies I'll read the material above. I'll double check with the therapist about how often to confront fear foods.
Welcome from me as well, Ruoka

We were one of those families who took the very long route to eliminating fear food.  My d lived on supplements for months during refeeding as all food were fear food. Our first aim was to gain weight  and avoid another inpatient stay and then to introduce food. However,  she had to 'taste' all the meals I made just to keep her in the habit,  an ideas which worked very well when it came to introducing fear foods.

After a couple of months we added a muesli bar,  then more snacks and when she needed more calories we started to replace one Ensure a day with a sandwich. It took a month to replace that ensure, but success builds on success and it became easier and easier to eat normal food. As she got used to food, a lot of food disappeared from the fear food list without us having to consciously having to work on them. Now she eats everything, no problem. 

If your d is not eating enough in terms of calories,  I'll work on that first.  As soon as weight gain is steady and she's able to eat comfortable at each meal and snack time, you can start to introduce a fear food a week. Give it to her every day so that she gets used to it. Expose is what will reduce anxiety. Good luck!
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