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

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We are at a tricky point in our treatment for our son (16.5 years). We are 6 mth into Maudsley and for the last 3 mths he has gone up and down to only be where he was 3 mths ago. We have tried to increase cals to up that part of the equation, and have stopped any exercise. Now he says that he feels so sick from what he is eating that he can't sleep, and has gotten up in the night to vomit. His therapist doesn't believe that this is bulimia behaviour as it is too long after eating (over 5 hours). I can see that he is visibly feeling sick (it is different to when he first came home from hospital and was uncomfortable.
So...how can we increase without getting him to the point where he is 'stuffed' too full?
He get very angry with us when we challenge it, and has been physically aggressive a couple of times, and verbally aggressive all the time.
Dear megd,

Firstly, welcome.  It seems like you got off to a good start with refeeding your s, but then got stuck.  Maybe we can help you get moving again with his weight.

As I see it, you have the 2 classic recovery problems.

  1. How to get the calories in.
  2. How to keep them in.
1.  I just don't know if there is a way to refeed and cure an anorexic without them feeling awful ('stuffed too full').  It's absolutely horrible to make a kid eat when they are suffering, whimpering, begging or reacting violently.  My d had digestive problems and pain for many months.  Whether psychosomatic or biological in origin, those symptoms are just an awful part of the process, I think.  We used hot water bottles, warm showers, OTC medications and 'alternative' products like probiotics, etc. for relief.

2.  The consensus in the ED world seems to be that BN (bulimia nervosa) and RAN (restrictive anorexia nervosa) are very closely related. Knowing this, h and I closely watched d for purging, despite being almost 100% confident she would never go there.  We knew she had a phobia of vomiting and we just couldn't imagine her doing it on purpose, but we had also seen how ED bullied her.  So my point is, if you know your s will get up in the night and vomit, then you might consider stopping him.  Even if it is not BN, then it is harmful behaviour and could lead to worse.  Have a parent sleep with him, maybe.  I know it seems extreme, but he needs protection from ED, and it won't last forever.

The truth of the matter is that he needs to gain weight, and that's hard right now, but will only get harder with time.  So, if it were me, I would buckle in and get that weight on him as quickly as humanly possible (and I know all about getting stalled, believe me!).  This may well be the worst thing that you ever have to do, so you might as well get it over asap. 

We know how hard it is, and we would love to help you in any way we can.  We can help you with all kinds of practical problems.  Protecting him from purging, preparing high-calorie yet small-footprint foods, dealing with abuse, and curbing violence. 

Sending you warm support,


D in and out of EDNOS since age 8. dx RAN 2013. WR Aug '14. Graduated FBT June 2015 at 18 yrs old. [thumb]
This was the very first problem we encountered doing FBT treatment.we gave our d all the right food and drinks but the weight never increased or if it did one week it was gone by the next.
Here's the stuff we found out -d hid food up sleeves,in waistbands,in pockets and then hid it in her room or flushed it down the toilet.
She waterloaded before appointments so her weight would track up then down from week to week but we never had a real gain.
We had violence,threats of suicide,running away and self harm.
We had to put her in a mental health unit twice to help keep herself and us safe.when she would then stop eating completely she was given an NG (nasal gastric) tube and was fed via this with 24 hour watch always in place.
I don't tell you this to scare you but to let you know that there are other options if things are not working currently at home.
We found hospital admissions to be very effective as they taught anorexia that we would find a way every time to get round what was thrown at us, no matter what.
Find out what is available to you.get the local crisis team phone number.have that and your local police stations phone number in an easy place to locate if you need to ring them.do not hesitate to do this if you feel your life is truly in danger.
Keep all your options open as different approaches work for different kids.
Good luck,
My advice?
Sleep in his room.

ALL exercise needs to be stopped. This may mean he needs to be with someone 24/7 for awhile. If he is in sports I would pull him out indefinitely.

Feeling uncomfortably full is unfortunately par for the course. You could try upping his snacks and continuing to add things like heavy cream, butter, and oil wherever possible.

My daughter needed 6000 ( no typo) cals a day for 2.5 years. She was only 11-13.5 years old. Every second of every day was like Thanksgiving but that is what it took to keep on top of growth, puberty, and slow gain.

I know it sucks. I know it is hard. I know his ED will fight back..... But the only way to stop Ed is to interrupt behaviors and get his weight up so his brain has what it needs.
Persistent, consistent vigilance!
What the others said:

1) Re-feeding is intensely uncomfortable.  It. just. is.  It's really, really hard to see them suffer, but we have no choice - your s needs more nutrition so he can regain the weight he needs.  Hot water bottles, heated blankets, distraction may help some, but mainly what helps is getting to a healthy weight.

2) Adding calories without adding (much) volume helps them handle the needed increase - canola (rapeseed in UK) oil. can be added to most foods/beverages without changing taste or texture.  Heavy whipping cream (double cream) and butter are also good friends on the re-feeding trail.

3) Difficulty sleeping is also pretty much par for the course at this stage. I know others here have developed good tips to help with that challenge.

4) What I have written so far is standard standard standard with ED.  What strikes me as unusual is vomiting during the night - we don't hear that much.  It makes me wonder if he might also be vomiting during the day or if he's doing something during the night  that makes him nauseated - I know my non-Ed d and her teammates would occasionally vomit during an intense practice so yes it would be prudent to monitor during night.  Also, are you keeping him with you for at least an hour after every meal and snack?  If not, I'd start doing so right away because if he's not vomiting by choice now, he likely will soon. I told my d she needed to uses the facilities before the meal so she would be able to stay with me for an hour afterwards.  She hated that and complained bitterly that I didn't trust her. As PsychoMom advised, I always replied, "It's not about trust; it's just what I do." She didn't like that much, either, but at least it got us off the topic.

Good luck, and please keep us posted. xx

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

Well, once early in refeeding I fed my d so much dinner that she threw up. It's possible that it can happen sometimes, completely unintentionally on everyone's part. But I'd say, (in my limited experience) not as a regular thing, not in the middle of the night. More likely he's exercising in the night (or taking an emetic or something?). Sleeping in his room seems like a good idea to see what is going on. 

Also, you might like to post a typical day of meals and snacks? It's sometimes helpful to get suggestions as to how to increase cals without increasing footprint.

best wishes,

D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
Yes... What psycho mom says!

My d also threw up a lot, think projectile vommitting on the table at dinner. For her it was anxiety related. That's a long story but it took a week of giving her sips and bites every few minutes to break that behavior.

Give us a daily look at his menu.
What is his current height and weight?
Persistent, consistent vigilance!
Mine would take laxatives, for some reason they made her vomit unintentionally in the middle of the night.

Being stressed/anxious about anything can cause vomiting, if he is lying in bed stressing over the calories.

Otherwise can only suggest adding oils/fats etc to increase calories while minimising bulk. There are some low volume smoothie recipes around this forum, and liquids may empty his tummy faster than solids.
I want a realistic dr and team, not someone who says what I want to hear and not a 'touchy feely nice' dr that doesn't have success.