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

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WeWillBeatThis
Hi there

Our daughter is 14 and has been diagnosed with anorexia for over a month now -

She is eating but we are struggling to get her to eat the last bites of a meal

She is strong willed and independent by nature

The ED declares it's not going to let our daughter finish the meal and our daughter is very clear she will have no more.  At best, she will negotiate up front - I'll have 1 bite or nothing.  Tell me which bite you want me to have.

Any suggestions on how to get her to finish?   We are going through FBT and we've read/listened to Eva Musby but nothing we've read has seemed to work yet. 

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Foodsupport_AUS
Welcome to the forum. Sorry that you have to find us here. I have heard it said elsewhere that anorexia lives in the last bite. I am not sure it is true but one of the starting parts of FBT at the family meal is getting your D to have at least one more bite than she/ED wants. 

That stubbornness and independence that you see is very common with eating disorders. ED makes them even more stubborn. 

My first question is whether you have started getting some weight gain, are you managing regular meals and snacks? If you are getting weight gain then right now you are doing the most important job and although there is still this resistance it is less important to tackle it straight away. If you are not getting gain then there is no option but to push forward and keep on working till it happens. Many have tried a LSUYE approach (either Life Stops Until You Eat or Life Starts When You Eat). Looking at making meals smaller foot print with higher calories? Changing the type of food offered? Requiring a finish and if not finished some restriction to activities till the next meal?
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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ValentinaGermania
2 ideas:

Is there anything you could use as a leverage that she is keen on?
We offered driving hours for every day all meals and snacks finished without stress. She was keen on having her driving licence and loved driving more than ED. 🙂

Is there a possibility to increase her portion size so she will in fact eat 100% even if she leaves a bit on her plate? Is it really only one bite or are we talking about 25% of the plate...?
Keep feeding. There is light at the end of the tunnel.
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debra18
This is pretty common I think. My daughter has this problem. When she needed to gain weight I gave her more and allowed her to leave some. Now I am working on the last bite. I reduced portion size a little. Whenever she leaves something and looks like she cant eat anymore, I tell her one more bite.
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Barberton
I am the same as debra18. My d has had a relapse so we are back to Stage 1 and because her cognitive thinking is so poor right now, I serve up more than is needed so that when she leaves that last bite, she is still having enough. It makes her feel like she has some control at the moment. Once she is thinking a bit more clearly, I will gently encourage her to eat the last bite. There are no set rules in this game, and often the rules need to change as progress is made or not made. 
D fell down the rabbit hole of AN at age 11 after difficulty swallowing followed by rapid weight loss. Progressing well through recovery, but still climbing our way out of the hole.
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MKR
Barberton wrote:
My d has had a relapse so we are back to Stage 1 and because her cognitive thinking is so poor right now, I serve up more than is needed so that when she leaves that last bite, she is still having enough. It makes her feel like she has some control at the moment. Once she is thinking a bit more clearly, I will gently encourage her to eat the last bite. There are no set rules in this game, and often the rules need to change as progress is made or not made. 


Great strategy for the early refeeding!

During the family meal session (where we bring a meal and the therapist observes the child's behaviour and the parents' response) our therapist asked us about the "last bite" strategy. Whichever we chose, the father and I had to be consistent.

We either had a larger meal (unbeknown to the child) or offering a lot more of something else in place of the last mouthful. E.g. when our d left behind a piece of chicken skin, I said Fair enough (because I don't like it much either), but have 2 more chunks of potato instead.

The ultimate aim is eating ALL that is on the plate. In other words, allowing that one bite encourages restricting - the child spends the entire meal "calculating" which mouthful to leave out. Distraction helps, to fill the mind with non-food thoughts.
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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WeWillBeatThis
Thank you all for the suggestions!

Some updates to the questions
-She leaves anywhere from a few bites to 10-15% of the meal.  It depends on which meal....things seem to get harder later in the day where she gets worn out
-We put extra calories where we can (e.g. dinner) so she can get what we think she needs even if she leaves a bit
-We use all the tactics outlined by Eva Musby - focused on calm, compassionate encouraging of eating.  We quite like her Bite-size audio clips which we purchased.
-That said, we have not gone to restricting activities (e.g phone, netflix) if she doesn't finish.....

We have a weigh-in in 2 days and will report back. We're hoping she will get some weight gain and then perhaps we are on the right track to get her to full weight recovery and get to the end of Phase 1.    If she doesnt gain weight, then we'll come back for other suggestions.   

Either
a) we find a way to get even more calories into her meals and she leaves some of each meal (we're finding that tough without getting into fear foods) or
b) we find a way to get her to eat all her meal (which again we haven't found a strategy that works)

Another topic we'll search for help on is "fear foods" as we think if she doesn't gain weight she really needs things like ice-cream, milshakes and smoothies which she is preemptively refusing.
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ValentinaGermania
If you have not restricted anything up to now then ED learned that not finishing has no consequences at the moment.
It might be worth a try to take the phone away and tell her that she will get it back right after she finished her meal. That is what they did in IP here, the kids were only allowed to have their phones in between meals.
Keep feeding. There is light at the end of the tunnel.
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PurpleRain
I think there are different approaches and. You can actually try different things. We (H and I) always insisted on the last nite and D wasn't too resistant, she gave us the look but are it, and I think it's important because it's an ED behaviour, but some (including some above) have waited a little bit longer when their kids are closer or at WR to insist on normal behaviour, it's the same with fear foods, we ripped the and aid but it's not the only approach. You could try to insist, try consequences, see what happens.
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
 
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whenwillthisbeover
We had this issue as well.  First, we focused on getting D wr and didn't worry so much about finishing every last bite.  Once she was WR, I noticed that she NEVER ate the last 1-2 bites.  She always left a little something.  Our therapist agreed that this is not a normal eating behavior.  When non-ED people eat meals, sometimes they leave a bite, sometimes they clean their plate, and sometimes they get seconds, so we agreed that this was a behavior we needed to nip in the bud (along with others).  D wanted to get back to her sport, so we used this as leverage.  Every time she finished everything on her plate, she was allowed to go to the next practice.  If she did not finish, she was not allowed to go.  She's so motivated to go that she's finished every last bite on her plate, no matter the amount.  

For us, we got the weight on first, then focused on behaviors.  We used this type of tactic to rid other weird stuff she was doing and it's been pretty effective.   I firmly agree with the earlier poster that says ED lives in the last bite because it did for our D.  If you notice weird things like that, they need to be addressed at some point, whenever you are ready to tackle it.  Good luck!!  
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