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

Welcome to F.E.A.S.T's Around The Dinner Table forum. This is a free service provided for parents of those suffering from eating disorders. It is moderated by kind, experienced, parent caregivers trained to guide you in how to use the forum and how to find resources to help you support your family member. This forum is for parents of patients with all eating disorder diagnoses, all ages, around the world.

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Waterman_48
Hi, I need to ask a follow-up question to my New Here post. I know this makes me sound weak as a parent, but what do you do when your child (in my case, a 13-year-old boy) is not ready to accept that we, his parents, and his therapists and psychiatrist know more about what is best for him than his ED is telling him is safe for him. If he refuses to eat his entire meals, whether in program or at home, and refuses supplements (like boost or carnation) and refuses shakes and other things that could help, how do we force him to do what we say? In his ill mind, he is full very quickly and hits a wall, so he can't eat any more, and then we can't seem to break through that wall. Do we keep trying? Or do we really take a serious look at IP--in our case looking at Denver recovery center--where he will be away from us for likely two months. How do you get him to drink shakes or force him to drink supplement if he can't finish a meal? He doesn't get angry at us. He just says no, I can't eat that whole pizza slice. And he doesn't. We try to coach him, and maybe get one more bite, but not much more.
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Mamaroo
Hi Waterman

I don't think any child is ever ready to accept a parent's (or other authority's) view point. You just need to be confident when talking to him (we all faked it initially). Try not to get into too much of a discussion with him or to use logic. Also don't think in terms of 'forcing him' rather 'requiring him' to eat. Try these phrases:
"pick up your fork"
"take a bite"
"you need to finish this"
"we know what we are doing" - no further discussion if he challenges you "we are not going to discuss this anymore, I've said all that is needed"

When he says he is full, you could tell him to take a 20-30min break and then he needs to come back to finish the meal. I've used aloe vera juice to help with stomach discomfort. A glass a day for about a week. 

If he doesn't finish the meal in general, you could give him a very large meal and correct this behaviour later. My d would also leave bits on the plate, but it is much easier to correct when she was WR than during refeeding. 

Best of 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
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ValentinaGermania
Waterman_48 wrote:
Hi, I need to ask a follow-up question to my New Here post. I know this makes me sound weak as a parent, but what do you do when your child (in my case, a 13-year-old boy) is not ready to accept that we, his parents, and his therapists and psychiatrist know more about what is best for him than his ED is telling him is safe for him.


That does not sound weak at all, that is the normal problem at the beginning of refeeding and that was the wall we were standing in front off, too.
By the way, if you want to keep the replies to your posts together feel free to continue your first post if you like. It helps us sometimes to be able to scroll back for information you gave us some days before.

Waterman_48 wrote:
If he refuses to eat his entire meals, whether in program or at home, and refuses supplements (like boost or carnation) and refuses shakes and other things that could help, how do we force him to do what we say?


First of all refusing meals must have consequences. Normally the way is refusing meal = supplement and refusing supplement = NG tube. The tube was a big threat here because it was the last thing my d wanted and that worked for threat here.


Waterman_48 wrote:
In his ill mind, he is full very quickly and hits a wall, so he can't eat any more, and then we can't seem to break through that wall. Do we keep trying?


Yes. They are always full at the beginning. They always complain about bully pain after eating. The secret is to make him eat ONE bit more than ED wants him to eat. And TWO bits with the next meal. If he says he is full but not finished you need a) to set a timeline before he needs to have a supplement (here that was 30 minutes for a meal and 20 minutes for a snack but others did use much longer timeslines which is o.k.) or b) you can give him 10 minutes break and ask him to complete the meal then. There is no other way that will help you to get the calories in. He has to eat them or get a NG tube.
Try spoon feeding. Try to offer him a straw for smoothies/supplements. Work with illusion (same portion in bigger glass/plate looks smaller).
We really sat there whole day with only feeding the first time. But with every bit you get into him that is one more than he wanted to eat that is a victory for you.
I am quite surprised that you need to ask that while under UCSD treatment. I did think that they will help you to learn that...what help do they offer when he refuses supplement? Don´t they set a tube???

Waterman_48 wrote:
Or do we really take a serious look at IP--in our case looking at Denver recovery center--where he will be away from us for likely two months.


The problem is to be honest IP might be a solution to get started but in the end you will get him back home and you need to feed him there again for a very long time. He is only 13 and he will need to gain weight until his mid 20s. So to prevent relapses you will need to learn how to make him eat.

But I am quite sure that you can do that. What I experienced was that it did not work as long as I thought I cannot do that but the moment I had my first victory over AN in that war I saw that I am not powerless and then ED saw that I am stronger than he is.
Try to seperate the illness from your child. The problem is that you feel pity for your child. In fact you feel pity for ED and that is not what you want to do.
My d told me much later that she was so hungry and she really wanted to eat all that but ED did not allow her to eat because she was not worth to have this food. Your boy inside is hungry. He would love to eat the whole pizza. He needs you to fight ED to be allowed to do it.

Tina72
Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS
It is a good question and the one that brings many parents here. No we cannot force them to eat, nor in general does bribery, bullying, pleading or cajoling work. Our tools as parents are left to requiring them to eat, such that they feel there is no other choice. 

As has been mentioned many inpatient units do move to NG feeding when meals cannot be completed, others will just use a supplement. We can do the latter at home but not the former, and even then it doesn't make sure the food goes in. 

Ideally when he complains and tries to persuade you of the errors in trying to feed him - acknowledge him - name the feelings he is having - I can hear that you are really anxious at the moment, it must be really hard - now "pick up your fork" etc. 

Sometimes it works, other times it doesn't - but you are validating his anxiety and concerns without getting caught up in the argument. Other things that can help are trying to offer options for what can happen as soon as he is finished, or you can put on distractions whilst eating then stop them. No one way works for every child.   

If you throw everything you can at this and he still can't complete his meals then unfortunately yes a higher level of care is needed. This is not a failure on your part rather it is a sign of the strength of the illness. 
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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smileymum

Following on from Foodsupport_Aus, IP is always a last resort and it is great you have found some helpful tips here that you will try first.

But, if it doesn't work, please try not to see IP as failure but just as necessary part of ED recovery. A good facility can kick-start things and with better nutrition and practice eating at regular intervals, I would expect your son to respond better to feeding at home. 

My D refused food in a psych hospital, started eating on transfer to the ED IP since she didn't want a tube. There was nothing I could have done (or the psych hospital could have done) to get food down before as I/they didn't have the NG tube threat. Once she was a better weight, she couldn't wait to come home. We had the leverage then of: Ok, but we'll be continuing with the meal plan, so it was easier for us to take over once the pattern of eating had been established.
We are not out of the woods but I can't believe how nutrition changed her attitude and mood (with a nod to olanzapine, too.) 

All strength and power to you. It must seem so dark now -  but they are young, it is treatable and it is amazing how the body and mind can restore once good nutrition is sustained. With best wishes...

Smileymum
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Torie
Waterman_48 wrote:
Or do we really take a serious look at IP--in our case looking at Denver recovery center--where he will be away from us for likely two months.


Has his current team expressed an opinion about the need for IP?  UCSD is an excellent provider, and I would tend to trust their judgment.

In general, we do our best to get the weight up and see what happens.  It always takes a while to get the hang of requiring full nutrition, so in the early days, the question is if you are making progress toward that.  It is very common that when weight is too low, that they do need IP.  My impression is that as the weight falls off, the illness gets much stronger.  My d, for example, never lost enough weight to be considered "underweight" by the regular chart.  And yet, it was still very hard to drag her back to health.  I'm quite sure that if she had continued to lose weight for even one more month, she would have ended up needed a high level of care.  Many do.

No one ever wants their kid to be in IP.  We do our best to help them avoid that, but in the end the question is:  Can he regain the weight he has lost without IP?  If the answer is no, then consider yourselves lucky to have IP available.  In many countries, it is extremely difficult to find a bed, and IP does save lives.  

So again, I would take a careful look at the current trajectory.  Are you making progress?  If the answer is no in, say, another week, I would be thinking quite seriously about IP.  I would also give heavy weight to the opinion of his current team.

Best of luck.  Please keep us posted. xx

-Torie


"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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debra18
He needs to eat calorie dense foods so you get the most in without making him full. I remember there was a video about how much 200 calories are equivalent to. Avoid foods like vegetables and fruits that have few calories and fill up the child. Fruits can be used only in smoothies along with juice and a lot of nuts.
You do not need to engage in any discussion with your son at all. Only say "this is what you need " I tell my daughter she has a very high metabolism and this is what she needs to be healthy. Your son does not need to understand he is sick and doesn't need to agree to treatment. He only needs to eat. If you are considering a program , kartini clinic allows you to stay there and teaches you how to feed your child. He will not come back recovered from any program and you will need to know how to take over
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