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

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germankidnrw
Hello

I would like to introduce myself and my family. We are a family from Germany.
Our 12 year old daughter was diagnosed with anorexia last week. She has lost over 7kg weight
in the last 3 months. She now weighs 38kg in a size of 152cm.At first we were with the pediatrician
who did not share our worries because she was not underweight
yet and could lose another 3 kg. Fortunately, he has issued a referral to the child psychiatrist.
This confirmed our suspicions after 2 dates.
Unfortunately, we have no possibility for FBT here but we try to bring our daughter back to normal
weight with support from the psychiatrist. Additionally, she will get support there through Therapy.
I hope through this forum on new information and especially with other parents.At the moment,
the Refeeding works fine. But it is much harder than expected to get as many calories
in small portions as possible. So far, food was always enjoyment with us and because we parents were
rather overweight that was never the topic.We work with Fresubin Shot and Muesli Power bars.
Fortunately, Müsli likes to eat our daughter
and thinks it is healthy. But she does not like the fresubin and I still have not found a perfect
solution to hide it without her tasting it. I would be very grateful for good ideas.Please
excuse my mistakes in English, I have not used it for a long time.

Thanks for this great forum and
in advance for your help.

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Foodsupport_AUS
Welcome to the forum. Sorry that you have had to find your way here. There are a number of resources around for you to read to try to get things moving with re-feeding. Fortunately some of them are even in German. https://www.feast-ed.org/wp-content/uploads/2019/04/Umgang-mit-Diagnose.pdf

Tina has also put together a number of other resources which may be useful to you in this thread. https://www.aroundthedinnertable.org/post/informationen-%C3%BCber-fbt-und-maudsley-therapie-auf-deutsch-9514879?highlight=germany&pid=1308835178

Please feel free to ask a lot of questions. I think if I had one guide to help me get started on re-feeding i would want this one - https://www.amazon.com/When-Your-Teen-Eating-Disorder/dp/1684030439
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
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tina72
Herzlich willkommen von einer Mutter aus Deutschland!
Wir leben in Hessen, meine Tochter ist heute 19,5 Jahre alt und kam vor 2,5 Jahren als Notfall mit der Diagnose RAN ins Krankenhaus. Wir haben sie nach 3 Monaten da rausgeholt, weil alles nur noch schlimmer wurde und ihr Zustand sich immer weiter verschlechterte. Wir haben dann mit Frau Dr. Roslyn Hopf aus Königstein im Taunus FBT gemacht. Sie ist die einzige lizensierte FBT Therapeutin in Deutschland und nimmt ab September wieder neue Patienten an, ich würde sie an Eurer Stelle mal anrufen. 🙂
Sie macht auch Skype-Termine. https://www.roslyn-hopf.com/

Ich schreib jetzt mal auf Englisch weiter, damit es nicht unhöflich wirkt. Ihr könnt aber gerne auch auf Deutsch fragen, wenn das einfacher ist. Hier sind noch mehr deutschsprachige Eltern unterwegs.

Are you already at 3 meals 2-3 snacks? That is important to eat regularly to keep the blood sugar level constant through the day. She should eat every 3-4 hours at least. ED thoughts and behaviour increase when they feel hunger so target is no possibilty to feel hungry at the start 🙂.

What therapy does she get? Be careful what is happening there. Most therapists in Germany are quite old fashioned in treatment and treat from Hilde Bruch and tell the kids they must escape from that "golden cage" at home and split parents and kids. Many therapists fight refeeding through the parents and want the children to be "in control". We needed to stop all that here because they worked against us and told us it is not possible to refeed a kid at home.

Ideas for more calories:
Put butter, cream and oil on everything possible. If she eats yoghurt, you can buy cream yoghurt or greek yoghurt and put a teaspoon of rapeseed oil (Rapsöl, am besten geht es mit dem Babylove Rapsöl von DM, das hat keinen Eigengeschmack) to it. You can also add rapeseed oil to applesauce for example (Apfelmus oder auch Baby-Obstgläschen, wenn sie das isst).
Check all the brands in your supermarket. You can easily get 300 calories extra just by buying bread, muesli, joghurt and all the other stuff from brands with more calories. Tell her the old brand was off or the new one was in advertisment this week when she asks why you buy that.

Change from Fresubin to home made milk shakes and smoothies. You can get a lot more in with that and you can change the taste for more variety. You can make milk shakes with a blender or a Pürierstab. Add 2-3 scoops of high caloric icecream like hägen daz or other cream ice and 150 ml full fat milk and add 20-50 ml cream (Sahne) after blending (not before, then it gets too thick). You can also add oil (Rapsöl) to fruit and juice and blend it well and she will not see and taste it. You can add easily 1000 calories a day with a milkshake added to breakfast or morning snack and a fruit smoothie added to afternoon snack or dinner.

If you tell us what she eats at the moment we can help you with ideas where you can add more calories. It is important that she re-gains that lost weight very fast.

What about fear food? Does she have food that she refuses to eat? Is she on a vegetarian or vegan diet (a lot of AN sufferers do that to be "allowed" to restrict certain food)?

Noch eine Warnung: Falls der Name, mit dem Du Deinen Post abgeschlossen hast, Dein richtiger Name ist, dann lösch das bitte schnell wieder (einfach mit dem Stift der oben rechts unter den 3 Punkten zu finden ist, das ist "edit"). Das ist ein öffentliches Forum hier und das letzte was Du jetzt brauchen kannst ist dass Deine Tochter rausbekommt, welche Tipps Du hier bekommst.
Keep feeding. There is light at the end of the tunnel.
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germankidnrw
Thanks a lot  for your nice an friendly answers.  I think we are in the lucky situationen, that we realize the anorexie very fast, so we have no problems with vegan or vegetarian diet right now.  She has some fear food (candy, all kind of fat, fried or cream food)  but she eats mostly what I plate here. The only problem is, that she also has a very heavy food allergie against peanuts so she need to look at the nutrian information to feel safe.  At home its ok for here to trust us, but outside she need to look.  And she is very clever she knows how to find information in the internet. 
We have 3 meals  and 2 snacks per day at the moment. Its easier to get her 5 small portions to eat than 3 big ones.   And its also easier to drink milkshakes and juice than eat for snack time. 

I think I will be a silent reader for the beginning and learn from your posts and when we get special questions I'm happy to finde good place to ask.    The name was not my real name, but I took it away eighter.   I wasn't sure if it was ok to post without a name.   

Thanks again from  Germany
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scaredmom
welcome germankidnrw,
I am glad she eats what you plate for her and 5 meals is great! That way you can get the amount of food in through the day. 
I do not know German so I may be repeating what has been said above. 
The goal is to get 0.5 to 1 kg weight gain per week. It is great she has the milkshakes you can add a lot of cream and oil to increase the calories in those and that will really help. 

Please let us know how we can help, but all means read around the forum and feel free to post whatever you wish.
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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tina72
Please come back with all your 1 million questions whenever you like. We are open 24/7 🙂.

And please make sure that 30 % of her intake is fats. So if you refeed on 3000 calories a day for example 1000 should befrom fats (that is about 100 g and a lot) because the brain runs on fats and can only recover with fats.

What does your psychiatrist think about FBT? If he knows it and if he knows that AN is a genetic metabolism disease and he does not need to search for underlying family issues this would mean he knows something about EDs. If he has never heard of FBT and wants you to have normal family therapy I would be careful.
Keep feeding. There is light at the end of the tunnel.
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germankidnrw
Hi
Fat is fear food so we try to hide it. I put cream and Fresubin shot in every possible way  in here food. I will ask our therapist about FBT but right now my Feeling is good. He didn't blame us and he First want to reffeding her and than start with other therapys.  He was total ok with our wish to keep her home and our negativ feelings about putting her in a fulltime overnight hospitel.

We  have for good luck 6 weeks vacation in Front with time for family and without  work and school. And without other girls in here lassen. There are 2 also with Anorexie and At least 3 to 4 on no good way.  I'm happy they Mix the groups next year.

I'm thinking about my working time next schoolyear and if she can go to school normal.  Right now its ok but I'm nervous. I'm normaly home about 14.00 and the Kids too. But they eat  in school right now.  There would be a time about 7.00 and 14.00 with no Controller just here older sister. And I dont't like the idea to put her in that role
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tina72
Try to hide all fats and get as much into the food as possible. Oil is easy in rice, sauces.
If the therapist is good and has some ED knowledge that is great but really rare in Germany.

So many ED kids in one class in school is REALLY concerning. What does the school against it?

I think if she is not much underweight at the moment and you refeed her in the holidays she can stay in school but you will need to find a way to supervise her snacks and meals there. Here the class teacher supervised the Pausenbrot at second break and I took my d home for lunch and brought her back afterwards for the last 1,5 years of school because it was not possible to supervise lunch there.

The older sister should not be in charge, you are totally correct with that. If you can drop some hours or have a break from work that would be great and needed. Also for you. Carer burnout is a big problem as caring for an ED kid is exhausting for a very long time. A family in south Germany recently got some Pflegezeit from Pflegekasse to care for their 13 year old d. You have a legal right for that. Please see my thread about FBT in german. You can contact me also privatly if you like for more information. Just click on my name and then there will be an arrow "send email".

Please know that your d has some legal rights in school, too. There are some articles about "Nachteilsausgleich" in my thread too. Please ask for that in school. AN is a chronical disease and therefor she must get help in school if needed. Here we had free hand to leave her at home whenever it was needed (which was great as we could say "without good breakfast you cannot go to school") with no bad results on her Zeugnis. School can help a lot.
Keep feeding. There is light at the end of the tunnel.
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germankidnrw
We've been at the doctor this week and my daughter got 1kg  more than before. So we are on a good way. But now she feels bad an don't want to eat fresubin or other stuff with lots of calories.  We are about 2500kalories per day at the moment but you didn't see here higher weight.  She seems to grow longer.  From starting re feeding her (now 2-3 weeks) she grows from 151 to 153  Is this normal? 

Thanks for your good tips and for the possibility to ask.   

😍
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Mamaroo
Hi, great job on the 1 kilo!

On the day of my d's medical appointment she would also be too upset to eat. Just keep on presenting the food with the expectation that it would be eaten. Also, when she says "I'm not going to eat this or that" just ignore it. It's the anxiety talking, don't go into a discussion,  I just completely ignored such talk. Is your d being blind weighed? It might be a good idea to do blind weighing as it takes some of the anxiety away.

My d also grew quickly, that is good news, but it also means you've got to give her more food now. Just keep on swimming!
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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tina72
Was she messured in underwear? Different shoes possible? 2 cm in 2 weeks is a lot. But possible. Maybe she catches up with a delayed growth now. Means more food must go in for sure...

As mamaroo said, ignore what she says that she will not eat and just present the food and expect eating. If I had got an € for each time my d said this or that I will never eat or do again I would be a rich woman now 🙂.
Keep feeding. There is light at the end of the tunnel.
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germankidnrw
Hi

She was measured in clothes but they always take 0,5kg off for that.  From next week on they will weight in underwear the doctor told us. At home we measure  in underwear and to different days. I knew about blind weight but I can't believe it makes less stress to here.  I would think about how much I put weight on  and in here head the feeling seems even worse than the real weight. I always tell here that we knew what here body needs and if she wants to become higher she needs to eat.  And she really wants to become higher😎.

How do you handle the situation when the sister loves all the good stuff full of cream and fat but she doesn't need to put 1kg per week weight on.  Don't get me wrong, I have no problem if she has little overweight, but I don't think she needs so much fat and medical food because she its perfectly fine.  I really  always love to cook for my family, but at the moment  eating just its hard work.   I try to plate for the whole family, but it feels straight and my  older daughter sometimes feel like she gets treated unfair, because her sister could eat all and she gets borders with candy or special food for here sister.  She knew why and understand by head but her heart feels unfair.  And I can understand here.  And sometimes I have the feeling she wants to make us happy by eating big amounts to show here sister how good/easy it is.
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tina72
We have that situation with grandparents that live with us. Grandpa must restrict fat and sugar due to heart issues and diabetes. My girl at the table should enjoy to eat that. Difficult situation.
We do it that way: I plate for all of us. D gets a special AN plate and grandpa gets a special heart disease plate.
Keep feeding. There is light at the end of the tunnel.
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debra18
I have 8 kids and AN daughter is the oldest. In the morning my daughter drinks her milkshake before anyone else is awake. If they see it and want ice cream I will give them after they eat breakfast. They know milkshakes are her medicine. Smoothies with supper I make my daughter's first with nuts and no water. Than I make a separate one for my kids that is watered down. If I am working on fear foods, my kids all get what my daughter has. It gets expensive to buy 8 bottles of lemonade on trips.  I try to keep everyone's schedule like my daughter's on the weekend so everyone is eating together. If anything I would say everyone benefitted by emphasis on eating regular foods every 2-3 hours. For some of my kids I saw improvments in behavior by making sure they ate regularly.
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tina72
"I knew about blind weight but I can't believe it makes less stress to here.  I would think about how much I put weight on  and in here head the feeling seems even worse than the real weight."

My d used exactly that argument to avoid blind weighing and when I convinced her to try it (it took me 4 months to get her there) she walked out of the GPs office and said "I do not know why I did not want to do that, it is so much easier not to know the weight at all, I will never do it open again". This was nearly 2 years ago and she never asked for her weight or gain again since then.

In their heads ALL numbers are bad. Even if they gained only 100g they can panic about that. No numbers works best for most families I know.
Keep feeding. There is light at the end of the tunnel.
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germankidnrw
Hello
We are now in week 4 of refeeding and my d. gains weight very good.  She's now at 40.8 kg and we startet about 38.  She is still raising and she is now 153,2 cm we startet with 151. The doctor put her minimum weight to reach up to 43 and told her to put 1kg on for each 1cm. He isn't specialist in FTB, but he is very open to what we do and helps us a lot because he told here we are doing the right thing.  And he give us a good support as parents as well.  
We check the blood for vitamin and other paramenters and they all are good.  The only thing I recognize is that our d. has a very fast pulse. Here blood preasure is ok.   She has always puls over 110. Is this typical for AN?
She seems much more relaxed even if she feels bad about gain weight.  But she gets clamer and we have a very good relationship.  Maby it's also because school vacation starts and all of us are more relax.  We will see, I don't trust the to good feeling but I realy enyoy it as long as its here.

She likes it to cook with me for the family and I she is allowed to if she eats some of this food.  And it works.  But I keep here out of the kitchen while preparing dinner and here special food.  She still gets nervous if she see fat in here food. But she eats it if she hasn't seen it.   

So thanks for your great support and your good tricks and motivation I've got  by reading your stories.   
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tina72
That high pulse is concerning. I would take her to a child cardiologist soon.

Remember that there is no target weight for a growing child and do not give her the idea that you will stop at 43 kg as this is very probably not enough...
Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS
Both fast heart rate and slow heart rates can be seen in eating disorders. Is the rapid pulse particularly when going from lying to standing? If so then it can be a sign of medical instability but my daughter it took around a year to settle after re-feeding. 
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
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tina72
You wrote her blood pressure was o.k., but was it messured orthostatic blood pressure (lying and some minutes later sitting and then standing?)? Many doctors here do not do that and it is very important to close out serious heart issues...
Keep feeding. There is light at the end of the tunnel.
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germankidnrw
Hello
I just wanted to thank you again for this greate forum.  I read a lot and found so much good information and it helps a lot to see, that we are not alone in our situation.  Even if I'm more a silent reader I want you to tell you what happens here in the last 6 weeks.  Over the summer vacation our daughter recover good. We put on nearly 1kg per week.  She is now about 43kg and we startet with 38kg in June.  Here period came back last week and she looks healthy and well again.  But every time she goes over  a kg/mark the next days become hard for here and us.  She seem to put all weight in getting higher.  She startet about 151 and is now about 154.  Her bodymark index is since last week over 18 again and she starts asking when to stopp refeeding here.  My feeling ist she needs to get back to a bodymass about 20 becaus thats what she was in January befor ED arrives.     

And I'm also nervous when school starts again  next week.  At the moment we have  3 meals and 2 snacks and in school she will be on here own for a least 6 houres. My plan is switch from a big  late Mornig snack/Shake  to an evening snack after dinner.  So we don't have to "controll" here in school but we have the security that she gets here calories.   The other "control" option is to tell here if she looses weight she can't do sports and she loves sports a lot.  Since she is over 42 she is allowed to do 1 houre sports every second day and she loves it. 

Next month ourer doctor will start the psycholic therapy and I think its usefull to get rid off all here straigth eating rules and bad feelings about here food and here body. 
My feeeling is good because we left the ED weight area where she was in  real health danger but I see a long way to got infornt to become ride of the psycolocical part of ED.

Thanks for all your good support and good wishes to all that our kids will recover soon. 
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sk8r31
Thank you so much for posting your update.  It's wonderful how well you have done over the summer with getting your d's weight up higher and getting her closer to nutritional rehabilitation.  I want to urge you not to 'slow down', even though you have done so well through the summer.  Your d will need more weight as she grows and that will continue (though of course slower) through until she is in her mid-20's.
Absolutely, if she is doing some sports, she must eat additional calories to 'fuel' for that exercise.  And I would be cautious in having her do too much sport, or at least start gradually until you see that she can eat enough to continue without losing weight.
It sounds like a good plan to have an evening shake.  That worked well for our d too.  I did not monitor lunch at school but made sure that all other meals and snacks were sufficiently 'dense' so that she could continue to gain weight as needed.  
Sending warm support to you.
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
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