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

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Heron
Struggling away here - does anyone have any suggestions?
D has reduced intake to 3 small meals per day. Ed very much in the driving seat. When I try to increase / make changes - aggressive outbursts - I then step back again.
I know I need to step up and take over but very worried that D will stop eating altogether.
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scaredmom
Hi Heron,
Welcome.
I hope you get the support and information you need to help your child.

I know it is so hard to deal with the ED push back. It take a while for us parents to learn how we must stand up to ED to get our kids to eat.
It would be helpful for us to know a bit more about your situation.
How old is she?
Do you have a specialized ED team?
What is she eating? We can help to get that up on calories.
Is ther purging or compulsive exercise?

We all worry about confronting ED and that will make our child not eat. And yes if that happens having a plan like taking her to the hospital can be helpful.

How long has this been going on, the Ed and you trying to feed her?

Once I had a plan that of d did not eat or was violent, take her to hospital or call the police, then that empowered me to push through the fights and stand offs.

Please ask all the questions you have.
XXX
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
Hi Heron,
a very warm welcome from Germany and sorry that you have to be here.
That is the big worry all parents have at the start: that they will stop to eat altogether when they try to take over and then they step back and ED wins.
To be honest we did it the same way at the start and do you know what happened? My d stopped eating altogether and drinking also and went to ER and to IP. She stopped eating because we did NOT help her and we did NOT take over. Do not let ED win that war.
You need to do this or she will go further down the rabbit hole. She cannot help herself out of that and when you take over she can blame you for food intake. She can say to her inner ED voice "I do not want to eat that but my mum requires it and I have no chance not to eat it". You must make not eating impossible to help her out of that hell.
How old is your d? Is there purging or exercising in addition?
Do you already know Eva Musbys great book? Have you seen her videos?
Are you alone or is there hubby to help you?
Have you seen an ED team and GP?
Get prepared, have a plan and tell her you will take over now and all she needs to do is eat what you serve. ED will explode first but in most cases accept that if you stay strict and do not negotiate about it.
Ask your 1 million questions, we are here to help you, we have been in your shoes and you are not alone.
Keep feeding. There is light at the end of the tunnel.
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Heron
Thanks ScaredMom and Tina,

D is 15 and nearly 2 years in. Year 1 went well but relapsed, started to recover then she has been stopping and starting over the past 6 months, but manageable. Has got particularly bad over past 6 weeks, coincides with team change - they are Fbt but not much focus on intake.
Having 3 small meals approx 1400 cal a day at the moment. Refusing all snacks (was having 3 snacks up until 6 wks ago, then 2 up until 2 wks ago).
Each time she has been aggressive I have let Ed creep in a bit more I think by negotiating with her doh...
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scaredmom
Hard hard stuff isnt it.
How can we help? Is there something that we can say that can help you push through?
Can you increase the calories in the food via oils and cream etc.... but still in a small “foodprint” ( typo intended).
What happened a few weeks ago when the number of snacks decreased?
XXX
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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debra18
Is she in school? Any incentives can be offered or things taken away for not eating?
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melstevUK
Heron,

'they are Fbt but not much focus on intake.'

I am so sorry.  You are being let down very badly by your team - they should be ensuring your d knows that she should be listening to you and backing you to be in charge.  Can you phone them and ask them to give her this message, and tell her very clearly that her intake needs to go up quickly or she will soon be back in hospital?  I would also be letting them know how little she is eating because if they are not backing you, they need to start planning for another hospitalisation. They need to get real, take on board how bad things are and start getting some rules in place for her, to help you.

Try and tell d that the snacks need to go back in NOW and that she will be back in hospital soon unless she complies.  Tell her that you know that it is difficult for her but that she has to learn to eat outside a hospital setting if she is ever going to get her life back.  If you can get even one snack back in as a start it is a victory.  Just start with making one small but significant change initally.  It is easier to fight for a small thing, get that in place, and then the ed knows that you mean business.  

This is such a tough illness to beat.  And the violence can be scary.  But one big battle could make a big difference.  Wishing you luck and sending a big hug of encouragement.

Believe you can and you're halfway there.
Theodore Roosevelt.
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Heron
Thanks so much for all help and encouragement.
Another query - Do you put a limit on food thrown in the bin before going onto the next meal?
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blondie
What we used to do with my sister is give her an amount of time to finish her meal - 15mins for snacks, 30mins for breakfast and 40 for lunch and dinner - I believe this is similar to what they do in many IP units. If it got to the end of that time and she hadn't finished then she would be given the approximate equivalent (always aiming for more rather than less) in a supplement. One of the benefits of this was that it meant no marathon sessions around the meal table - no arguments - it was either eat that or you will drink this - and I think that once she realised she could well be given more calories via supplement than she would have had finishing her meal she realised that eating the food was the better option  - thus the supplements were rarely needed
Also, to try and stop her leaving everything until the last 5 minutes, there was a rule that she was allowed to re-heat things just once - after that if it was cold then it was tough - eat it or have a supplement
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MargieMom
Heron, I am so sorry you are going through this — again. Such an awful disorder. I’ll share some of our situation in case any of it might be helpful for you.

I’ll note that supplements rarely work for us —once ED said “no eating” a supplement wasn’t going to go down either. The only thing has been effective is having our pediatrician’s mobile number. D knows that one skipped meal means a text to the doctor to be readmitted. One NG tube experience was enough motivation for our d to never want to do that again, but I know that is not always the case for all kids. I also know how hard it is to find a doc that “gets” EDs, and would be willing to do a similar “one strike, your out” approach. 

Tonight, however, we have lost that leverage because a space finally opened at a residential facility and, based on our team’s advice, she is being admitted tomorrow. That gave ED free reign to skip dinner, on the logic she’s already going to essentially a hospital tomorrow. So this gave us the chance to try super boring bed rest consequence that our FBT therapist recommended: flat on back, no entertainment other than conversation. ED really hated that, especially since it meant no shower before bed. Raving, alternately aggressive and teary. So hard to see so much anxiety, but it did seem effective and maybe will be remembered at the next meal?

Good luck ratcheting up the pressure, Heron. I hope you can get some good support from your team.
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Heron
Thanks all thats really useful xx
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silvermoon
It’s such a difficult thing to be confronted with aggression. With our D we used WiFi and phone access as leverage which was the “carrot” we had. We really relied heavily on high calorie drinks like a milkshake in the morning and a 1000 cal hot chocolate in the evening, her incentive was to gain extra time of WiFi in the evening after bedtime.

i found any potential consequences of GP visits or worse ER was also helpful when she was refusing to eat or drink.

thinking of you. Try to take a few minutes at least each day for time for yourself. I used guided meditation on YouTube and anxiety medication to help me through the re feeding months. X
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silvermoon
It’s such a difficult thing to be confronted with aggression. With our D we used WiFi and phone access as leverage which was the “carrot” we had. We really relied heavily on high calorie drinks like a milkshake in the morning and a 1000 cal hot chocolate in the evening, her incentive was to gain extra time of WiFi in the evening after bedtime.

i found any potential consequences of GP visits or worse ER was also helpful when she was refusing to eat or drink.

thinking of you. Try to take a few minutes at least each day for time for yourself. I used guided meditation on YouTube and anxiety medication to help me through the re feeding months. X
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tina72
Heron wrote:
Thanks ScaredMom and Tina,

D is 15 and nearly 2 years in. Year 1 went well but relapsed, started to recover then she has been stopping and starting over the past 6 months, but manageable. Has got particularly bad over past 6 weeks, coincides with team change - they are Fbt but not much focus on intake.
Having 3 small meals approx 1400 cal a day at the moment. Refusing all snacks (was having 3 snacks up until 6 wks ago, then 2 up until 2 wks ago).
Each time she has been aggressive I have let Ed creep in a bit more I think by negotiating with her doh...


That is really a bad team to be honest, they should concentrate on intake as WR is target NR. 1 in FBT and with 1400 cal you will NEVER get there. Can we help you with ideas where to get more calories in? What is she eating?
The snacks are very important because you need to keep her blood sugar constant. A low blood sugar increases ED thoughts and behaviour. She must eat at least every 3-4 hours. Your team should know that.
Where are you located? Can you change to anyother good FBT team?
Keep feeding. There is light at the end of the tunnel.
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tina72
Heron wrote:
Thanks so much for all help and encouragement.
Another query - Do you put a limit on food thrown in the bin before going onto the next meal?


Do not put it into the bin - put it into the fridge and serve it again if possible so she sees that it will go in the next time if she does not eat it now.
We had 20 min for snack and 45 min for a meal. If not finished in this time she needs to take an ensure/supplement.
Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS
ED loves holding us all hostage. My daughter like some others was never going to have a supplement at home. We had one try of 12 Fortisips from first discharge from hospital. She never had one. For her she either ate all or none of her meal, and she also only would eat what she felt was safe. The problem with this is that it can trick you into thinking something is better than nothing. Ultimately it is important not to be scared of her stopping eating. Yes it means consequences, yes it may mean hospitalisation, however this is the fault of the ED and not your fault. Starvation is not a tool to manipulate with. So lots of insistence on all meals with consequences for not completing. Aggression is usually a sign that you are doing something right. Try not to back down, rather press on but don't tolerate violence. 
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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Heron
Thankyou. This is so helpful and encouraging.
Unfortunately d is the one throwing the food in the bin. Continues to do this even when asked to stop. Multiple meals thrown each time.
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tina72
So first aid is to get the bin out of the room or lock the bin door so she cannot access it.
Tell her that it is not good for the environment when food that is good to be eaten is thrown away and that it is too expensive to throw food away (they normally are economical and want to save the environment). Replace the food that she throws and use plastics to save your good china. She must see that not eating is not possible.
Keep feeding. There is light at the end of the tunnel.
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scaredmom
I plates the food a few times over when she threw it.  And had another equivalent meal ready sometimes for a substitution.
my d would finally give in and eat some don’t. Many parents will follow the child to feed them even spoon feed them or when they don’t eat or throw take them to hospital. Sometimes that threat helps sometimes you have to go to hospital. I have heard a few times that when they got to the hospital parking lot the child ate the food that parents brought. Striking the right tone that food will always be eaten and finding what works for your child is the hardest.

You can’t ask her to stop as she has no control, you have to take the bin away and replate if needed. And be prepared with more food. 
Having a plan when she does not eat or go to the hospital can help your confidence too.

Does she need to go to hospital IP?
if things are not going well at home?
XXX
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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Heron
Great to move the bin. 3 went in at lunch time then she made her own low cal despite my 'i'm doing the food' and refused to add more to it.
Running out of options IP may be the only way forward.

Thanks for all suggestions xx
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scaredmom
We started our journey in IP and I found it helpful. 
Please consider it her ED is strong and you are really struggling to.
sometime we need to press the ‘refresh’ button and start from the scratch again.
if she is not eating please get her assessed by the emergency department even today.
if no fluids for 24hrs or no food 24-48 hrs go to the hospital.
XXX
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
You need to think how you can make her behaviour impossible. So if she is making her own food, how can she do that when she has no access to the kitchen? Can you lock the kitchen door? Put the fridge and a cupboard with all food storage in the garage and lock that? She is not allowed to make her own food. So make this impossible. Be creative!
This will be the same after IP by the way. The earlier you learn that the better... you will not get her back in a healthy state. She will not eat on herself when she comes back. IP does not solve all problems...
Keep feeding. There is light at the end of the tunnel.
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scaredmom
Heron,
I know this is year 2 for you.
I know you know what to do and that it is so hard right now for many reasons.
What worked the first time? Is that working at all this time?
IP is one tool to move forward and hopefully if that happens it can get her to a state and weight where feeding can be easier for you too. Although you still have to do it when they get home if she is not medically stable you and her need the hospital.
Does she have a medical appointment soon and if not can you make one soon? She needs her Blood pressure done and HR.
Honestly I feel she needs medical attention soon with a view to more intensive monitoring in hospital as right now being at home  is not working. And so hard for you! At 2 year ED seems very strong.

XXX
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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Heron
Thanks Scaredmom and Tina72,
assessed for IP this week, bed not offered as the 'least restrictive option is preferable'
I think being consistent worked the first time round. I think I have been wavering and loosing confidence, giving ed more ground. Trying to claw it back is met with increased resistance - hostility / restriction.
Tina72 - have you known other carers to have to go to such measures?

xx
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scaredmom
Many have had ups and downs and round and round.
you can do it! 
Fight through it, set your goals, keep calm (at least fake it). 
Sending support!
XXX
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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