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

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Blue
Dear Forum members,

With my AN D's diagnosis, my brother has asked for advice to help him support his 9yo daughter with very low appetite, who goes long periods without eating but no sign of no fear foods or restriction.

He does the Atkins diet and his wife is vegetarian, so there is some confusion how to ensure D's intake is sufficient and appropriate for her age.  Their philosophy to date is to 'only eat when hungry', which can be a small breakfast at 8am then piece of cake at 4pm then small dinner at 7pm.  But this may not be appropriate now that we now there is AN risk in the family?

I would think:
- start plotting age/ height/ weight over time and keep an eye of changes
- keep an eye on any restriction or signs of fear food developing
- start a regular rhythm of 3 meals/ 2 snacks every 3 hours

Would you very experienced parents of young ones out there please amend/ add to the list?

Also, is there a trusted resource that advises food and amounts appropriate for this age that he can check her intake against? 

Thank you in advance,
blue
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ValentinaGermania
Please reach out to atdt31_US here, they have refed a child with similiar age.
I hope they do not feed that 9 year old a vegetarian or vegan diet???
Why is he dieting? For fun or for medical reasons? Both parents not eating "normal" is no good role model for a child...
I agree with Ronson that regular eating and regular meals fit well into the daily routine of a child. A child (AN or not) should be offered food regularly.

Do the parents know that some children cannot eat only when they are hungry because they have no hunger cues at all? Mine did only eat because we all ate. She never said she is hungry when she was a child. I did not realise that then but looking back I think it was a blessing that we already ate 3 meals 2 snacks in our family long before AN moved in (and she got only sick because she dediced to eat "healthy" and not do morning and afternoon snack any more).

Please encourage them to go to a doctor to see if their d is already underweight. Has she grown normally or is she very small in addition? Maybe growth is already delayed... it would also be interesting to see if there are already deficiencies in her blood.
Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS
I think you are right on the money re feeding your niece. Like Valentina's D my D also never had strong hunger cues as a kid. She never asked for snacks, treats or seconds. I don't think she ever will. She at regularly because this is what we do. Some people don't have good hunger cues. It can lead to poor development and weight gain and of course increase the risk of developing things like AN. 
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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deenl
Hi Blue,

We always had a regular mealtime schedule but I trusted my son's appetite as regards amounts, trusting that he would naturally eat more as puberty and growth kicked in. While that happened with his older brother, it did not happen for him or for his younger brother. My middle son ended up with a restricting ED aged 12 that took many years to overcome. I learned my lesson and monitor the youngest son's weight and growth.

The FEAST website has a resource on ARFID that has many useful recommendations for books and facebook groups. While your niece has no diagnosis, I think there is probably something useful in there.

I would add to your list, a trip to a pediatrician in order to see if your niece is growing adequately, has no nutrient difficiencies and advice for the parents.

Warm wishes,

D
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal.
  • We cannot control the wind but we can direct the sail.
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Torie
People seem to find mygrowthcharts.com useful.  I can never remember if it is that or mygrowthchart.com
xx

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

I used to think that all kids would eat if they were hungry, and I was far too laid back around my d's lack of appetite - which we recognised because her father had been the same.  Neither of them had well developed hunger cues.  What I did not realise was that she simply was not eating enough for her activity and growth needs - and eventually, as she was falling behind her peers in terms of growth and development, it made it even easier for her to fall down the rabbit hole of an.

The suggestions you have made are sound.

What I would add is that perhaps your brother should ensure she starts eating more than HE believes she needs - it is really easy with children with poor appetites who don't eat large quantities, to have a warped idea of how much children actually need for growth.  You simply get used to seeing them eat small quantities and lose track of what 'normal' eating should be like for a child of his or her age.  I don't know which country you are in - but it might be worth pulling in a paediatrician to help think about quantities in particular and advise on that. 

Believe you can and you're halfway there.
Theodore Roosevelt.
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PurpleRain
Hi! I will add give her more variety than the parents have (every food group) at least once in a while to prevent fear foods.
My D started her descent to ED by wanting to eat "healthy" (no sugar, then no meat, then no snacks, only fruit or veggies for lunch and breakfast, and so on). My father does Atkins and my mom is vegetarian and I think my D got the message that restricting is "healthy".I also tended to be "careful" with what I ate, I'm now completely flexetarian, as Valentina would say🙂
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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Blue
Thank you for sharing your thoughts and experiences- we are very grateful.  There is really nothing like the wisdom of parents who have been there. xx
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atdt31_US
You have not said if the nine year old is underweight.  The advice you got, above, all sounds good:

1.  Go to pediatrician for well child check.  If you perceive there is malnutrition, draft a letter to the ped beforehand with your concerns and tell him/her that you would prefer to talk about nutrition outside the presence of the child at first to see if there is a problem the doc sees and if so, how they would approach it.  As you may have gleaned on this board, not all general practitioners say the right things and some do damage by saying the wrong things. So feel it out with adults only imo.

2.  Get prior well child checks (in US we have them yearly and you could plot height and weight).  Mygrowthcharts really is a terrific, free, website that has proven very helpful.  Go in and plot the heights and weights you have.   If you have a ton for some reason, you could just plot every six months to a year.

3.  Start feeding three meals and two snacks per day (to be honest, I suspect a lot of households get by, with non-ed kids, with 2 meals and 3 snacks ... breakfast can be hard to do as a big meal on a school day).  

4.  If she is underweight or lower weight than her own curve suggests she should be, consider enhancing some of the menu items with butter or oil to get to .5 to 1 pound of gain per week (actually, it is hard to say what I would shoot for without seeing the curve and current height/weight).

5.  If it truly is just low appetite, but weight is appropriate for height AND historic curve, maybe it is more about setting up better eating routines to be ready when puberty requires more intake.  If there is a problem, however, with actual weight/malnutrition, OR if there is restriction that is other than "lack of interest in food", it may need to be approached differently.  If there are restrictions based on texture or a very limited number of acceptable foods, it may need an approach more like a slow exposure therapy to gradually broaden her palate.  If there is a fear of choking or something behind the small consumption, there are good treatments for that. A lot depends on knowing a little more info than you have provided.

6.  I think you are spot-on to start monitoring. You can do nearly all of this in stealth mode, it seems to me, and only involve the child once an issue has been identified (and maybe not even then, depending).  If you need periodic weights and going to the doctor is an issue (it can be for a variety of reasons), at that age you can probably get a compliant blind weight IF there is not a restriction issue.  I was able to weigh my kid easily because she did not care a bit about her weight ... so, maybe we needed to be sure the cat was okay so we'd have kid hold cat and get weight, then alone, and subtract to get the cat's weight --- her weight was not spoken of.  Maybe you need to mail a package and you need to know its weight -- same thing, have kid do it.  Or luggage.  Once a month or so is pretty easy, at that age, to manufacture ways to get the weight, in my experience.  Later, she'll be on to you, but if there is no real issue with weight or malnutrition, you can monitor for a bit this way. 
Mom of either pre-diagnosis or non-ed underweight 12 yoa (as of March 2018) kid here to learn how to achieve weight gain.  BMI steadily in the mid 12's for nearly her entire life.  Born 2006. UPDATE:  April 2018 diagnosed ARFID, based solely on weight being less than 75% of Ideal Body Weight.  Mildly picky, but mostly the problem is a volume/early satiety issue, along with abdominal discomfort and chronic constipation, all present since birth.  UPDATE:  July 2019 diagnosed with PANS. Dr. said likely started first PANS episode at less than 1 or 2 years of age.  On long-term daily prophylactic antibiotics. BMI now about 16 after period of intense refeeding prior to PANS dx,  followed by stagnation as we sort out what is next. FWIW ED-D is a fraternal twin and we have no other kids.
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