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

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We are pretty new at this - our 12 year old has been diagnosed for about 3 months and we have been doing the Maudsley FBT which sometimes does not seem to do anything...we have been struggling with a few things lately.  The first is her violence, she will punch and kick - basically anything to get out of the kitchen or bedroom if she has reached meltdown status.  This usually comes after a ton of swearing at us.  I think maybe I need to get a Psych assessment as this is such foreign behaviour for her but I really don't know.

The second thing is how do you get them to eat faster.  I brought her  lunch to school today and she took over an hour to eat it.  Dinner and breakfast are the same. It's constant coaxing and encouragement...I just want her to get it down faster.  Plus I want her to eat more..we are at the refeeding point and she has only gained a couple of kilos after going up and down a couple of times.  I know it sounds like we are not being stict but we are.  

Any help appreciated.
Hi there,

im sorry you’re in this situation but everything you describe is horribly ‘normal ‘ and what most of us have been through.  The disorder takes them hostage and malnutrition means their minds are compromised, so they feel low, can’t reason etc and the way through this is fat, lots of fats.   Violence is unacceptable so by all means walk away from that until she calms, some people have had to call the police (the threat was enough for my d) but try to understand that these symptoms are the result of restricting.

id try to give as much high fat food in the smallest footprint to get the food in, but honestly the slow eating is again to be expected, can you give a high calorie shake or smoothie.  In my experience CAMHs (if you’re under them) advise woefully low meal plans and weight requirements, I’d question too if your d is well enough for school if she’s having such meltdowns, rest is vital to heal and school uses a lot of energy.   How many calories is she taking at the moment?   

One thing we tend to have in common us carers are having good, sweet kids who ED has made monsters of, starvation will do that. 
I've just bought Ensure and replaced it twice a day with the milk she was having - double the calories.  She has a large breakfast, lunch and dinner and 2 snacks - fruits though...so I would guess about 2500 calories a day.  She seems to keep the meltdowns for home and holds herself together at school.  What did you do exercise wise at school.  Did you stop any PE (Sports)?  Did you get rid of every sport?    I've tried threatening with Police but she doesn't listen....
My daughter needed 3000 calories and she still does even after a healthy weight for one year. She drinks a milkshake in the morning with breakfast and smoothie with supper. Keep going it will get easier. Try using one liners to stop bad behavior like violence ("I don't tolerate this behavior"). And try using a lot of distractions. My daughter reads while eating and doesn't notice what she is eating.
I would follow through on having the police talk to her.  It sounds drastic but it was the best thing I did when my daughter got violent.  They told her that any amount of violence was not okay and they reinforced what I was doing.  I video taped one of her meltdowns too and told her that if it continued I would need to show it to her treatment team.  If she doesn't have meltdowns in public then she should be able to exert that same control at home so I would require it of her.  My daughter had a place I would send her if she started kicking off.  I also set time limits.  45 minutes for a meal and 30 for a snack. After that she got Ensure to make up the calories.  I also told her I wouldn't tolerate swearing, violence or disrespect in any way.  If she kicks off in private, then invite friends over for meals and snacks.  Another thing I found was distraction was a big help.  We are both big BBC/British TV fans so we watched all of Upstairs, Downstairs, All Creatures, etc.
Thanks guys that's really helpful.  Funny enough I have a tape of her meltdown...it was to show my sister.  I thought the same thing..she should be able to control them.   We do invite friends over and yes that helps.  Any idea on how to get them to stop exercising?.  We have taken the lock off her bedroom door and it has to stay open but she will literally exercise in the toilet.  We are about to remove those doors too....
Hi bfiz and welcome,

Unfortunately what you describe is totally normal for children in the early stages of refeeding. I know that I felt that I spent about a third of my waking hours planning meals, shopping, cooking and tidying up and the other two thirds supervising meals.

We were eventually able to instigate a timed element to the meal. So 40 minutes for a meal and 20 mins for a snack. I reminded him when it was half way through, at 10 mins to go and at 5 mins to go. Often he would not begin to eat for 10 or 20 mins but I said nothing. I think he was plucking up his courage and distracting himself with youTube and any encouragement from me sent him into a panic and meant he ate nothing for that meal. I did not have any consequences for going over the allotted time.

There are many variations of this theme - the times may be different and many parents give a supplement like Ensure for any part of the meal not finished by the end of the allotted time. Most parents find that some form of distraction is needed before, during and/or after meals. This may be in the form of something on the iPad, reading, listening to a podcast and/or playing board games. Some parents have found it helps to play the video/game while they are eating and to pause it when they stop, restarting when they take the next bite. Another trick that works is to positively phrase the benefit to getting through the meal 'When we're done you can go off back to your friends, we can go to the cinema or whatever'

In the early stages, we did not eat with our son. He ate at a table in the living room, very closely supervised by one parent and the rest of the family ate in the kitchen.

Unfortunately, there is no way to avoid the trial and error involved in finding out which are the best options for your particular situation. It is all part of the process.

Almost all have stopped all sports and any form of exercise while refeeding. It makes it doubley difficult to get the weight on when they are burning it off with exercise. Exercise also interferes with the hunger and saitey hormones making recovery more difficult. A slow walk with the dog and a parent to supervise the pace can be acceptable. Many children, especially young ones like our kids, feel a very strong urge to move and/or stand constantly when undernourished. I would recommend that you check that she is not exercising in the bedroom at night or in the bathroom.

I am not sure if there are Community Liason Officers in the Australian police. If so, it is often useful to connect with them and explain the situation. They may be able to call out when your daughter is not in a crisis to talk to her or to react appropriately when you do call the police. It may be that simply knowing that you have liased with the police will be enough to help your daughter to avoid violence.

The other option is to ask your FBT team to recommend how to deal with the violence, they will know what support is available in your area. I know that I had the number of the Mental Health Crisis Team in my phone for our out of hours crises.

Please feel free to come on the forum and ask any and all questions that you have.

Wishing you continued strength and courage,

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.
We had issues with our then 14 year old with violence. My arms and legs were very bruised! I did call the police on one occasion to follow through as I had threatened. Unfortunately they could not come immediately and then the situation passed. They did come at a later time to talk to my husband and I and we explained the situation should it happen again. I discussed the violence with our CAMHS nurse and the consultant psychiatrist because I could not stop it to get enough calories going in to gain weight. 

For us an inpatient stay was required to start recovery. Please make sure your team are aware what’s happening as they should be able to make it clear that it’s not acceptable to behave in that manner. 

All the best. We didn’t have exercise issues but we did remove handles from doors so she couldn’t blockade herself in to avoid eating.

To answer your other question school PE was a no-no, in fact I don’t think d will participate again in school sports. Possibly team games at some point but no keep fit type PE.  She also had a year out of school and was still part time at the end of term. Recovery first always (but if a little life helps with recovery...there’s a balance I think) 
Thankyou everyone this is so helpful and makes me feel far less 'alone'.  I'm going to try a few things you guys have suggested and see what works best.   I think a visit to the police station may be in order too. This is such a terrible disease and such as shock when you're in it...I'm truly speechless as to how rampant it is.  Thank god for this forum...I have been needing to talk to other parents and this gives me hope and strategies to work with.  
Welcome bfiz, though sorry you have a need to be here.  There is terrific peer support available here on the forum and many great resources as well on the main F.E.A.S.T. website.  In addition to the excellent suggestions above, I would recommend When Your Teen has an Eating Disorder by Lauren Muhlheim.  It provides great info and many ideas/tools on getting through the tough times.  Eva Musby has excellent videos and resources as well.
"When you're going through hell, keep going"-Winston Churchill
I found that quote very helpful when trying to keep myself together when times were tough.  Sending warm support to you.
It is good to not only hope to be successful, but to expect it and accept it--Maya Angelou
Also check out Eva Musby’s website and buy her book. It’s a great resource

I will share what we did with d. She stood all the time and short slow walks turned into speed walking or running.
We did have to stop all non essential movement. It took me a bit of time to clue into the fact that standing all the time was exercise! Really she did not sit. We pulled all gym at school and recess time was in the school sitting. Supervision and extra calories is what some have done. We did as well. 
Mamabears d (search her threads) had sever exercise compulsion. She had to give extra ensure for any activity. KLBs son has exercise compulsion and they have used motivation for swimming to keep the food intake going. So many different ways, try something see how it goes and reevaluate if it does not work the first time.
All the EDs have different personalities and so it is our job to figure them out and how to get the job done.
There is no failure here, there is only feedback and at the beginning there is a huge learning curve for us as caregivers.
Sending my best.
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)
I'm having some differences with my husband in terms of at which point to compromise.  This morning L ate 98% of her breakfast of eggs (3) and mushrooms on toast with Turkish bread all cooked in butter of course.  So that was fine.  I also give her a cup of ensure and the idea is that she must drink it all before leaving.  This morning after drinking half a cup she poured the rest down the sink.  I was sitting by the kitchen door and told him to make some more  Ensure up but he seemed to think that she will make it up 'later' which I think is impossible - plus she was going to run late for school if we kept pushing - plus she would have 'lost it". I disagreed but allowed this to happen.   It's hard when you're not exactly on the same page...and I'm wondering how everyone else goes with their husbands or partners?  Do you have many arguments like we do, how do other Dad's handle it?  
hi bfiz, 

It is important to get on the same page as parents. Having a united front will help your child as the messages from mom or dad will be the same. We had similar issues here. My H felt that by making it easier for d, it would help. It did not help me feed d, it gave ED power to split us. I usually was in charge of making the food and her dad was just there to ensure she ate it all. It took my h an admission to hospital for my d to see how ill she was. 
I think discussing with him in private, how you both wish to proceed would be best. She will get upset and throw tantrums, that is ED. If you give ED an inch he will take 5 miles! 
As for being late for school, school does not matter right now, her "medicine" which is food is the most important thing.There is a lesson for her here too, no food no school... that worked for my d.

We have a saying here that it is "feedback and not failure". We all learn as each situation arises. I used to think that my H understood the illness and what we had to do exactly the same way as I did. I was wrong! Until we figured what each could do and what we needed to agree to (full nutrition), there was a lot of conflict between the two of us. 
My H had to learn to just follow my lead and that worked. I cooked and plated, my H sat with her to ensure she finished her food. My H played ping pong with her while I prepared the food. My H sat with her watching Netflix, or when she painted. We each do figure it out as couples, but sometimes it takes some conflict to get there. It was quite normal here for us. 
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)
Hi bfiz
Well done on the breakfast that sounds like your doing a great job!!
my h still does not “get it” even after my d has had 3 hospital admissions 
go figure?? 🙁
he still asks me why I watch what she eats......I’m serious.....big sigh!

we are 3 years down the track 
we had the private discussions, behind closed doors (away from AN d) about not arguing in front of d about the food and eating of it, about being on the same page etc etc
but for  some unknown reason my h can’t get this so it’s really been me who has been the one to “manage” the situation
even my older other adult children do not understand this illness (try as I might to educate them on it) they just think she’ll snap out of it and I’m being overprotective of her 

at the same time my h will tell everyone what an amazing job I’ve done with d
this illness effects the whole family on so many levels that I’m sure we all deserve some sort of medal once we’ve survived the nightmare of it all!! 

if you can in fact get your h on board/same page it will be so much easier for you and better for your d (ED) not to not split you (it’s the master manipulator) and tries to triangulate  everyone 

its a learning curve though and we all find out strengths and what we can do to help our loved ones 

my older children are always there for love and support for my d (be it from afar as both reside overseas) nonetheless they call almost daily or msg and AN d knows she is loved and valued

my h has been able to secure a job for her so now she is working with him and so that’s awesome as he can be flexible with her for her work hours to change for appointments etc which with another employer could be tricky to say the least and as my d is now a YA working is very important for her recovery 

so I’m saying we all find out way and what we can do to help our loved ones on their journey to recovery 

it’s so very hard but worth sleepless night, stress and worry and tears once they come back to you
which will happen once your d gets the nutrition in!! 

On the subject of sport/exersize in my d case initially she didn’t stop (GP advised it was ok)
in hindsight she should of stopped and once admitted to hospital all exersize stopped for near on 2 years 
she gradually was allowed a slow walk once weight went on
my d was EXTREMLEY ill by this stage though
so IMO I would stop exersize until she is WR and then can maintain her weight 
it’s a slow process and I’m sure your team will advise you of what’s best in your d case 

My husband also never understood the idea and never wanted to read anything or supervise any meals. He still doesn't get it. But he has continued supporting the family and I stopped working so I made peace with the situation. But if you and your husband are both supervising meals you will have to agree. maybe you can supervise and he can do other things like grocery shopping or playing games as distractions?
Thanks...we are trying to distribute tasks according to our strengths..and so we don't get burn't out.  Funnily enough she is more aggressive towards me...possibly because I'm more direct and he is better at distraction...did you guys get a Psych evaluation?  I'm finding it really tough to get one...
If you are doing FBT with an FBT therapist and as part of diagnosis, I would expect there to be a psychiatric assessment - to establish AN and not other similar appearing illnesses, to look for other co-morbids such as anxiety and depression, to assess suicidal ideation. That being said the nutritional rehabilitation is the most important part of the equation for recovery. Prioritising that above work, school, an everything else is what often makes families successful. It may seem to be over the top but this illness does have a high mortality rate ( as high as childhood leukemia) and the faster she gets back to where she needs to be the faster she is likely to recovery. 

When it comes to aggression to one person more than another, that sometimes happens because they see more wavering and uncertainty, other times it is because they want to yell at everyone but the do it to the person they trust the most not to turn away. Only you can really work out what is the motivation behind the behaviour. 
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.
Yep thanks.  We are focussing on the food first.  And yes she is gaining but slowly.  Are you aware of the butterfly foundation 12 week program?  If so have you done it?    I'm trying to hear from others that have.
There are a number of Butterfly programs in Australia. We are in Melbourne and D was booked in to the program there. We had access via the psychiatrist who attends the program. There are lots of pros - goals of consistent weight gain, clear protocols, sessions for support. I understand families are somewhat involved but it is primarily a 5 day a week day program. I do know of some girls who attended this and found it helpful. For my own daughter however we never got past the intake. The plan had been to step down there after her fifth hospital admission in six months. At the time she was just too ill. One of the requirements is that they need to sign that they agree to the goals of the program and will follow the rules. That includes consistent weight gain. At the time my D was unable to agree to this so she was unable to attend. 
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.
Hi bfiz,

I found the aggression during meal time difficult at first too. The key things that helped me were (a) a distraction of a game or Q&A cards to take the focus off the food, (b) no negotiation for anyone on what had to be eaten, and (c) constant reassurance that my d was safe (once she would let me hug her, it made a point of calming her down before and after meals). 

Our d was 11 when diagnosed and we are 2 years into our recovery journey. After a lot of traditional recovery work (psychologists and dieticians) we are now firmly in the 'Migration Theory' camp and are focused on nutritional rehabilitation first and foremost. Listen to Tabitha Farrar's podcasts if you want to know more. My d has been listening to these podcasts and we are finally able to have constructive conversations about what is going on inside her head (2 years working with psychologists couldn't get there!) rather than having cyclical arguments.

While we never had movement/exercise issues, I think there is merit in gentle movement post a meal  as a distraction. It took a while for my d to want to try yoga, but it has also helped her feel like she's moving, but not expending too much energy.
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.