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.

Join these conversations already in progress:
• Road To Recovery - Stories of Hope
• Events for Parents and Caregivers Around the World
• Free F.E.A.S.T Conference Videos

Visit the F.E.A.S.T website for information and support.

If you need help using the forum please reach out to one of the moderators (listed below), or email us at bronwen@feast-ed.org.

Sign up Latest Topics
 
 
 


Reply
  Author   Comment  
Penny31

Caregiver
Registered:
Posts: 156
Reply with quote  #1 
...we seem to have our old D back! She's been in IP (on and off) since May - not an ED unit, but a general adolescent psychiatric ward. For the first couple of months she seemed to be 'lurching from crisis to crisis', as her psychiatrist put it, and despite the fact that she was eating we had no confidence at all that things weren't going to slip again. In fact, she repeatedly told us that she would stop eating as soon as she was discharged. She also said she would never go to school ever again in her life - and this from a straight A* student (she's the kind of girl who puts a huge amount of pressure on herself academically, however much I gently tell her that top grades aren't the most important thing in life). Over the past couple of weeks though her mood seems to have lifted. It's early days, but she seems to be eating almost intuitively again, and she even attended a half day at school last week. Luckily we caught the ED before she lost too much weight, so her weight is fine. At the bottom end of 'fine', admittedly, and she can't afford to lose much, but she's doing really well.
I'm under no illusions whatsoever about long term recovery. I would be surprised if she didn't relapse at some point, either sooner or later. But tomorrow she should be home from hospital, and we feel that for the time being at least, it's the old D back. I am so hugely grateful for all the NHS doctors and nurses and support workers who've cared for her over the past few months.

__________________
14 year-old D diagnosed with AN in March 2016. Episodes of self-harming, anxiety, severe depression. Waiting for a CAMHS assessment to see if there's an additional diagnosis. 
Kali

Avatar / Picture

Moderator
Registered:
Posts: 1,082
Reply with quote  #2 
Hi Swash

That is great news!!!!! I am so happy for you and your d!!!!! Some of the things we did at home to help d. when she came home were:

I kept to a similar meal schedule as the RTC had. As we moved along, after a few months at home we introduced a little flexibility. For example if she slept in we had a slightly altered schedule but still had the 3 meals a day and two snacks in.

She had a step down plan with PHP, IOP, and then outpatient providers so she did not go right from the RTC to home with no support. I think this was really helpful. Do you have a plan with a team in place for after she leaves the hospital? My D. was still very ill upon leaving the hospital even though she was fully weight restored.

She made a mealplan with the dietician at the RTC before release, and we stuck to it pretty religiously however we added several new meals a week. The mealplan was basically nothing more than her choosing meals she liked and the dietician signing off that they had enough calories and nutrition. Also amounts were indicated. It seemed really helpful for her to know what the weeks meals would be beforehand so we sat down each sunday and made a plan together and then i did the shopping. I tried to make it interesting and we looked at recipes together and sometimes she cooked or brought home takeout for us to eat. She was not in the kitchen with me when I was preparing the food. The program she was in had her packing her own breakfast 4 days a week and lunch one day a week, and then bringing it to the program where she ate it with them. And then they could comment on what she was bringing and whether it was enough or not. We keep all the recipes for meals she likes in a binder and I have an idea then about how many calories and the breakdown of protein, fat etc is. After 3 months I was able to start just putting good meals on the table instead of her wanting to know what she was eating before hand. We also worked out some meals which could be a little more on the go if she woke up late: there is a protein smoothie she likes and some granola bars which she will grab for breakfast if she wakes up late so I always keep them on hand for her. A quick 600 calorie breakfast. Since waking up late and not having time to eat was one of her previous methods to avoid eating I made sure to work on closing that loophole and practice a different plan.

Portions: We let her take her own portions, pour her own drinks, etc, under our supervision. We then let her know if she was not taking enough and encouraged her to take more. In the beginning when she first came home she measured portions so that she could see what was appropriate. We don't do that anymore but it was helpful at that point. 

Fear foods: We went very slowly with fear foods but we encouraged her to try as we went along. Most important was full nutrition.

Dinner table: We never speak about anything unpleasant while we are eating. Gentle encouragement and reminding her that she is motivated to be well again worked with her if she was having trouble finishing her meal. All food is presented looking as good as I could get it to look, in nice plates, I keep flowers on the table, there is music playing in the background.

Breakfast smoothies: Keep them coming even after weight restoration.

Drinks: D is strongly encouraged to drink a caloric drink with each meal; milk, juice etc. At first this was difficult however she was able to start doing this consistently.

Flexibility: Flexibility seems very important to me since the ED is so rigid with rules and regulations about what can and cannot be eaten. So encouraging flexibility around food choices and being able to learn to fit meals in when she has appointments, is going out with friends, or is working is a very important life skill to focus on and we are still doing that. But that came later after she was used to being at home and was eating properly. Also we have one restaurant night a week where we eat out. Eating at parties or family occasions has not always gone so well so I encourage her to either eat before going to the party, or we have sometimes left the party and I get her dinner somewhere else or at home instead. The important thing is that she eats and for the time being I don't care whether it is at the party or not. 

Loopholes: And finally, I thought about the ways d. was getting out of eating before she went into treatment and tried to counter them. She was claiming to have eaten with friends and then telling the friends that she had eaten at home. She had a job at a restaurant and then claimed she had eaten there. So those loopholes were closed. She is no longer allowed to have a job in any kind of food service. She did not go out and eat with her friends for a very very long time after coming home. So if your daughter had some ways of avoiding eating try to think about what they were and try to close those loopholes and establish new habits now with her. Check the toilet if you need to, check the trash if there have been incidents of self harm, etc.

And mostly try to stay positive and enjoy having your d. home again!
Your cup is half full, as they say!

Kali

__________________
Food=Love
Torie

Avatar / Picture

Caregiver
Registered:
Posts: 5,514
Reply with quote  #3 
Oh yay, Swash! So glad to hear the positive report! Thanks for sharing. xx

-Torie

__________________
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
mjkz

Avatar / Picture

Caregiver
Registered:
Posts: 1,602
Reply with quote  #4 
Glad to hear it Swash.  Good that she was talking but not necessarily acting on what she was saying.  Hope it continues.
NELLY_UK

Avatar / Picture

Caregiver
Registered:
Posts: 1,928
Reply with quote  #5 
This is great news. If she has been on a section MAKE your outpatient team use a community treatment order. You can only use it following IP sectionning. This makes outpatient treatment mandatory and if she starts to not attend and get difficult this is the only tool in the uk that can enforce attendance.
Once the section is off you cannot use it.
You cannot apply for it retrospectively.
When she is 16 not 18 she can refuse treatment and there will be nothing you can do inless she becomes medically unstable.
X

__________________
NELLY D 20 bulimic since age 12, diagnosed in 2011. 20 months useless CAMHs,7 months great IP, home March 14..... more useless CAMHs.now an adult & no MH services are involved. I reached the end of my tether, tied a knot in it and am hanging on. ED/Bulimia treatmentis in the dark ages in West Sussex.
Penny31

Caregiver
Registered:
Posts: 156
Reply with quote  #6 
Quote:
Originally Posted by NELLY_UK
This is great news. If she has been on a section MAKE your outpatient team use a community treatment order. You can only use it following IP sectionning. This makes outpatient treatment mandatory and if she starts to not attend and get difficult this is the only tool in the uk that can enforce attendance. Once the section is off you cannot use it. You cannot apply for it retrospectively. When she is 16 not 18 she can refuse treatment and there will be nothing you can do inless she becomes medically unstable. X

Thanks - she wasn't on section (she would have been, but at the very last minute she decided to come voluntarily), so unfortunately a treatment order isn't an option. Unfortunately she's not out of hospital yet, as she threw away most of her lunch on the ward yesterday, something she hasn't done in a while. Why, why, why? When she was doing so well, and she's potentially so close to being discharged too! So now she's on home leave, but they want her back on Monday. And now at home it's 10am and she's still in bed, and I'm worrying that this could be a ploy to avoid eating rather than just normal teenage behaviour. I mean, normally I'd be fine with a teenager being thoroughly lazy (especially, er hem, as I'm no role model in that regard). But now...

__________________
14 year-old D diagnosed with AN in March 2016. Episodes of self-harming, anxiety, severe depression. Waiting for a CAMHS assessment to see if there's an additional diagnosis. 
Penny31

Caregiver
Registered:
Posts: 156
Reply with quote  #7 
Quote:
Originally Posted by Kali
Hi Swash

That is great news!!!!! I am so happy for you and your d!!!!! Some of the things we did at home to help d. when she came home were:

I kept to a similar meal schedule as the RTC had. As we moved along, after a few months at home we introduced a little flexibility. For example if she slept in we had a slightly altered schedule but still had the 3 meals a day and two snacks in.



Kali

Thanks so much for your detailed response. Her AN is quite atypical (she's now in fact got an EDNOS diagnosis), so she doesn't really have things like fear foods. For her it's either she eats, or she doesn't. And when she doesn't, she REALLY doesn't (i.e. she fasts more or less completely for days on end), which is why hospitalisation is so critical. We have got a meal plan though, which she is supposed to be sticking to. The plan is quite vague and allows for a lot of flexibility, which is both good and occasionally slightly annoying. 

__________________
14 year-old D diagnosed with AN in March 2016. Episodes of self-harming, anxiety, severe depression. Waiting for a CAMHS assessment to see if there's an additional diagnosis. 
Penny31

Caregiver
Registered:
Posts: 156
Reply with quote  #8 
Quote:
Originally Posted by toothfairy
Hi Swash, Uuuggggghh Did she eat her breakfast? X

Just a piece of fruit. She 'just wasn't hungry'. I'm in two minds over whether to crack down at this stage though. She's rarely been much of a breakfast eater, and in the past that hasn't interfered with a normal growth/weight trajectory. IF she can make it up at other meals (and she does appear to be eating well at other meals), then that might be fine. I know some of you may throw your hands up in horror at me taking a 'wait and see' approach and allowing her to effectively skip a meal, but her weight is OK at the moment and I know from past experience that if I don't overlook the occasional minor blips in her eating then she stops eating anything. I've asked her psychiatrist for advice. I guess it depends a bit on what the scales say next time she's weighed. 

__________________
14 year-old D diagnosed with AN in March 2016. Episodes of self-harming, anxiety, severe depression. Waiting for a CAMHS assessment to see if there's an additional diagnosis. 
Kali

Avatar / Picture

Moderator
Registered:
Posts: 1,082
Reply with quote  #9 
Hi Swash,

When d. wants to sleep in I let her sleep until 10 and then gently wake her up and tell her breakfast is ready.

This usually gets her down to eat by 10:30 or so and then we do a 10:30 bkfast, 2pm lunch 4 pm snack 7:30pm dinner and 9:30pm snack.
I do try not to let her get up later than that. Keeping the meal schedule is very important after coming home from the hospital and then, actually, forever after that. Our usual schedule is 9am bkfast, 12pm lunch 3pm snack 7pm dinner 9pm snack.

So if d is still sleeping now go up and wake her! If you are wondering whether sleeping late is a ploy to not eat then it just might well be, listen to your 6th sense and then plug up any loopholes and create firm limits.

Did the hospital give you an idea of how many calories she will need to eat each day to maintain her weight in her meal plan? The dietician could recommend something, I went in and met with her and d. before discharge to discuss the meal plan together so that I understood what we were going to do.

I even make her get up when she has a cold, says she is not feeling well, etc. She has tried those things and I am firm that no meals can be skipped and if she is not feeling well or is tired then she can go back to bed after eating and nap. Guess what, it is usually just ED chatter and she does not end up going back to bed in 95% of those instances.

Be firm and matter of fact but compassionate and kind. I don't want to scare or discourage you but the months after coming home from the hospital seemed the hardest to me and that is when I really had to (and still am) become a foot soldier helping to defend d. from ED. I do my best to make sure that things are very different at home now from how things were before she went into treatment. But d was still ill when she came home. She had been weight restored and had gone through excellent and intensive treatment but was still ill, even though I saw glimpses of the old d.

Kali

__________________
Food=Love
Kali

Avatar / Picture

Moderator
Registered:
Posts: 1,082
Reply with quote  #10 
Hi Swash

I'm sorry your d. did not eat a good breakfast. ED may be trying to see what it can get away with at home.- sleeping late, then eating too little. I agree with toothfairy, if she is not able to eat a good breakfast, can you bring her back to IP? 

My rule is no skipping meals. I let her know that we really loved having her back at home but that she would need to go back to a higher level of care if she could not manage to be in recovery at home and she does not want to go back so that was a motivator. Can you let d. know that you really want to have her at home and for her to be successful in recovery, but that if she is not able to follow a balanced diet that she will need to go back to the hospital? And that you and your family will all work together to help her at home? Is there anything you can motivate her with that she might like to do in the near future? Can you plan some outings or fun things to do that she might like so that life outside the hospital and feeling strong enough to participate in life is much much more appealing than being ill in the hospital?

Here is my caloric daily breakdown that I aim not to go under in my cooking for d (and not every day is perfect but I wake up each day and do my best), d is 5'3.75" if your d. is taller she will need more. This is for someone who is weight restored and the goal is to maintain, it is not a weight gain protocol.

Bkfast is at least 600 calories
Lunch and Dinner 700 calories each
2 snacks 200 calories each.

"Just isn't hungry" is ED speaking. Can you add in a breakfast smoothie each morning? Eggs on toast? A hard boiled egg? Pancakes? A bowl of cereal with milk? Home baked scones or muffins? Oatmeal with raisons, nuts and cinnamon and a little cream or milk? Fruit is ok to add when eating these other things but not as a stand alone for a meal. I often put some fruit in a little bowl for her to eat in addition to the more substantial part of her breakfast. And a good multivitamin every morning is important. When d. tells me that she just isn't hungry, I let her know that I am sorry that she does not feel hungry but that she needs to eat anyway in order to be able to be in recovery and do the things she wants to do in her life. And that I understand that it is challenging for her but it is the only way she is going to get well again. College, trips with friends, time spent with friends, having a part time job and earning some money....all big motivators.

Breakfast Smoothie recipe: this is not super high calorie but good for someone maintaining weight restoration: whole milk, vanilla yoghurt (not lo fat) some finely ground almonds, a banana, some strawberries, a little honey, a couple of ice cubes, blend and serve. It tastes very good. I was not able to get her to drink this when she initially came home but we worked up to it.

Also, I sit down with her and eat exactly what she eats and we talk during mealtimes. If it is hard for her I let her get up and take a 15 minute break and then come back to the table and finish the meal. She is not allowed to eat any meals in her room. IMHO home after hospital can have many of the same rules she follows there since that is what she is used to now and then you can loosen up slowly if she maintains her weight. 

Kali


__________________
Food=Love
NELLY_UK

Avatar / Picture

Caregiver
Registered:
Posts: 1,928
Reply with quote  #11 
Yes she can have a lie in but no she cant skip breakfast. Or any other meal. The meal plan will be absolutely your anchor when she comes home. No compromises or bending the rules especially this early.
My d refused breakfast the day after she was discharged fully having been very compliant during home visits.
Ugggh.
I have a nightmare teen now in full control of her ed and i am powerless due to her age.
Be firm be extra firm. I know you want her home she has to live by your rules in your house. Easier said than done though that i do know. Ooo they are so tricksy.

__________________
NELLY D 20 bulimic since age 12, diagnosed in 2011. 20 months useless CAMHs,7 months great IP, home March 14..... more useless CAMHs.now an adult & no MH services are involved. I reached the end of my tether, tied a knot in it and am hanging on. ED/Bulimia treatmentis in the dark ages in West Sussex.
Previous Topic | Next Topic
Print
Reply

Quick Navigation:

Easily create a Forum Website with Website Toolbox.

WTadmin