Here are my thoughts.First, I would at the minimum get her vitals and labs done and make sure her heart is ok.
Your daughters restriction hit at the exact time when she should have been gaining a large amount of weight and growing. You cannot base her needed weight goals/gains only on her growth chart of the past few years. Also, since it sounds like she’s always been very thin and very active, it is possible that she (And her twin) has been underweight for many years. Have you had her growth charts looked at? The majority of doctors and dietitians etc do not look at the growth chart in its entirety- looking at patterns in time etc.
Your daughter needs MUCH higher calories. Dr.Peebles from CHOP ( one of the top centers for adolescents) recommends 4000 calories daily minimum for several years. Your daughters body will become hypermetabolic. This is normal. Once her body can trust that it’s getting fed regularly it will first repair internal organs and muscle. Then it will start to actually make up for lost time in growth and hormones/puberty. All of this takes a ton of energy. My daughter needed 6000 cals a day from ages if 11-14. It is completely normal for kids in this situation at this age to need 4000-6000 plus. My daughter grew 9 inches, went through puberty, and had to morph into a woman. She’s now almost 20- in full recovery for many years. It was hardcore and it was worth it. She is completely free of ED.
The number one biggest mistake made by almost all ED professionals is setting weights too low. It will keep someone in permanent ED purgatory. And frankly in situations like your daughter, there really is no “ goal weight” bc she’s going to grow and change massively. You feed to FULL NUTRITIONAL BRAIN RESTORATION. And you will know when that is happening because of significant improvement in behaviors etc.
I have written 2 pieces that are now in the “ expert by experience” blog that may help you. One is on puberty called “ The Long Game” and one is “ 8 hours from any treatment provider we had no team, we were the team” . For some reason I cannot put a link in here.
Do you have Lauren Mulheim’s book? That is an incredible and easy to follow book. Eva Musbys is great also.
ED wants our kids dead. And it will do everything it can to intimidate us, to play on our maternal instincts to soothe and “ minimize anxiety”. But the reality is we have to be able to tolerate their distress. We can not negotiate with the beast trying to kill our kids. The only response to anything ED says is “ hmm hmm. I’m sorry how hard this is. Now take another bite. The quicker you finish the sooner we can paint our nails....watch that show....play a game....etc”
I know that much food sounds so impossible. But I promise you it’s not. I know bc we did it and I’ve been around now ten years and know thousands of others who have too.
There are so many ways to get calories in.
For example: my oatmeal. I used to make this on weekends and in summer and spoon feed my daughter at like 5:30 am so she could go back to sleep.
1 cup heavy cream (800 cals)
1/2 cup oats
add butter, brown sugar or maple syrup, Nutella or peanut butter, raisins, dried fruits, etc.
EASILY 1200 plus calories in a small serving.
milkshake every day at 3:30
1 cup cream
container of Hagan Das or Ben and Jerry’s
1/3 cup coconut cream or can add canola oil
This has well over 2000 cals but is a bigger shake. You could cut it in half as well.
Butter can be melted and added to just about anything. Example: coat her noodles with olive oil. Add melted butter to her spaghetti sauce. Right there you can easily add hundreds of calories.
crushed nuts can be added to lots of things too- without detection.
If I can be of any help- please feel free to email me.
My heart goes out to all of you dealing with this especially during Covid.