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nxk0707 Show full post »
Enn
nxk0707 wrote:
Thanks again! Just to answer some questions.  Her weight has not changed significantly in the last year.  Her growth chart shows normal weight tracking and her height is probably where it is going to be, given her maturity rating.  Her ED is characterized by: a. carefully logging everything she ate and its calorie content; b. giving herself a very small budget of calories through the day; c. "bingeing" usu!ally after school or at night and then purging in response; d. obsessively measuring her portions and using measuring cups to serve herself certain foods.

OK it is good she is tracking on her height and weight percentiles. As for the measuring cups and counting calories, try to make the food so she cannot really count. She still will do it, just make it harder and distract. My d had her favourite ramekins to measure all food. The best advice here I received was to get rid of all ways to measure foods. That is not what a normal teenager does. 

All of her labs and health tests were normal.  And she remained active in sports and with friends.  The biggest thing is the shame factor; she remains extremely resistant to discussing this with us and gets angry even if we express our concern.  

The anger at discussing it is normal. My d still will not discuss it at all. As long as the behaviours are changing, then you know things are improving.
Question: How much do you all enforce "healthy" eating versus just allowing her to eat what many would call a normal teen diet, fast food, junk, etc.  She actually is eating pretty well this week, but at school ordered chips, soda, an apple, and a rice crispie treat.  Yuck!  But, it seems like high fat, high calorie to me so I didn't call it out.  thanks!

Embrace that she eats this stuff. There is no bad food really is there? Unless it is rotten or poison, enjoy that she eats this. That is a normal teen! We all have had to come to terms here about healthy and not healthy foods. For our kids who are so focussed on food and society's view of what is "good or bad", the less focus on the foods the better- not just for their sake's but for ours as well. As long as she getting a nutritious foods most times, let it go. 

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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ValentinaGermania
nxk0707 wrote:

Question: How much do you all enforce "healthy" eating versus just allowing her to eat what many would call a normal teen diet, fast food, junk, etc.  She actually is eating pretty well this week, but at school ordered chips, soda, an apple, and a rice crispie treat.  Yuck!  But, it seems like high fat, high calorie to me so I didn't call it out.  thanks!


There is no healthy food and no bad food, it is all a question of amounts. You can get sick by only eating burgers but you can also die by only eating salad as some of us learned the hard way here.
Try to accept a diet with great variety and embrace her eating teenage stuff and junk food! They need a lot of fat at that age and I am a mum that needed 1,5 years to get her d to eat at McD again so please try to see that positive!
Keep feeding. There is light at the end of the tunnel.
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nxk0707
Thank you!

The anger at discussing it is normal. My d still will not discuss it at all. As long as the behaviours are changing, then you know things are improving.---This advice is so reassuring. 

And thanks for the advice on eating junk food.  I've spent so much time counseling people to eat "healthy" and obsess about fruits, vegetables, avoiding junk etc.  Here I am thankful that my d is eating rice krispie treats.  The ED treatment paradigm really flips things around doesn't it?

My d loves to bake and has been doing so for years.  I just was reading in When your Teen has an ED that these kids sometimes love cooking and baking for others as an offset to binging and satisfying their hunger queues.  But they will often not eat what the bake.  Last night, she baked brownies for her friends who slept over and ate it and then had it for breakfast.  She also ate strawberries without cutting them up into little pieces.  Progress!
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Torie
I can't think of anyone here who was not surprised (shocked, really) to find out the things their kid was doing that they didn't know about (e.g., unexpected times and ways of purging, secret exercising, self-harm, lying, secretly throwing away food just to name a few).

I was really sad that I had to turn into one of those nosy, snoopy, intrusive, overbearing moms that I had never been.  I learned that I had to watch her like when she was a toddler - not what I had expected to do as the mom of a high schooler!  I could not trust her at all, about anything ED-related, period.  (And previously she had been one of those easy kids who ticked all the correct boxes.)

Purging is a tough nut - at least as hard to stamp out as restriction.  It will put you to the test for a l-o-o-o--n-g time.  

Normally it is entirely useless to reason with them, but occasionally someone will report that explaining about the effect on their teeth can make a difference.  And it is important for her to know that she should not brush her teeth after purging because the acid softens the enamel.

As the others have said, to me food is food.  I think that is slightly different with purging because it seems to help with that to make sure each meal and snack has a good mix of proteins, carbs and fats.  Try not to let her binge on hyper-palatables not because those food are bad in the conventional sense but because they seem to be associated with the urge to purge.  In moderation they are good, and they are fine in situations where you will be supervising afterwards for at least 2 hours.  Someone who has had actual experience dealing with purging will want to fine tune / correct that. 

You're doing really well so far.  Keep swimming. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Scaredmom2019
Boy do I understand how ED changes your way of thinking!!

I cringe when I hear parents talk to kids about eating junk etc! I now embrace when my D shows off her body (crop tops, leggings etc) as it means her body image issues aren't strong. 

Everything I thought was important; such as eating healthy and wearing full clothes is all flipped now!

A friend of mine took his 14 S for an annual check up and he said the doctor went on and on about healthy eating and avoiding sugar. My response was to never take him back to that doctor again! Oh how ED changes one fundamentally.
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nxk0707
I believe your sentiments are correct.  In recent years, my counseling on healthy eating has really shifted away from categorical advice giving to more listening and tailoring a more "mindful eating" approach with a little bit of education on what makes good choices.  Children need empowerment and resiliency about their eating in our food environment, because it is so toxic.  Food is fuel for growth and play.  Sometimes it is medicinal, and can be fun and celebratory at times.  But, ultimately, it is a means to enable growth, learning, playing, and giving back to others.  Thanks guy for all of your support!
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nxk0707
We met with our ed therapist and had very good visit.  She reminded us that our current monitoring program is "very loose" and leaves ample room for temptation to binge and purge.  We are now packing lunch, taking a picture and an inventory, sending it to her counselor, and having her monitor our d during lunch.  At the same time, our dietitian and therapist confirm she should be at 2200 calories a day, which to us was a lot to think about.  We moved a bed down tot he second level near the hallway to monitor bathroom all night long.  We have NEVER learned so much as parents.  We prided ourselves on knowing everything and were negligent in seeing any deficiencies in our parenting styles.  We were at best B- parents.  Now, we are completely relearning new parenting skills that many people less educated than we have probably been doing all along.  
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Enn
Many of our kids need more than 2200 cal. As you are aware, BMR can vary depending on pubertal status, activity, growth etc..
I know your d did not lose weight but  she needs to KEEP the calories in her.  The  small worry I have with your plan about school is that having her eating be monitored is one thing, but some kids can purge hours after. Is there supervision for bathroom breaks?  Glad you will be monitoring her activity in the night. 


Yes we all learned to parent differently. Gone are the days here of collaborative parenting, but firm parenting has taken its place. Our kids feel safe with us being firm. That is all you are doing. We are all different- I don't think it is about being more or less educated, it is just a human experience that is outside the norm.I hope you know what I mean by that.
As long as we love our kids ,none of us are "better" or more or less learned  as parents. And remember, everyone's circumstances are so different. If my other kids had other illnesses, I may be better or less able to handle it. This is a transition in your and wife's skills, that is all it is and what is needed for our kids. They dictated the change, and it is not really what anyone wishes to need to happen. 

EDs are usually a wake up call for us. These are usually the kids that were just so easy to raise, so responsible, so organized. We never had to help them do anything in life, they just were so able. Hence it is hard to not to miss what we were never aware of- right? Remember you did not know what you did not know. What you know now, you and wife will take care of. You are able and equipped more than you give yourself credit for. We all feel this way at the beginning. I am a stronger mom, I think. I am more compassionate overall for other's hardships and I have a deeper appreciation for "Normal" life.  
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)
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ValentinaGermania
nxk0707 wrote:
At the same time, our dietitian and therapist confirm she should be at 2200 calories a day, which to us was a lot to think about. 


As ENN said, that is very low intake for ED and for refeeding.
I wonder how that dietitian found that number. I guess she used a calculator where high and weight and what movement is asked. If so, forget that.
Nearly all ED patients have a very high metabolism. My d burns calories with sitting around and thinking 🙂. She eats same as hubby and she does burn all with nearly no sports. Most ED patients need 3500-5000 calories a day. To gain and to maintain...
Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS
I also agree it is a low intake for re-feeding. Is your  D gaining weight? It sounds like there is an acceptance that she has not really gained from some of your earlier posts but I am a bit confused because else where you mention she is maintaining centiles. 

I was the parent who took the food directly to the school nurse. Prior to this I supervised all meals myself.  D was required to eat in a specific room in the health complex - there was few places food could be hidden and the nurse had been advised to make sure there was no dumping of food. My D did not purge, but it sounds like your D may need some supervision for a while after meals to manage this as well - commonly an hour is required. For my D it was easier to have this in place before she really got to protest - I let her know that it was not that I didn't trust her but I knew that her thoughts would tempt to to hide or dump food and I wanted to not have her feel tempted. 

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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nxk0707
Hi all.  Thank you for all your responses.  Just to clarify, we reviewed her growth charts and she has gained weight and maintained BMI percentiles without deviation throughout puberty.  I'm wondering if that changes your thoughts about her calorie goals?  She is just now getting up to 2000+ per day and with soccer, will be eating more but also burning more.  She just seems so much brighter and in a much better mood lately.   

Question about sleep. Has changing bed times plus melatonin or other sleep aids been part of your treatment plan?  She is so resistant to going to bed early.  How aggressive are you with sleep?
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ValentinaGermania
When my d was in the dark days she did not want to go to bed and sleep as she wanted to burn calories all night. We insisted on regular sleeping times and locked electricity in her room in that time so it was dark and no internet 🙂.
When she came home from IP and we did FBT she was so exhausted and tired and we too that we all went to bed around 9 p.m. which is not normal also.
Now in year 4 we are all back to normal sleeping times of an adult 🙂.

What is she doing in the nights? Is she exercising secretly? Walking around?
Do you know that there are weighed blankets to calm someone down that is too active?
Keep feeding. There is light at the end of the tunnel.
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nxk0707
Hello community!  I wanted to update you and seek additional advice.  We have been doing our family based therapy, which has transitioned to mostly 1:1 sessions between her and her therapist.  Our schedules are such that monitoring eating is difficult, but we feel she is eating well.  We are not detecting any purging.  Just to remind everyone, she maintained weight and we are mostly dealing with binge/purge. We started all of this in February 2020.

What I need to know is basically, how am I doing?  I regularly try to touch base with how she is doing, but there is a lot of anger.  If I don't see enough eating, I might ask her to eat more or use bigger plates, etc.  But, she gets pretty mad and reminds me that she is eating a lot of snacks I am not seeing.  I don't know if I should be allowing her this independence.  I don't have her weight to go by.  I can't assess her preoccupation with eating disorder thoughts.  She is not purging.  So, I don't have a good sense of how to let go or keep providing structure and reinforcement.  It's like doing something with no data and no measurable indicator.  What do you all think?? Thanks.
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Enn

Hi there some good things in your post : no purging that you have  seen. Also weight is good. 

A few questions: is she gaining appropriately for  her age or is she following her curve. Can’t recall if she has gone through menarche? 

The brain takes a few years of good nutrition and good eating no purging to heal and until
she is 25 or so there will be development of her pre frontal cortex. So that may take awhile to know. The anger is normal for such an early stage. Only 3 to 4 months right?

Now I am gong to be a bit provocative and ask how do you know for sure she is eating when you don’t see her. I ask this because she gets
Angry  when you ask her to eat more and says that she is eating a lot of snacks  that you do not witness. For us here, that was ED trying to get me off her back when I knew in  my heart and soul she was not eating enough when  I was not there. She doth protest too much. 

Her behaviour and attitude can tell you her ED thoughts. She does not need To  explicitly tell you. My d at 3 years and doing great won’t tell me to this day. 

I say keep as much control as you can and support her making good choices with her food for at least a year. I know you want to move on. I wish it was so short lived. 
All kids are so different and your d may be ready to move on, I just feel at 4 moths or so it seems too early. I have seen here when control is given to the child too early it usually does not bode well. 

I say this  with with concern, kindness  and care for you and your situation. I am glad you came back to update 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)
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nxk0707
Hi there,
Yes she is menarchal and stopped growing taller.  To use a medical term, her bone age is fully mature, which means the growth plates are closed.  Her actual weight itself we have not measured in a while due to no in-person visits at the therapist's office.  We have asked about getting a scale, but we are told not to.  On snacking, it is fairly easy to see our kids going to the kitchen, and I find popcorn, wrappers, and evidence of junk food in her room.  Pretty normal.  And we do periodically search her room for stashing, purges, and other "prohibited" items.  Lately, I've just seen little signs like smaller breakfasts and using the little plates at dinner, reminders of the past!  I have to talk to her about those things, which of course leads to tears and yelling.  That's when I ask about snacking, and she tells me her meals are smaller because of the snacking, which I don't see, etc.  
You guys have been life saving!  We are NOT ready to move on.  I told her she can yell all she wants, but I am not going to stop.  I'll keep the group posted!
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