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

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Hope42019
My D is 14 and just started freshman year of high school. She was diagnosed in April 2019 with RAN, WR by mid June with a moving target as she started growing. She requires 2600 cal to maintain and seems to gain a little at 2800 cal. Since starting school She is getting around 1400 cal in food/drink within 3 meals and 1 snack and the rest of the cal is in a 1200 to 1300 cal shake that she finally consumes without argument or rages so we are thankful for that now. We are trying to get her daily intake up (calories consumed beside the shake) so we aren’t putting it all in the shake. I want her to get use to eating a normal amount during the day. However, she is in school and doing volleyball so we haven’t pushed as hard as we are trying to adjust to high school life. Do you think it is harming our progress by the way she is getting her intake? Is it okay to stay with this eating plan for a while as we are finally down to only 2 outbursts a week? She actually has gained 1.5 lbs since starting school so weight wise we are not loosing any ground. I feel like there is no perfect way of feeding but I don’t know if we are catering to the ED by the method we are using using right now. What happens if we continue this way? Can we just gradually push for more daily intake as her brain continues to heal? Or do we need to be more insistent and push harder for eating more during the day? Thanks for any feedback! 
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scaredmom
Hi there,
I think it is wise to think about moving to more normal ways to eat. When you do that and how depends on how ready she and you are. You could start by adding a small snack to her schedule now and see how it goes. ED will show you soon enough how it is working.
You say she is doing volleyball and you have not pushed too much. I am not sure what that means, sorry.
Do you mean you have not added more food because of the sport? I would suggest
for sports that is a good time/motivator to actually add in more food. That is what we do here. D eats 3 meals and 3 snacks on regular days and 7 meals/snacks on sport days. For her having he extracurricular sports is a huge motivator and so has been compliant so she does not lose that privilege. 
Pushing hard or gradually either are fine as long as gaining and her brain
improves. Good job on weight gain in the first weeks of school. That is a trigger for my d.
she gets anxious with those changes in routine.
My d is the same age yours. It takes time and a lot of stamina. 
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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Hope42019
Thank you for your reply. School and volleyball can be stressors (although helpful for her mental health by providing distraction from ED), so we haven’t pushed as hard to add more daytime calories because it adds additional stress. She gets really angry still when we push for more and ultimately we are getting all the calories in right now even if it is not the way I want it. That is why I am having an internal struggle of how much to push her or just take it slower right now and be happy we are getting the calories. It feels good to have a little peace in our lives after 4 months of hell so I guess we have backed off some from aggressively trying to change all her behaviors. We still work on them daily but pick and choose our battles.  As a result we have slowed the pace of normalizing her eating and that is where I question our methods. Thanks for your input. I appreciate it and hope we can add another snack soon. 
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tina72
We sticked to shakes and smoothies with addings until about a year after WR and I then slowly took down the addings (and served the shakes without them) and my d lost some weight and learned to eat more slowly. It took us about 6 months to be able to cut off all the addings.
We have set targets on a list RE eating behaviours and worked them down slowly one after the other. Now in year 3 nothing is left on that list.

Listen to your gut. If you think she needs a break and is comfortable with these shakes leave it for some time x. If you feel she must do the next step now and learn to do xy then try it. There is no right or wrong. Some do rip the band aid off quickly and some do it slow.
Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS
There is another way of looking at this. Although your D is having 3 meals, one snack and a shake as a meal plan, if you were looking at energy input alone she is having one large meal, three smaller meals and a snack. Many would use three meals and two snacks as a long term plan. So although the eating may not look quite what one would expect in terms of food types, it is very typical in terms of food intake. Go with how you think this is going to get you there in the long term, it doesn't really matter what route you use. 
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
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PurpleRain
Hi hope, my d will be 14 in a couple of weeks, WR to her historical curve in June and now above it, no more meltdowns just the occasional "look" when asked to have a bigger serving or have an extra snack. We do the super shake with addings first thing in the morning as part of breakfast, 3 proper meals and 2 snacks, or 3 if she stays up late or has dance class. Sometimes we vary it a bit, for example during weekends I let her sleep in and then during the day I feed her more often so she can have all her meals and snacks. Sometimes, for example if she stays overnight withy mom (it happened last week) she didn't have her super shake, she had a good breakfast and later I made sure she had something extra to complement. It's my job to make sure she has all the calories she needs and not to go more than 3-4 hours without food but I think flexibility is important too to a certain point. It has worked for us. I obviously watch her mood and state like a hawk. 
13 yo d started to eat "healthy" september 2018, she had a growth spur a bit later, followed by tummy bug. She started restricitng breakfast and school lunch in january 2019 (that we know). We are refeeding at home (succesfully I think) since the beginning of march.
I have found inner strenght, patience and compassion that i did not know I had. Never retreat, never surrender
Just keep feeding
 
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Hope42019
Thank you all for your input and sharing your strategies. I appreciate it and it helps to put things in perspective. So glad to have found this forum! 
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kkhrd
Hi Hope, We too are very reliant on the shake, as it got us weight restored and made life easier for all.  Now with some brain healing D wants to eat more normally (ie. more calories from food less from shake) and this is what we want as well so she has a better understanding of what a day of eating looks like for her to maintain weight.  We are starting very slow removing one shake a week and adding an equivalent snack to compensate and at weigh ins we gauge whether or not the snack and meal allotment are enough.  So far it is working well and have been able to remove three.  Hardest struggle was having to eat additional food when no one else was eating, but we are working through that too.  I think it's a good plan for more independent eating, but it is a process to get there.  Don't feel bad about how you get the calories in as long as they are going in.  Once weight is restored it will be easier to change things up.
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Hope42019
So we met with our nutritionist today and she wants us to improve her food cal intake to 1800 within 4 weeks so shake will be 800-1000. She also wants us to work on our D finishing her meals. D always leaves a little of everything. She knows she doesn’t get credit for food she doesn't eat and the calories will go in her shake. Well, we decided to take this challenging behavior on tonight at supper. She had 6-8 bites left. It was a 3 hour ugly standoff. She tried to run away, climbed the fence and pushed and shoved me which she has not done before. We had to declare a consequence so we could get her to eat. We told her no school or volleyball tomorrow. It finally got her to finish. The ED we saw during refeeding showed up in full force and it was a wake up call to the fact that we were probably making ED comfortable and happy by not challenging it enough. I am not looking forward to the next month of challenging this behavior now but I do believe it’s what we need to do. I hope we can keep our strength. We have an extremely stubborn D that doesn’t seem to care or trust that her parents know best right now. 
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tina72
Have you tried to eat in front of TV? My d often finished there without realising it while watching TV shows...
Have you tried to offer her an incentive when she finishes? We "paid" my d with driving lessons for every day she finished all meals.
Just an idea.

You need to work through that as it is an AN behaviour and ALL AN behaviour needs to be tackled and stopped. It gets better when she sees that she does not get through with it any more.
Keep feeding. There is light at the end of the tunnel.
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kkhrd
The consequence was definitely a good call on your part.  We took school away too as a consequence and it was the only thing that worked.  Sometimes bed didn't come until 3 am because she was fighting to finish a meal or a dessert.  Just stand firm and ED will see that there is no way around, and the change will come with less resistance.  Keep challenging, I know its hard, but you can do it.  Good luck!
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tina72
I remember a day when it took nearly 20 hours to get all the food in and she went to bed around 4 a.m. She expected to be allowed to sleep in and was very surprised when I woke her up at 8 a.m. for breakfast. She was super tired and had no power to negotiate about anything. She never did that again after that.
Keep feeding. There is light at the end of the tunnel.
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mnmomUSA
Hi.  Coming out of lurker status to comment on this.  I was really struck by the comment about leaving food.  This was the LAST behavior we had to extinguish in my DD to get her back to health.  I kept thinking that it really didn't matter because she was "overall" getting all the calories she needed, so it was unimportant.  Yet, there we were, 3 years after diagnosis, still stuck with the outbursts and still fully immersed in the "thought" process of anorexia, even if her weight was good.  You must root out every single behavior and get rid of it because the ED "lurks" in those thoughts and behaviors and will come right back out.

For us, what worked on getting rid of these last few behaviors was the "contract" we came up with at the UCSD one week family intensive.  It gave DD "rewards" for meeting her goals, and logical consequences when she did not.  For example, if she finished every single meal, 100%, within the time limits established by her agreement, she got "points."  Enough "points" for a week and she got a small reward, larger rewards for a month of compliance, and a big reward (something she wanted badly...a new iphone....she was a teen after all) after 90 days.  After 90 days, the behaviors we were seeking to extinguish were gone and she was truly in a good place, physically and mentally.  Important attributes of the contract were that she bought in to both the rewards and consequences.  It also ended the arguments and discussions about what would happen.  It was all spelled out in black and white.  Everyone could react more calmly to non-compliance.  Second, we did not expect "perfection" to get rewards.  As there were 5 eating opportunities per day, a total of 35 points were possible in a week.  32 was the number required for the "reward" so one slip wasn't the end of the world.  :-)

My DD was a dancer, which morphed into musical theater.  That was baked into her contract.  If she failed to meet her goal of 32 points a week for more than two weeks in a row, she had to withdraw from productions.  HUGE motivator for her.  We never had to implement that, but we would of if she had not met her goals.  I would encourage you to think this way about volleyball too.  :-)
D, age 18, first diagnosed March 20, 2013, RAN, at age 13 Hospitalized 3 weeks for medical stability. FBT at home since.  UCSD Multi-family Intensive June 2015. We've arrived on the other side.  :-)  D at college and doing great!
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Hope42019
Thanks for the support and ideas!  We actually started a verbal contract on Friday that our psychologist suggested to help us out. Since our D is so stubborn and resistant to us and our efforts to make her finish her meals she could tell we were growing weary as a family. This is a little unconventional but she said it is sink or swim time. I am making sure all meals and snacks meet the calorie requirement and it is up to D to eat it. Shake will be the same size every day so if she doesn’t eat enough in the day she risks losing weight. I am not adding those calories to the shake. It’s a 2 week trial. At the end of this she will go inpatient if she loses the amount of weight we decided upon. We kept this in a safe range as we aren’t going to risk her health. It puts it in her hands to get better and allows us to back off a little. Totally not FBT but it’s just a trial to work on her cognitive behavior. We are on day 4 and she has increased her cal intake by 300-400 and has been pleasant and taking charge. She asked to go to Starbucks for her snack! She asked me to pick up 200 calorie granola bars because she has a few go-to bars that are only 150 and she said “that’s not enough”! I am floored by this method and that it is working at the moment. She has been talking to me a lot the last 2 days about school, friends, etc and it resembles old times. I know not to get too excited as things can change quickly and this is just to get her back on track but I feel like I can actually breathe a little at this moment knowing my D Is fighting ED and not just against us. 
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tina72
mnmomUSA wrote:
I was really struck by the comment about leaving food.  This was the LAST behavior we had to extinguish in my DD to get her back to health.  I kept thinking that it really didn't matter because she was "overall" getting all the calories she needed, so it was unimportant.  Yet, there we were, 3 years after diagnosis, still stuck with the outbursts and still fully immersed in the "thought" process of anorexia, even if her weight was good.  You must root out every single behavior and get rid of it because the ED "lurks" in those thoughts and behaviors and will come right back out.


You are totally right with that. The moment they get better you think, if it just stays this way I can live with it and you do not insist on getting rid of any single ED behaviour at this moment. But that is a big mistake.
We aim for 100% recovery and not for 80% or 90%. If it was cancer you would aim for getting rid of the tumor 100% because if you leave a bit it will grow again. Same with ED. We were on 90% since last year and it took us until now (year 3 after diagnose) to get rid of ALL ED behaviour but now at the moment I would dare to say that is 100 % recovery here.
This is what kills ED. And this is what all our kids deserve. Do not be content with 90%.
Keep feeding. There is light at the end of the tunnel.
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tina72
Hope42019 wrote:
This is a little unconventional but she said it is sink or swim time.


I really love that picture! Sink or swim!

Hope42019 wrote:
We are on day 4 and she has increased her cal intake by 300-400 and has been pleasant and taking charge. She asked to go to Starbucks for her snack! She asked me to pick up 200 calorie granola bars because she has a few go-to bars that are only 150 and she said “that’s not enough”!


Hey, more intake, Starbucks and bigger granola bars!!! That are gold star moments! This is really great!
Keep feeding. There is light at the end of the tunnel.
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kkhrd
Hope that is really fantastic!!  Sounds like you really thought it through.  
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Mamaroo
Just a quick note when you're at a standoff. When my d would- sorry couldn't- finish a snack or meal, I would nag a bit and give her a short break (just bedrest, break was more more me). Then we tried again and I would tell her that "you could've been done by now" and that often did the trick.
D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
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scaredmom
I think what your psychologist did was brilliant. She changed the dynamic. It was really taken out of your hands in one way. The psychologist took it our of your d's hands as well. She actually set the rules so d did not have to comply with what you said but what SHE said. That can make a world of difference. That works well with my d too. If she thinks the pediatrician has deemed something necessary d does it. I am glad things seem better so far. 
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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