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.

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silali
Hi there,

my 13-year-old daughter has developed AN last summer. She has just come out from a 3wks in hospital.
In hospital she was very brave at following the meal plan.

She came out only yesterday and immediately after 12 hours at home she started refusing food, skipping meals! Today we only managed to feed her 2 meals.

The difficulty we have is that she shuts down, does not talk to us and refuses to move when we ask her to eat.

How do you do it guys? I can persuade my daughter to eat if she does not do or say anything?! 

thanks 


 
 
  
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EC_Mom
Silali, welcome to this forum. Good people and good advice here.

What you are describing with shutdown and refusal are unfortunately typical with AN. Many of us whose kids were hospitalized found that while hospital eating went ok, at home the refusals and shutdowns returned.

Please read around on this site a lot, and maybe read some of the books that are recommended on the FEAST main website. You will discover that AN is now understood to be a kind of hostile takeover of a patient's brain, making them behave in challenging and totally irrational ways. It's NOT your d's fault, and she is not truly "choosing" to do this. You need to separate the illness from her, in your mind. This is to keep from blaming her and making her feel even worse.

How to get her to eat--the big question! It differs among families. One framework we used is "Life stops until you eat" (or "Life starts after you eat"), so no other activities can go ahead until a meal is finished. No school, no friends over, no shopping, no tv watching. First the meal has to get done. Also it is helpful NOT to frame this punitively--not "I'm taking away the phone until you eat" but instead "I'll hold onto your cell phone while you get started eating, and then you can have it while you eat."

Another element is to do what works for your family. I ended up spoonfeeding my d, in her bed, for weeks, hours per meal. It was awful. But it got the food in. 

You have to reconceive of things, that you are REQUIRING her to eat and so you do what it takes--trying as much as possible to frame that positively instead of punitively.

Another tip is to come up with VERY short-term leverage for eating: "After lunch Aunt Jane is coming over with the new puppy, it will be fun to see that!, now please let's start so I can phone her that it's time"' or "Let's have a snack and then we can go to the art store and buy those nice paints" or "Let's get you started on dinner and while we eat we can watch the movie you wanted to see on Netflix." 
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mjkz

EC-Mom has some great suggestions.  The other thing to keep in mind is that if she won't come to you or the table, take the food to her.  My daughter was a great one for hiding in bed so I took the food to her. 

When my daughter shut down and refused to talk, I would just sit there waiting her out.  We didn't talk and in fact I used to read or do cross word puzzles.  I'd offer short term rewards as EC-Mom suggested.  One thing I did to keep my sanity was not stretch meal times out.  She got an hour for meals and half an hour for snacks.  Whatever she didn't finish in food, she was given a supplement to replace the lost calories.  If she refused the supplement, she went on complete bed rest which is exactly what it sounds like.  She stayed in bed until the next meal to keep her from burning off calories.  No TV, no reading, no internet,  no nothing until the meal or supplement was finished.

What you are seeing is pretty normal for kids with ED.  Mine never made it 12 hours eating.  She usually quit the minute she was out of inpatient and never ate very well inpatient either.

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Foodsupport_AUS
Welcome to the forum. Sorry that you have had to find your way here. 

As EC_mom has said there is no magic one size fits all with getting the food to go in, it must however go in. If not then your D may need further readmission to hospital. You don't say where you are, but some hospitals even have a policy that if meal plans are unable to be followed at home then return for extra bolus feeding eg. Fortisip or even NG feeding as a short or long term option can be there. 
The real trick is to make not eating an option, that is the full meal must be completed. The lack of option is how your D was able to eat in hospital. My D would also eat in hospital, if a meal wasn't completed she would have a NG feed instead. Once this was not available she could not keep on eating. 

There are lots of tips and tricks on the Hall of Fame 


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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ValentinaGermania
Hi silali,
welcome here and great that you found us!
The big question is: why did she eat in IP? Because it was requiered and she had no chance not to eat. There were consequences (refilling with sublements or nasal tube). So at home the biggest step is to develop a routine. Fix meal plan and meal times. No excuses and no exception. Food comes first. No food, no school, no friends, no TV, no phone, whatever is needed. You have to find out how to get her to eat. Sit with her and tell her: This is your lunch. You need to eat that now. Repeat that like an old record. No discussions about portion size or calories. This has to be eaten.
It is hard to get started but every patient/family is different and what worked for us must not work for you.
Try to see food like chemotherapy. If she had cancer, you would not discuss with her about having that medicine or not. It is necessary. Food is her medicine.
It is so sad that you seem to have got her out of IP without any help and advice. Do you have a FBT therapist? Where are you (region/state)?

Ask whatever you need. You will get great help here.
Tina72
Keep feeding. There is light at the end of the tunnel.
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Mamaroo
Just a quick note to welcome you here and let you know the same thing happened to us. I looked at my notes again today and saw after ip, it took 7 weeks before she was back on her mealplan. We used incentives to get her to eat. She would get points for every one of the 6 meals she completed and bonus points if she completed the mealplan for the day. With the points she bought itunes cards to buy tokens for her games. We made some game inventor very rich I can tell you, but it worked for us. Keep to a strict feeding routine, 6 meals a day at the same time every day. She also found it hard to eat with the family, so she ate in her room, while I supervised. It's hard, but after a couple of months esting became a habit and she ate much easier, then we moved her eating area to the family room and then later to the dinner table, now she can eat with us without a problem. Today we ate out and my d ordered the battered chicken even though her sister ordered the grilled chicken, I was so proud of her!

Sending you best wishes and plenty of hugs 🤗🤗🤗🤗🤗🤗
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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Enn

Hi silali,
I too, welcome you to this wonderful group.
I am sorry you have had to find yourself here. But this bunch is the best!!

My D has RAN and was admitted for 3 weeks and she was the "model patient", when she came home she was anything but a model! We stuck it out by requiring her to eat everything we plated. And she did refuse, but I or my H would sit with her until she ate it all. If she threw it we replated more food. It took over 2 months to really get the hang of it for us. When my D would get mad it would be at me and I would walk away and H would sit with her. She never seemed to outlast OUR stubbornness. (she is 12) She knew we would sit all night and we told her so, so that she would eat. She would get so mad that she would just gobble it up out of spite! [smile]It was painful to see her struggle and really hard on us trying to save her life. Once she knew that the routine would be the same whether she fought or tried not to eat, I think she surrendered to it all and ate.
The fight lasted a good 2+ months and then it got easier. I still have broccoli quiche stains on my dining room cushions.

You will get so much help here. Ask anything you wish, there is always someone who has been there!!

 

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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Torie
So sorry you needed to join us here.  Have you seen this video by forum member Eva Musby?  It was a tremendous help to me in the early days. 

Please feel free to ask all the questions you like.  xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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ValentinaGermania
From today looking back my d said, that one day she discovered that we would not let her starve any more. No way. That we will make her eat whatever time or work it costs. And that was the turning point, she said. When she discovered that she will have to eat anyway, then she decided to eat what she like again. Because she was hungry all the time and deep inside she missed all the food she hasn´t allowed herself to eat. 

It is hard to get it started but if you are consistent and calm and confident, you will get there. It will get easier. It is a bit like raising a puppy. If you do it consequent he will learn what is allowed and what not. ED shows a great resistance at the beginning, but it will get less with every fight you win in that battle. If she is angry, ED is angry. Then you know you are on the right path. If she is compliant and does whatever she is asked, be aware. Then usually ED has found a way to trick you out.

Try to get some help (family? friends?) and cut down school and work if needed and if possible. Many of us had to get them out of school at the beginning (my hand up). At that age that is no great harm and when you stay in contact with the teachers she can get back into her class when she is better in some weeks or months. We had to lay down work for 6 months. But it was worth it. Every single day.

Tina72
Keep feeding. There is light at the end of the tunnel.
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rose08
Hi Silali
It's a test of sheer will at times. Yours against the Anorexia. You can do this, one meal, one snack at at time. With added nutrition it will get better but the beginning stages are really, really tough. I learnt to be incredibly "hard" on the outside while on the inside I was a quivering wreck - this tough immovable exterior was directed at the Anorexia and the requirement to eat. BUT I had to learn to find compassion, no matter how frustrated and angry I was, it wasn't her, it was her illness and I reminded myself and our family of this often. I saw her struggle through different eyes - every mouthful in the beginning was torture for her and the pain was almost unbearable to watch and I can't imagine actually living it. She must eat. Try pack as much as possible into the smallest footprint, especially in the beginning when "normal" portions look huge them. Smoothies were the single biggest help for us in the beginning to get the nutrition in quickly and adequately. A single breakfast muffin can pack more calories than toast, butter and jam and fruit combined - all in a single item. Find meals that work for you - or create your own. Make a stand, and then do it again and again. You can do this xxx Sending much love, Rose
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silali
Thank you all for your replies and advice!!

All you said makes sense but I find it so tricky to keep calm, keep cool, keep confident when I am in the thick of it.
I think the real truth is that I am scared of my D and the ED! 
Until I overcome this fear I don't think I will be able to help my daughter out of this nightmare.  

Today I pushed her so much (obviously using the wrong techniques)that in the end, she became so aggressive, she hit, punched and push me and shouted if I didn't leave her alone she would jump out of the window! 
I will not make that mistake again! 

My CAHMS team (which uses a FBT) haven't given me a replacement meal option if she doesn't eat, maybe I should inquire about it again.      
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EC_Mom
Silali, no wonder you are scared! Still you should know that my d did similar hitting, punching and kicking, with self-harm threats as well. This does NOT mean that you are "using the wrong technique". That sounds impossible, but it's true. Unfortunately some of our kids do get violent when pushed to eat. The ED will do ANYTHING to get out of eating. Many of us on here report violence. It's scary but it is a sign that ED knows you are serious. You're afraid--but so is ED, and so it will raise the stakes.

I did a few things to deal with the punching, kicking and smashing that my d's ED drove her to:

1. I contacted local police, they have a "mental health liaison" to whom I explained our situation. She was interested and added AN to the list of illnesses that can cause domestic violence. I found out what would happen to d if I called the cops on her. THEN I, in a calm, non-eating moment, told d that I had talked to local police, they were aware of our situation, and that they instructed me that I could not allow violence in our house. Then next time she started with the punching/kicking I went to the phone CALMLY (fake) and said, "Ok, I'm going to be in touch with police now because this isn't safe and I want to keep us all safe." My d stopped--and she hinted later that she was relieved that I would not allow her to do such terrible things. They DO inside feel ashamed and guilty, it's important to use external authorities to keep them from doing all this.

2. To deal with my own inside turmoil, I got myself antidepressants (they work over the longer term) and tranquilizers (for short-term use, before feedings). They helped me fake calm and confidence.

3. YOU can set up the replacement option. Two Ensure shakes if she eats less than 50% of the meal, one shake if she eats more than 50% but not the whole thing. No negotiating on smaller breakdowns of those amounts. 

4. Eva Musby's meditations also helped me to get ready for a feeding. But frankly, I was terrified for months. I faked calm, and I saw that it was a tiny bit reassuring to d. But I was shaking in my shoes for most of it. 

You are on the way to success, you will have terrible times while you refeed but speaking from (knock on wood) a place of return to normality, it's worth it.


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EC_Mom
Just realized I used a lot of words there. These are key:

You are NOT 'using the wrong technique' insofar as you are requiring her to eat. It may not be possible to avoid some extreme behavior. That happens in a lot of our families when ED realizes that it's getting cornered by some competent, dedicated parents. You do need to keep yourself and your d safe--but the extreme reaction is NOT a sign that you are doing anything wrong!
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Foodsupport_AUS
ED in a rage is frightening. There is saying however, that if you are getting flak you are over the target. Safety is important, in particular it is important to let your D know that violence will not be tolerated, no matter how distressed she is. She does need to eat, it is not a choice. Many here have had plates thrown, death threats, hitting, broken windows. Recovery from AN is not pretty. She is frightened and at the moment feels forced by her illness to test the boundaries and know how far are you willing to go. Separate from her meals she does need to clearly have those boundaries laid out, not as a threat, but to give her clear guidelines. 

If you are doing FBT, you get to choose her meal options. That includes what happens if she can't eat a meal. So as part of the guidelines you give her can include timed meals, replacements if not completed or not finished in time. Where you will need some assistance is looking at what happens if she cannot follow through. You don't say where you are but given you use the term CAMHS I suspect Australia or UK. Every region has different back ups for meals not completed. You can set consequences yourself however. So no meals, no school for example. Trying to put a positive spin can be helpful with this, such as you can do X when you have eaten. Rather than you cannot do X because you have not eaten. 
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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ValentinaGermania
You will get that. It is quite normal that you fear ED and your d at the beginning. But you must see that behind all that is your little d and she is waiting for you to help her. Try to separate her from the illness. We called him ED. That made it easier. We said "we are not talking to ED" or "Ed needs to be shown where the door is".

Read Eva Musbys book "Anorexia and other Eating Disorders: how to help your child eat well and be well: Practical solutions, compassionate communication tools and emotional support for parents of children and teenagers" asap. You will get a lot of practical help for every situation you will get in there.
Think about locking the doors and windows when she says something like that. Safety comes first. Take away the key for her room and for the bathroom. It is hard, but it is necessary. Be aware that she will get very angry during and after meals and close away scissors and knifes and everything she is able to hurt you or herself with.

"Today I pushed her so much (obviously using the wrong techniques)that in the end, she became so aggressive, she hit, punched and push me and shouted if I didn't leave her alone she would jump out of the window!"
You didn´t push her too much!!! You did the right thing! Not she became agressive, it was ED who saw that you will fight him! If you show ED that you will fight him and that there is no way not to eat she will calm down again by time. It is hard, but as long as you see the enemy you know he is still there. You have to push through.
Go on. You are doing the right thing. It is a terrible brain disease but you can cure that.
Tina72
Keep feeding. There is light at the end of the tunnel.
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