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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pbrennan
Hi All,
Very recently our daughter 16 yo was diagnosed with depression and AN. Our therapist recommended posting on this site for suggestions and strategies that might help us to help her to eat again. 

Background of Daughter: 
 7 months ago - Happy, loving life, high academic achiever, family life great!
6 months - Serious trauma (parents worst nightmare, please ask no more questions)
5 months - daughter withdrawing from life.
5-2 months-  Us Seeking help from anyone and everyone
2 - 1 month - pharmaceuticals  for depression / anxiety.
1 - Now - Diagnosis of AN after weight loss, fainting and refusing to eat any quantity of food.

We are engaged with local GP, councillors, Psych, Royal Children's Eating disorders, and waiting on dietitians. 

I'd love to hear any idea's on strategies that have worked or not worked on increasing calorie intake. More specifically, what works around the dinner table.

So far our strategy has been to sit for hours around the dinner table until one or all break or the food is eaten.(at advice of therapist)

Our advice is "AN has control of our daughter, so we need to take control, and do what ever it takes to get her to eat" 


Un-Happy Days ATM

Peter


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Torie
Hello and welcome.  So sorry you needed to join us here, but glad you received the good advice to try out this club no one wants to be a member of.

I'm really sorry your d experienced trauma in addition to (or as a trigger for) AN.  I don't know about dealing with trauma, but I do know a fair bit about AN.  The "best" thing about it is that the goal is very straightforward:  Your d needs to regain all the weight she has lost, and she needs to avoid purging (excessive exercise or vomiting).   Many here require ED-kid to visit bathroom before each meal / snack so that they can sit with us for at least an hour afterwards.  Trust me, you do not not not want to deal with purging.  Much better to prevent it.

It is not so much that she won't eat as that she can't.  It is as though the wiring gets tangled so that the sight or smell of food triggers fear that has been compared to jumping out of a plane without a parachute.   I remember one mom who rushed upstairs thinking her d had been mortally wounded based on the screams of terror, only to find that the problem was that a banana had been left on her d's bed.

Eating enough to gain weight at a good clip will cause your d tremendous distress.  She will need to learn to tolerate that, and you will need to tolerate her distress, too.  

One of the best tips I learned (here) was to add canola oil (rapeseed in UK) wherever possible.  I was surprised to learn that it disappears without changing the flavor or texture if you stir it in briskly and don't add too too much.  Trial and error will show how much you can add.  Soups, yogurt, shakes, smoothies, rice, etc. are all good candidates for this treatment.

For grilled cheese, butter both sides of the bread.  Use full fat cheese, yogurt, milk etc.  No water or diet beverages - every sip needs to count.  The more calories you can pack into each sip / bite, the fewer sips and bites she will need to manage.  Also, the brain needs a lot of dietary fat for brain healing as the brain is made up largely of fats.

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

There is no one way to do this, and all of us have had to find our own ways forward. There are however lots of strategies that parents have tried. What works depends on your child, their personality, their illness along with parental factors. Some of us are way more patient than others, can separate our child from the illness, tolerate distress, and model calmness in the face of terror. 

There are a lot of threads about getting started including in the Hall of Fame (which unfortunately needs re-writing, a whole new story) - http://atdthalloffame.feast-ed.org/
There are also great tips in the FEAST Family guides - https://www.feast-ed.org/family-guide-series/
This is an Australian guide for family led refeeding http://ceed.org.au/sites/default/files/resources/documents/FamilyLedRefeedingRecoveryResourcePartA_Nov_2017.pdf  and http://ceed.org.au/sites/default/files/resources/documents/FamilyLedRefeedingRecoveryResourcePartB_Nov_2017..pdf

This recent blog post on the FEAST website may also be helpful. https://www.feast-ed.org/tips-for-helping-your-child-to-eat/

What I would suggest is starting with a strategy giving it a try then being prepared to flex or move with things depending on how things are going. Trying not to be afraid of the ED and responses is really important. 

Let us know what is happening and we can perhaps help you problem solve, come up with more ideas. 
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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Enn
Welcome, 
We are glad you are here. I hope you find the information you need to help your child. 
If you let us know what is happening we can trouble shoot and share what worked for us or what did not work for us.
Here is the high calorie thread.

What is eating now? 
At the dinner table some have had to positions themselves so that child can not leave the table. Many have used distractions, TV, videos, games so the child would eat. 
Some have had to go to different rooms to eat as well. 

How are you doing? It is a challenging illness for us too. We have to become the doctor, nurse, therapist, and chef, the organizer etc...
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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Mal

Dear Peter,

 

I am sorry to hear of your daughter’s experience. Each young person, families, circumstances are different. The illness is very different each time. What follows is the result of my observations and research in relation to my child being in the grip of AN. I am no clinician, just the parent of a super-resistor living in Melbourne, Australia. I don’t pretend being right, experienced, non-biased or have the magic bullet. Maybe you will find in my words some useful elements that work for you.

 

Some young persons develop an ED on its own, some have a pre-existing mental health related terrain.

They lose the ability to feed themselves, sometimes consciously (desire of control), sometimes not (lack of awareness that they are ill). In any cases ED has its own agenda and is highly addictive as starvation prevents insight (Regions of the brain affected) and creates a state of happiness as a side effect (Designed so the starving person would be more alert to find food?).

The young persons are left unable to eat and comprehend the criticality of their situation. They feel that they need to defend themselves against all the people around them who want to force food on them.

 

The typical treatment for AN is indeed food: Replenishing their body and with restoring the brain functions the insight will increase (despite the addiction to starving or the food phobia).

The cost for the family may be very high depending on the level of resistance the young person will show.

For some families, taking control of the food and sitting at the dinner table for hours has worked. Maybe because the parental authority was accepted enough by the young person to be able to replace the lack of insight and fight back the desire for control AN kids often display.

With older children, and adults I suppose, this approach may backfire (leading to a super-resistor patient?) or just be inefficient. The young person may “start to recover” and/or may relapse.

 

My experience is that nothing can replace treatment compliance by the young person. And for this, they don’t necessarily need to be aware of their illness (of course it helps if they are! But typically, a starved brain loses very quickly whatever is left of self awareness). So the key question is, how do you get an ill person to comply to their treatment, even if they have no awareness of being ill, have a great fear of the treatment or reject your authority?

 

It helped me to first change the way I looked at my child:

Let go of everything your dear child has achieved in school or in society in general. They may be so successful that their achievements define them, in the eyes of others, their parents, even maybe in their own eyes. This is not who they are inside, it’s just their outer self. Their academic performances, their great personality may come back with time, or not. Who cares, the challenge is about surviving the illness and living a good life, whatever it may look like for them. If they truly “recover” along the way, which is definitely possible, that will be the gift of a lifetime.

 

Put yourself in their shoes: Speak with them to understand how they experience their reality. Do not judge or offer your opinion. Genuinely gain their trust and keep it (Be a real, unconditional friend and support). The illness is not about you. You do not collude with the illness by listening to them, it doesn't mean you agree. Make sure your child knows that what they say is respected (You don’t have to agree with someone to respect their point of view). Your opinion will play a role later, to guide them, but is counter-productive until you have their trust.

 

Do not let the illness provoke you into reacting to the deeply disturbing thoughts your child may become able to express (something amounting to: “I will starve myself and you are going to watch and let me do my thing”). Some parents believe that caring for a child with AN is the worst thing they ever went through in their life. You mention in your post that you have experienced the worst trauma and I’m deeply sorry for you and your family. For the regular lot of ED parents, I think it helps to consider that our suffering in the face of AN is nothing compared to our child’s suffering.

 

Make them feel accepted as they are, love them with warts and all (Stop telling them they are ill, don’t tell them they are not, it’s just irrelevant). Maybe your child will separate the illness from themselves, maybe not. If yes, then blame the suffering they experience on the dark side and work with their “healthy self”. If not, do not talk with them when the AN is controlling them (you will see it in their eyes, face or language), delay the interaction even if you’re desperate, angry or want to be right. The idea is to foster compliance, cooperation, instead of relying on coercion & confrontation to break though the illness.

 

Give them other things to think about. Food thoughts and sitting at the dinner table has overtaken their life (and a great chunk of yours. Don’t assume they sleep better at night than you do).

It is not collusion to give your child a non-AN space. Give them normality in between yours and their efforts. Laugh, play, clean the bathroom, watch movies, study, talk about American politics, take care of the pets, etc. This too is “the treatment”

 

Don’t expect them to let go of their view of their situation or to be thankful. Like any human being, they don’t want to be wrong, to lose face, be humiliated or their ideas ridiculed. Again, they don’t need to think you are right to comply with treatment. You are right and it does not matter. They will respect your position only if you have listened to them, demonstrated your understanding of their point of view, showed respect for them as person. It is enough if they find reasons to comply, which may be completely different than the obvious one (=survive).

 

Do not be afraid to change your ways. Listening and admitting you were wrong in acting one way or another is not a sign of weakness but demonstrates a sense of responsibility and strength. Apologise to your child if you lose it or had the wrong approach, everybody makes mistakes and may hurt someone without wanting it. Apologising is simply recognising the suffering you may have caused or increased. It’s accepting responsibility, not necessarily guilt (and even if it was, who cares!). 

 

Concentrate your efforts on getting them to comply with the treatment (Great life, good food to fuel it):

This is the most important part once you have their trust (or are no longer threatening them). What is it your child wants apart from starving?

Do they like to have a great relationship with you, who care, understand and respect them, who don’t dismiss them as ill and who don’t tell them to just eat that sandwich, who don’t guilt-trip them.

Do they want to be treated as a normal person? Live a normal life, stay out of the hospital? Can you respectfully agree to disagree regarding the criticality of their health declining? Can they accept that you can’t let them starve because it will lead to the destruction of their inner self (Soul? Personality?) that you cherish above everything? Focus on the common ground, it will grow with time (and food).

 

Move away from coercion, cooperate:

It’s ok if they are just doing it for you: Not because you are suffering or telling them to eat the whole plate or you will make their life harder. But because they care for the relationship they have with you, they care about the life that you’re helping them have. They will only become compliant with the treatment if they find the overall solution you offer better than the addiction of starvation & control. In other words, even if your child may think that everyone is wrong about AN, they can choose to cooperate. Your job is to make it their decision.

 

It seems that coercion (parental authority, force feeding etc) may work for some kids. If it doesn’t work or carries an unbearable cost (psychological trauma of the young person or the family), changing gear and approach seems right.

I believe that no matter what path you choose, the one described above is helpful and may even be used alongside a regular AN treatment (take control of food intake etc). Trust and respect, sounds simple, right? I know AN targets exactly that. I think there is a case for going back to basics and fight back your rightful despair (anger, frustration, sadness, mourning their former self) because it will take the better of you. Personally, I moved from saying to my child “AN is not your fault, but it’s your responsibility to recover from it” (I know, that’s not great…) to totally accept her symptoms (anorexia, lack of awareness) and solely concentrate on how I can help her comply with the treatment. I believe it is possible and essential to build a great relationship with your beloved child despite the horrible grip of AN, and no matter how it will mistreat them and you. I want to believe that this solid and loving relationship may along the way create better prospects of recovery.

 

 

Parent of daughter diagnosed with AN 6 months ago. Super-resistor.
Melbourne, Australia.
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pbrennan
Thanks everyone for your thoughts, links to resources and gifts of advice; they are gold. We have already started implementation on adding the canola oil, and exchanging milk with cream where possible.(not that D will eat much of it)  We have downloaded the food plan from CEED's  site and are trying to use this until we can see a dietitian. Today was not great, only a few teaspoons on vegetables and 1/4 of a patty before she declared she could not eat any more. She immediately brought out her laptop and phone and said "you can have these, I'm not eating" (this was a punitive approach we took trying to convince her to eat on advice of Dr) and then went to her room to sob. I took her plate in, but I could not talk her around to eating any more 🙁
D is now in the bottom 1% percentile for BMI, so the responses and advice are received with great gratitude.  Next thing is to try a a distraction during meal times. We feel so exhausted dealing with the AN nightmare and everything else that is going on. Bloody hard work 
Thanks again 
Peter
 
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Enn

I am very concerned about her low weight and lack of nutrition. 

Has your team given you instructions for when you need to get her to the hospital? It sounds like it may be time for emergency medical intervention for stabilization. 

If eating less than 500 cal per day or no water for 24 hrs are  reasons to get her there today. 
Emergency rooms are open. I can understand worries about covid19, but please take her. Here in my small city some have been so scared to go to the hospital  for things like heart attacks that  waited too long and that has caused significant morbidity. 

 

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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Foodsupport_AUS
It is good to hear that you have found the suggestions helpful. I agree with Enn that if things are continuing in the same vein hospitalisation for stabilisation may be required. 

In hospital there is no option but to eat- each meal and snack is required. It sounds like your therapist was recommending "life stops until you eat" Others have found that "life starts when you eat" can work better. 
Good idea on trying to take the food into her even though it didn't work.

Isolation can be very common for those with AN. It may be better to try to limit her time "to brood" and perhaps try to engage her more if at all possible. It is all hard work. It is also worth offering her the opportunity to have her things back if she eats X in a short while. 

Trying to find currency that works for ED can be hard. Some kids do have things they want to do or achieve. Others are so withdrawn and miserable, hoping to die, the best we can do is insist on hospitalisation and feeding to get things started. 
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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pbrennan
Today has just been a bad day. We know we are bordering on hospitalisation and have packed the bags on a couple of occasions thinking things must be bad enough now for hospitalisation, but on triage, due to high demand they prefer to keep them in the home. We had a comment tonight that she would rather die then eat. Also that the eating plan is not working as she thinks about it during the day and thinks she is eating too much. 
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Enn

Is she getting any medical assessments? You can do this at home yourself too. Blood pressure and heart rate while  lying for a few minute then same with standing after a few minutes. If her BP drops systolic top number by more than 15 or drop in diastolic the bottom number or a very low heart rate of 40 that would be a medical emergency.
 Tachycardia or fast heart rate also is a medical emergency
https://eatingdisordersreview.com/orthostatic-hypotension-and-tachycardia-in-adolescent-patients-with-anorexia-nervosa-a-marker-of-illness-severity/

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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Mal
Dear Peter,

From my experience, the criteria of admission in hospitals with ED beds in Melbourne are currently following for AN:
- Heart rate: Low resting HR (<50bpm), increase in HR by 30bpm or more with change in posture from lying to standing
- Blood pressure: Low blood pressure (resting systolic BP ≤ 85 mmHg), decrease in systolic BP by 15mmHG or more with change in posture from lying to standing
- Blood sugar: < 3.0mmol (< 54mg/dl)
- Temperature: < 36oC
Her BMI may also be taken into account (I don't know that).

Your D would have to first be stabilised in ER before being admitted as an inpatient. Typically increasing her blood sugar if too low.
My experience is that if your child hasn't eaten much more than 500 calories for several weeks, they will most probably qualify for admission (Does she have blue fingernails, is she cold, shaking at times? Is she tired, dizzy?).

I share Enn's immediate concerns for your D's health. The Covid19 situation in Melbourne is currently not so that a patient meeting some of the criteria above would be turned down.
Hospitalisation is a big scary step but definitely the right one if her vitals are bad. Look at your child and follow your guts. If ER do turn you down, at least you will know she's ok. If you don't go to ER, at least make your GP check her.

I've found following article helpful (specifically on depression & eating disorder):
https://centerforchange.com/hope-hopeless-depression-eating-disorders/

Please let us know how you go
Parent of daughter diagnosed with AN 6 months ago. Super-resistor.
Melbourne, Australia.
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Torie
pbrennan wrote:
... due to high demand they prefer to keep them in the home.

THis may be a time they don't get to do what they prefer - it may be time to insist that they give your d the treatment she needs rather than what "they" prefer.

From what I can tell, Australia is doing a fabulous job dealing with COVID-19 and the number of cases is something we are dreaming of in the US.  (Kudos to Australia!!!)  I realize there must be local hot spots - if you are in one, are you allowed to take your d to a hospital outside that area?  One way or other, it sounds like it is time to insist on a higher level of care.  xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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kay113
Hello all, it’s my first time posting.
My 16 year old d diagnosed with Restrictive anorexia (nov 2019) and depression. She’s ( we’ve) had a really rough go with suicidal ideation and self harm. A couple in-patient  with the ED clinic and a couple in the mental health ward.

What helped:  Since her anxiety was sooo amplified after taking in nutrition, she was prescribed Ativan to be taken at meal times.  It helped to get the nutrition in and keep her anxieties lowered after eating.
However, it was the olanzepine that really helped to take away the eating disorder voice.
She found that presenting her meals on a tray like in the ED ward helped. I didn’t overwhelm with the amount on the tray at first, just tried to up the calories with canola and butter etc..

Trying 🙂
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deenl
Hi Peter,

Just thinking of you and hoping that your daughter has had a medical checkup. At his worst my son had similar measurements to your daughter and he needed his temperature, heart rate and blood pressure measured at home every single day. This was only allowed because we were 5 minutes from the hospital and there was a co-ordinated plan for when we needed to head to A&E. In the end he needed to be hospitalised because we could not get weight gain going at home and his heartbeat was falling to extremely low rates. He was hospitalised for a month, only gained a kilo but it enabled us to start some good techniques that meant he gained more at home and continued to improve ever since. It has taken a long time but he is healthy, happy and getting ready to head off to university in the autumn.

The very fresh trauma is an added complication that makes the ED more difficult to treat. Starvation does have the effect of dulling the emotions and refeeding may cause those very difficult emotions to be felt again. On the other hand, therapy for the trauma is next to impossible because of the increase in anxiety and depression, together with the cognitive slowness caused by the lack of nutrition. There are cases that I am aware of where the ED and the trauma have had to be worked on in tandem. Fefeeding, together with love and safety from the family and tiny steps on the trauma front. What supports does  your daughter and your family have for the trauma? Of course, malnutrition needs to be addressed as the No1 priority because that is directly life threatening, especially at the weight your daughter is at. But she will likely need support to help her feel safe after her trauma while refeeding is going on. Here is where the family is so important, you already have a reservoir of warm and safe feelings between you all from before the trauma.

Sending you strength, courage and hugs,

D
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal.
  • We cannot control the wind but we can direct the sail.
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pbrennan
Sorry about the slow reply and thanks for the advice. Our daughter has started quetiapine 4 nights ago for increased anxiety which we have been giving at bedtime. The evening meal is still extremely hard with distress, anxiety and suicidal thoughts involved.  Is there any benefit in giving it before the evening meal. Things are not getting any better. Does anyone know of any good inpatient facilities in Australia or recommendations on what to do when out of ideas and nothings working?
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pbrennan
Thanks for all the replies, I wish there was a "like" button to express our gratitude .
Question for people from Australia, when your child is suicidal and wants to speak with someone, who do you have them call? And who do you guys call when it gets too much
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Foodsupport_AUS
Sorry that it continues to be such a struggle. 
Regarding the quetiapine - it may or may not work in helping with the meals. My D like yours was suicidal. We tried olanzapine, benzodiazepines and quetiapine along with other anti-anxiety medications. None of them helped at all with the eating. In the end the thing that helped the most was just keeping her eating. It took a long time, but they do get there. We did find the other medications helpful in certain situations - both olanzapine and quetiapine helped with sleeping at night. My D would stay awake all night thinking over all of the things that had happened during the day, how much she had eaten etc. This helped to stop some of this and allowed her to rest. 
The benzodiazepines helped when she was having overwhelming anxiety, she would sometimes self harm, tried to jump out of moving vehicles, etc. When the distress was overwhelming - we used them less than 10 times over a few years - they would put her to sleep. 
The other anti-anxiety medications and anti-depressants did help her mood but these were long term treatments. 

If your D is reporting suicidal thoughts it is important that she be appropriately assessed, generally by a psychiatrist. You could start with your GP or your ED team as well to look at trying to create a safety plan. This for us looked like a list of what to dos, who to call, what medications etc. when things were truly getting out of control. 

Is your D managing to gain some weight, are you seeing progress as yet?
As for inpatient facilities in Australia there are very few if she does not need medical stabilisation which would be in a public hospital. 

Your choices are: public inpatient psychiatric care - you would get no choice of facility as it is zoned according to your residential address, or private psychiatric care. From the above posts are you in Melbourne? If so the private facilities do take 16+ . Melbourne Clinic, Geelong Clinic and the recently closed due to COVID Albert Road Clinic. Both Geelong Clinic and the Melbourne Clinic have eating disorders programs. You are otherwise looking at interstate. The private clinics require her to agree to treatment, that is they must be voluntary admissions. There are also some outpatient programs such as BETRS or the Butterfly program - again voluntary. The only residential facility in Australia is currently under construction in Queensland - on the Sunshine coast. 
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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Torie
I am not a doctor and so not qualified to give medical advice, but I think some have used quetiapine earlier in the day to help with meals.  I wonder if you could split the dose in half and give half before dinner and half before bed.  Have you asked her doctor? xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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pbrennan
Thanks for the replies.  

Torie - have not asked GP yet as only thought of it last night.  Better night tonight with eating, all eaten bar one roast potato.  Splitting the dose sounds like a good idea.

Foodsupport mod - she has managed to gain 1.4kg since dx, although had a lose of 0.3kg this week which was due to increased PTSD and depressive symptoms which in turn resulted in her not eating all her tea again and until last night, after the weigh in, we hadn't been pushing too hard.  Both my partner and I are experiencing a bit of carer burnout this week.  Her progress is very slow and kind of 2 steps forward one step back. We are located > 300K's from the nearest capital city. Thanks again for the replies.
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