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Posts: 980
Reply with quote  #26 
Hi j9k22,

So a good place to start learning about how to help your daughter recover and refeeding is to read a couple of books. If you have not read these already I would recommend:

Help your teenager beat an eating disorder by James Locke and Daniel LeGrange

The best book I found about with tips about refeeding:

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 by Eva Musby.

Also there are resources and videos on Eva Musby's website which you might find helpful.

Also check out the high calorie thread here on ATDT.

and read around on the Eating Disorders Learning Center on ATDT:

Basically you will need to prepare food and she will need to eat it. 3 meals a day and 3  snacks.

Here is a good online article by Eva Musby about getting your child to eat:



Posts: 1,534
Reply with quote  #27 
I would recommend Eva Musbys book, too, because you find a lot of practical advice there for situations you will get in.
Also Laura Collins book "Eating with your anorexic". Laura Collins does skype-sessions and can help you face-to-face if needed.
The start is to get her to eat all you serve. No excuses. All on the plate. 3 meals and 3 snacks. You need to give her full nutrition and add a lot of fat. Most kids here gained some weight with an intake of 3000-6000 calories a day. That is a lot of food and her stomach is not used to these amounts, so the secret is to serve heavy food in small amounts. Shakes with canola oil or ice-cream, heavy sauces, noodles, rice. Do not take her into the grocery (that is triggering) and get her out of the kitchen so she doesn´t see what you add to the meals. Look for fulfat products in your supermarket, double cream if available. After 2 weeks I knew what were the yoghurts and puddings with the highest calories [biggrin]. Believe me, all the other women watched my shopping venture with envy...
You need to sit with her at the table and take a lot of time. Stay calm and encourage her to take the fork and eat. If she is not able to, spoon-feed her. If she tries to run away, follow her with the plate through the house. Life stops until she has eaten.
Try to give her some distraction while eating. Eating in front of the TV watching funny soaps or animal videos helps. Some play cards or colour a book while eating.
Most important thing is that you make not eating impossible.

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Posts: 5,232
Reply with quote  #28 
Originally Posted by j9k22
I am interested in the UCSD program.

I suggest that you give them a call.  Forum members have reported that they are helpful over the phone, and some have said they were told they weren't a good fit at that time.  So I don't think they would encourage you to go unless they really believe they can help.

One way to start refeeding is to make sure she eats more tomorrow than she ate today.  And more the next day, and even more the next.  With plenty of fats.  THe brain is made up largely of fats so a lot are needed for brain healing.

And as the others have said, read read read.  THis is a confusing and counterintuitive illness.

And keep asking questions here.  We love questions.

Keep swimming.  xx


"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 

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Posts: 654
Reply with quote  #29 
This illness has such a steep learning curve.  Don't be upset with not doing something when you didn't know what you were dealing with.  A popular quote on here is "Feedback, not failure" which means each day you learn a little more and adjust anything that's not working. 

To answer your questions of FBT and refeeding.   FBT stands for family based therapy and it is a mapped out program with 3 stages of recovery, the first stage, stage 1, being mainly refeeding.  If you are working with doctors and therapists that follow FBT then you will have set appointments, usually weekly at first.   For our D when she was doing the PHP program, my h and I would go there once a week for "family therapy" which was just us and our D and one therapist talking about the food that was eaten for the week and any problems we were having.   Our D HATED this more than anything!  She would usually cry and run out of the office after a few minutes.  She did not want to hear about the food that was eaten all week.  She also had a one on one apt with a different therapist.   When choosing a good therapist it is important to know their beliefs of ED's -  like to make sure they don't blame the parents or try to get at a root cause of the ED. 

Refeeding just means getting your D's weight back to where it should be today if she never got sick.  A lot of docs will say to get back to the weight they were before they got ill but you need to take into account for all the months/years of the illness.  If you are doing an FBT program, then refeeding means that the parent picks out all food to be eaten each day.  Usually 3 meals and 2 or 3 snacks.  You don't give your D any choices in the beginning, you just prepare and plate the food and put it in front of her and she eats it!  This illness is so counterintuitive as normal parenting.  In the beginning of the illness I used to think that giving her choices was a good idea because she would fell in control -- boy was I wrong!  I eventually learned that my D's brain was hijacked and that she couldn't make any good decisions for herself.  She was always going to choose the lesser of two options or the "healthier" choice.  It actually got easier when she was given no choices -- because she didn't have a choice, she could tell her Ed that it wasn't her fault.   When she attended the PHP which was 5 days a week for about 8 hours a day, she ate two meals there and two snacks. She ate one meal and one snack at home with us.  At the program she wasn't given a choice either, she just had to eat what was given to her each time.   When she left the program and we were still in stage one and refeeding at home, I didn't fully understand what to do so I started giving her more choices and more freedom.  She relapsed right under my nose! I don't blame myself because I didn't know what I didn't know! 

Another saying on here is LSUYE or Life Stops until you Eat.  This basically means: you get up in the morning and give your D breakfast, nothing else happens until her breakfast is eaten.  She can go to school after her full breakfast that you have given her is eaten.  That's assuming she is medically cleared to be going to school.  If she doesn't eat her breakfast she stays at the table until she does.  No phone, no laptop, no tv, nothing.   When she was done I would drive her to school.  For lunch, I would drive to my d's high school and she would come out to my car and eat her lunch in my car.  She was not allowed to go back into school until her lunch was eaten.  There were some days that she couldn't do it, so I drove her home.   This was all part of her 504 plan with the school so that I didn't need a note each morning when she was late or late for her first class after lunch period.  As soon as she comes home from school, she must eat a snack.  Then she can do other things that are approved, but no sports or walking around the mall either!  Limit her activity so she's not burning calories.  Then same for dinner and night time snack.  It's very hard in the beginning because your D will put up a huge fight.  My D threw a lot of food, smoothies at the wall, pizza thrown on the ground, cleaning spray sprayed on dinner etc!  But after a while it does get easier.  Your D will be able to tell her ED that she has to eat because you are not giving up on her. You need to be stronger than the ED voice in her head. 

I know how overwhelming this can be.  I do suggest you call UCSD and talk to them.  They will tell you if your D would be a good fit for their one week program. 

Hang in there!

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Posts: 654
Reply with quote  #30 
How are you holding up j9k22? 

Posts: 1,024
Reply with quote  #31 

Sorry for the late reply. I am not on the forum much anymore. You have already received great advice, but I wanted to add a couple of things.

First, try not to beat yourself up for not recognizing there was an issue 4 years ago. We don’t know what we don’t know. The important thing is you are addressing it now. You will find great support and advice here!

I can totally relate to your concerns about your daughter’s treatment affecting school and college. My d was also diagnosed her junior year in high school. Like you, I was worried that treatment would impact her getting into college. I thought we could do it from home. Bottom line is it is very hard to get on track in an outpatient setting. Based on your view, your daughter has had some eating issues for 4 years. That has allowed the ED to become entrenched. Recovery is totally possible, but it is going to take some work. Residential will not cure her, but good residential will help you all get on the same page and then you can continue when she gets home. It takes a long time to turn this around, but it can happen. In the end, it did not work for us to treat on an outpatient basis. My d ended up missing most of her junior and seniors years in HS because of one type of treatment or another or because of side effects of her anorexia. Her grades and SAT scores were impacted. I was worried she would never be able to go to college because she wouldn’t be able to get in. In the end, I decided that none of it would matter unless she was healthy and 100% recovered. We threw everything we could at ED and did all of the things people on this forum have mentioned. Even though she was doing well in recovery, we kept her home from college first semester to give her a stronger foundation. It was all impossibly hard and she HATED us. She applied to colleges her senior year and then once accepted asked for a one year deferral. Most schools provided fhis automatically without even getting her into her medical issues. Taking a year off before college has become a big deal even for healthy kids.
Once healthy my d went to her dream school out of state and graduated on time, although she would have been OK if it took longer. She even studied abroad for a semester in South America. She is now in grad school in another state and thriving. It was hell getting her there, but so worth it.

I would definitely contact the one week programs at UCSD and OH mentioned. They might be good resources for your family to get on the same page and then have a plan for when you come home. I totally understand your concerns about not supporting Veganism. Before my d got sick, I had a long list of foods I would not eat because of health reasons. I learned though that for anyone who has the genetic predisposition for ED, ANY restriction of food regardless of the reason is incompatible with recovery. For my d “healthy” eating means ALL foods in moderation. This was a VERY hard change for me. However, like you said, I realized my d’s health had to come first and I worked to change my thinking. It was something our whole family had to adjust to. If your daughter had cancer and they said she had to give up veganism you would do it in minute. That analogy really helped me. Anorexia DOES have the highest mortality rate of any mental illness.

Most of all, keep coming back here. I KNOW my d would not be recovered were it not for the advice I received here. Sadly, many experts don’t know what they are talking about and don’t practice evidence based treatment. The parents on this forum though know their stuff!

Enjoying my 23 year-old daughter's achievement of active recovery that was made possible by the resources and education I found on this forum.

Don't give up hope!
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