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bbs1968

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Reply with quote  #1 
Hi,
My dd was admitted this year at 13yrs for anorexia. She was in for 8.5 weeks and gained some weight, she was eating and given supplements, did not have to be tube fed at any stage. We are very lucky to be put on a camhs eating disorder programme which is FBT for 20weeks. We go once a week. She is at 77% of her weight and they need her to get to 90% minimum. She has lost weight the last 2 weeks. We were gutted last week as they told us she may be readmitted if she loses again. We have been supervising every meal, apart from 2 lunches we didn't make. I'm presuming now we are not giving her enough calorie dense foods.
This is a typical school day
Breakfast
45g branflakes 150ml Milk Full Fat
200ml juice
2 slices wholemeal toast with flora (has never eaten butter and can't stomach it)

Lunch
6"sub brown with 2 slices chicken and one slice cheese Full fat with salad and flora.
(We had give a wrap up until last week then realised it wasnt calorific enough)
Milk when at home or water in school.

Dinner
Chicken Curry ( Would be cooked with mayflower sauce and olive oil),
Taco meat,
Roast Chicken,
cod (am substituting now with salmon),
chicken fajita (has with rice instead of wraps,
Roast beef with veg. These meals are accompanied by brown rice or new potatoes and I have been making my own oven chips 2 times a week. I know I need to start adding gravy also.She has a glass of milk with dinner.
She has an adversion to roast potatoes and mash. She can't tolerate pasta as got sick last year after bolognaise and has a block against it. Although I am going to try lasagnes tomorrow and say nothing.

Snacks
1 Yoplait Yoghurt
I piece fruit
1 Fortisip
I Special K cereal bar (I know I could do better here)

Evening snack normally 2 ryvita crackers and one triangle laughing cow cheese, Or toasted chicken and cheese sandwich (if we didnt supervise lunch).

I know its all very black and white. There is little sugar here. She never ate sausages or bacon and would not be a big meat eater in general.

There is little support from school. They know her condition but there was no offers of help with lunches so I drive from work and it is a hurried half hour.
She will drop,hide spit food at any opportunity so we sit with her.

She walks home from school, 10 minute walk and we have stopped her walking anywhere else. She is not doing sports.

I am looking for advice as to increase calories so any help would be much appreciated, if she dosent gain this week our lives are going to be very different.
Thanks for any help








Foodsupport_AUS

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Reply with quote  #2 
Welcome to the forum. Sorry that you have had to find your way here. I know how frustrating it is when weight is not going on, but it is very common for needs to increase. If you are sure there is no purging the only thing to do is increase her intake. Fortunately many have been there before. I would suggest entering high calorie in the search boxes and a whole wealth of options will be there for you.
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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.
teecee

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Reply with quote  #3 
Welcome and so sorry you find yourself here.
We are being supported through CAMHS and we are WR so I can only use our experience of what helped us to get our D up to this quickly. Please bear in mind before AN diagnosis she was a good eater with no real issues about any foods. She had meals that were bigger plates portions than mine but slightly smaller than dads. Also the below was a MINIMUM. Also water throughout the day on top.
So typically the day would run as follows:
Breakfast:
FULL bowl of porridge with one whole banana chopped on top and a handful of almonds (whole milk used throughout). Plus 2 large slices of wholmeal toast with either butter/peanut/almond butter on. Plus 250ml juice.
Morning snack:
4 x rectangular multigrain crackers with cream cheese and topping (prawns etc). I also made smoked mackerel pate which has mascarpone cheese and lemon juice with pepper for the topping. Plus glass milk/milkshake.
Lunch:
Sandwich (4x slices whole meal bread) chicken/ham/tuna mayo plus salad. Plus packet crisps plus yogurt. Can also have choc bar, fruit, rice pudding...plus milk
Afternoon snack:
Fruit pot (fruit/yogurt) or breakfast biscuits x4 plus milk...
Dinner:
Half plate carbs(potatoes, rice, cous cous, pasta etc), quarter plate protein (meats, quorn etc...) quarter plate veg/salad. PLUS (within 10-20mins of finishing) a pudding... 2x large scoops ice cream, good wedge of cheesecake, fruit yogurt, rice pudding....
Supper:
Bowl porridge plus 2 x slices toast with topping plus milk.

This was to ensure she wasn’t waking up through the night hungry, which she initially was. She was waking to go to toilet but you I would after drinking all that!
We noticed very quick improvements.
Initially I did question if it was too much but looking back I now know it certainly was not and was just enough to ensure she was on the right path. Yes she did complain but that’s ED.
Now her diet is slightly adjusted but not much. Everything is full fat/whole meal - no 0% or low fat anything. We use olive oil in cooking too. Cream cheese...I used Phili but we were encouraged by the dietician not to stick to the same brands and stores own brands were fine.
Also I never weighed/measured food I just trusted that I had brought her up ok so when I plated I plated what I used to do plus a bit more (due to illness).

Hope that helps you and much love. I hope you have the strength to keep going. You’re doing a great job. Xxx



tina72

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Reply with quote  #4 
Hi bbs1968,
you have already done a good job to get her to 77%. The problem is that weight gain is no straight line and you may need a lot more calories to make her gain this week than last week. Some here needed 3000-6000 calories a day to see weight gain of 500 g a week.

Two things:
"She is at 77% of her weight and they need her to get to 90% minimum."
You will need to get her at least to where she was before AN started and adding 1 kg for each year since then.
Look at her historical weight chart. If she has always been at 50% percentile she must go back to that. If she had always been on 75% percentile that is your target.
You wil not see any recovery at 90%. We all experienced that professionals tend to set target weight too low and we needed to add more weight than expected. Your d is 13 and still growing and at the beginning of puberty and she will need to gain weight until her mid twenties to recover 100%.

So how to increase calories?
That is quite easy. Forget all the calories counting and add butter, cream and canola oil/rapeseed oil to EVERYTHING possible. You can hide it in pudding, yoghurt, applesauce, soups, sauces. You can add cream even to the full fat milk.
Her brain needs a lot of fat for recovery. The brain is made 80% of fat. And it needs more sugar. The brain needs glucose to work well and the body cannot produce that itself so without sugar there is no brain recovery. Start to add honey or sirup to applesauce or yoghurt.
If you are interested in the processes of the brain work read "Decoding Anorexia" from Carrie Arnold. There you can learn why fat and sugar is so important for AN recovery.

First aid:
Try to introduce smoothies. We made fruit smoothies with fruit and juice because that looks "light" and "healthy" and you can tell her it is for her vitamins. Put 400-500 g fruit and juice into the blender and then add up to 100 ml canola oil (start with 50 ml and increase it daily). It disappears in the blender and you can get easily 1000 calories extra into her with that. Try to make her drink two big glasses every day.
If she does that, try the "milky" smoothie: ice-cream and full fat milk. Smoothies saved our life [wink]. It is often much more easy to drink than to eat for them.

Come here and ask whatever you need, you will get great help here. This forum was a life saver for us.
Tina72
teecee

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Reply with quote  #5 
“Try to introduce smoothies. We made fruit smoothies with fruit and juice because that looks "light" and "healthy" and you can tell her it is for her vitamins. Put 400-500 g fruit and juice into the blender and then add up to 100 ml canola oil (start with 50 ml and increase it daily). It disappears in the blender and you can get easily 1000 calories extra into her with that. Try to make her drink to big glasses every day.”

Totally agree with above. We’re doing smoothies at the moment...in fact she just asked for one today!!! This is a result as the dietician is allowing her to choose when she has snacks!!
We add yogurt but also honey is good to add.....that’s the way to go.
Xx
scaredmom

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Reply with quote  #6 

Hi bbs1968,
I too welcome you here. I am sorry you needed to be here. You really are doing well and understand what is needed. It is such a learning curve.

I agree wholeheartedly with teecee and tina72. I did what tina did and added canola oil, olive oil, extra butter, extra sugars and cheese to everything. The smoothies are great. Some have added high calorie ice cream (hagen daaz or ben and jerry's- 1 cup is over 500 cal) and have been able to make a 1000-2000 cal smoothie. I added heavy whipping cream to the milk container or her glass to increase the calories of one cup of milk to 300 from 150 or so. That way the volume of food/drink still looks normal but very high in calories. I kept two containers of milk one with cream (marked off) and the other one so we knew which was which. Also do not give yogurt in the original containers, actually put it in bowl or plastic larger container if taking to school and add cream to it. 

Grape juice has a lot of calories 180 per cup vs apple juice 120 or so, so use things with the most impact.
My D needed over 4000 cal to keep up with good weight gain and for her brain to heal.  She still is at about 3500-4000 per day. I needed to count the calories more for myself so that I would not give her less, now it is just intuitive. I added oil to the meats and all sauces all the time. 

As for some of the foods you say she would not eat, are those "fear foods" for her (meat and pasta, bacon and sausage)? If so, you may need to tackle them in order to help her overcome her eating disorder. Is she purging? If you have been supervising most times and  she is NOT gaining, you need to look for another place she would be losing the calories- secret exercise at night, purging and as you say when you don't watch her - throwing the food out. 

As for her weight, again I agree with tina, that most set the bar too low and there is not harm to push further. I found that when D got to her goal of 40 percentile, I just pushed and now she is above 60th percentile for age and then started really seeing changes in her brain. 
You will get there! You are doing so well. We are all ears and please ask any questions you may have. There is always someone her who has literally been there! YOU ARE. NOT. ALONE.

XXX

Food+ more food+ time+ Love =Healing

bbs1968

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Reply with quote  #7 
Thank you so much for your helpful and kind replies.
There are many tips here that we can use especially the smoothie one. Have never even heard of Canola oil hopefully tescos will sell it, We live in Ireland.

As far as we know she is not purging or exercising at night but we are on alert for this also.

Have bought cream and those belvita bars also. 

A lot of the foods mentioned she would never have eaten or had when younger and decided they were not for her. Nuts of any kind, Peanut butter.

scaredmom the sausages and bacon she has never really eaten.

teecee We havent got to crisps chocolate or desserts yet. We need to get a handle on this. thanks for the honey tip also.

foodsupport_AUS I wish all the best to your dd it must be hard for you.

tina72 thanks for all those tips

sk8r31

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Reply with quote  #8 
Welcome to the forum, though sorry you have a need to be here.

In general, we honoured the dislikes and food preferences our d had long before ED was in the picture.  In our house, that meant not much red meat, though plenty of chicken and fish.  We did have to battle many fear foods along the way...things that d had previously enjoyed and eaten regularly prior to ED.

We were most successful at refeeding when we were able to get a daily smoothie in; this was a very challenging battle for our d, and did take a long time to get going.  However, it was remarkable how much it helped.  Our d was older, at 17, she was finally able to admit that the amount of food required without the smoothie was pretty overwhelming.  She never liked having the smoothie, but we did have success offering it as an evening snack while watching a light-hearted comedy show on TV.  It was the only time d would let me touch her for a long while....she would lean into me while drinking her smoothie.  

Canola oil is sometimes referred to as rapeseed oil, depending on where you are located.  Adding that to a daily smoothie is a great strategy.

Sending warm support to you,
sk8r31

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teecee

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Reply with quote  #9 
Dear BBS1968
I completely understand you will not be at the crisps/chocolate stage yet. The important thing is just to get what you can in to her.
I posted the typical day for us as something for you to aim for. Even before AN we were not eating like this and I thought we were healthy! I have seriously had a crash course on nutrition since AN came in to our lives 😁
I found that the typical day now is what we should have always been eating. I actually feel so much better for eating well...we also need to look after ourselves.

In terms of secret purging, we decided early on to take it in turn sleeping with her. I’m soooo glad we did as we can confidently say we know she is following what we require her to do.

I really wish you all the very best. You will get there. Keep going and your beautiful D will be back with you....I know because we are slowly starting to see this in our home.
Food is medicine....it’s a marathon not a sprint...one day at a time ......my mantra !!
Xxx
bbs1968

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Reply with quote  #10 
sk8r31 thanks for that tip I bought some rapeseed oil last week so will give the smoothie a go tomorrow. Do you make it with fruit, yoghurt  and honey or with fruit and juice? 

Teecee thanks just really would be a major battle to eat the treats atm, the normal stuff is hard enough! Hopefully one day we will get there! We have managed to eat out 3 times this weekend which is good going.

Really appreciate all your help


teecee

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Reply with quote  #11 
Absolutely you will get there...sooner than you think with compassion and consistency.
I stick fruit, yogurt, water and honey in our smoothies....never tried adding oil but suppose it wouldn’t hurt...just enhance it 😬
Torie

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Reply with quote  #12 
If you freeze the yogurt, it will make a nice slushy smoothie.  I put it in ziplock bags and then into the freezer so I can easily break it into chunks to toss into the blender. xx

-Torie

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hopenz

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Reply with quote  #13 

Welcome, bbs, and congratulations on the great work you're already doing.

You've already had great advice and encouragement above.  I just wanted to add our voice to those for whom a daily smoothie has been a real boon.  I think, as Tina says, they're easier to drink, but can really pack a calorific punch.  And they can be so darn delicious!  If you search 'smoothie' you'll find excellent recipes developed by other hero parents here.

Our smoothies, which my d has before bed at night, are usually a combination of fruit (frozen, tinned - including some of the syrup, pureed, fresh) + full fat yoghurt + full fat cream + honey/syrup/cinnamon + topped up with a little full fat milk to the right volume/consistency.  Favourites are banana and vanilla with cinnamon;  berries, with berry flavoured yoghurt or full fat strawberry milk;  or tinned mangos/apricots/peaches, with a little coconut cream for tropical flavour.

Don't be surprised at just how MUCH your d needs to eat.  Six months after weight restoration, my d still has to eat a mountain of food just to maintain her weight.

Keep up the great work, and ask lots of questions.  Good luck x

toothfairy

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Reply with quote  #14 
Hi bbs1968,
Welcome, so glad you joined.
Your meal plan looks far to low in calories to re-feed your D.
Many of our kids need a huge amount of calories to re-feed, and also for a very long time after that.
Dr Peebles in CHOP ( Childrens Hospital Of Philadelphia) is a leading world expert in Eating Disorders.
She recommends 4000 calories per day for 4 years for most anorexia sufferers.
Dr Walter Kaye in UCSD in San Diego which is a world leading eating disorders treatment and research centre talks about how some sufferers need up 10,000 calories a day to re-feed.
Many sufferers go into hypermetabolism and need a huge amount of food.
https://www.scienceofeds.org/2014/05/07/hypermetabolism-in-anorexia-nervosa/

Here is our plan example
Breakfast-
Large bowl of granola full to top with full fat milk.
2 slices of toast with butter
Glass of milk

Snack - smoothie including a large amount of haagen daas or ben & gerrys, cup of double cream & 3 tablespoons or so of ground almonds. 1000-2000 calories.

Lunch - full dinner - example
Chili con carne & rice with garlic bread
Chicken curry & rice with garlic bread
Roast chicken & chips
Pizza
Pasta carbonara
Spag bol
Spagetti & meatballs with bolognaise sauce
Lasagne & chips
Chicken enchiladas and chips
Roast beef roast potatoes with yorkshire pud
Fish & chips
Burger & chips
Bangers & mash
All with
Glass of orange/apple juice


Snack
4 biscuits of at least 100 cals per biscuit
Or 6 crackers & cheese
Or chocolate muffin approx 500 cals

Dinner -
As per examples of lunch
Served with a glass of milk

Desert
Slice of cake
Apple tart & cream
Cheesecake
Chocolate brownie
Rocky road
Etc

Really I did not bother with salad ,fruit & veg, there was just no point, I needed to make every bite count with calories.
Please note that butter, cream & ground almonds were added to everything I could, in huge amounts.

Every bite needs to be supervised or you can assume it did not go in.
Some carers re-feed with “safe “ foods and others tackle fear foods head on & “ rip the bandaid off”.
We ripped the bandaid off & tackled fear foods from day one.
The problem if you dont is that you will still need to deal with this after, which can be like going through re-feeding again.
Here is a great article from Dr Lauren Muhlheim
https://www.verywellmind.com/facing-fear-foods-in-eating-disorder-recovery-4114751

I strongly advise you to supervise her for at least an hour after every meal.
You may need to sleep with her too.

What is her weight & height or BMI now?
Best wishes,
TF

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Food is the medicine. Recovery is possible.
toothfairy

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Reply with quote  #15 
Hi again,
Regarding the target weight.
As mentioned above, she needs to be brought back to her original growth curve plus 10%.
So 110% is what she will likely need to be.
Then she will need to be gaining steadily into her 20’s.
It is unlikely that you will see recovery at 90% , this is a common mistake .
Please see this video to explain more.



Best wishes

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debra18

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Reply with quote  #16 
I agree with the high calorie drinks. Chocolate, honey, and hot milk. Milk shakes with ice cream and whole milk. Chopped nuts in everything. But once I used walnuts and my daughter complained it was bitter. Use chopped almonds. Also look for bread and products that look smaller but have more calories in a smaller amount.
EDAction

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Reply with quote  #17 
Hi bbs1968,

I agree with the smoothie recommendation.  I made them with whole milk vanilla yogurt, canola (rapeseed) oil, frozen bananas, frozen strawberries or raspberries and apple juice.  Sometimes I added protein powder.

Some other ideas are: scrambled eggs made with eggs, cream, oil and cheese; grilled cheese sandwiches (butter both sides of the bread); chicken and cheese quesadillas (cook in oil); and oatmeal made with cream, brown sugar and cinnamon.

Thinking of you!

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DD diagnosed with anorexia at 14; FBT at home with the help of psychologist and medical dr; 3+ years later and doing well (knock on wood)
tina72

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Reply with quote  #18 
If you make her a bread, put butter on both sides.
Add cheese to everything possible. You can melt it in soups and sauces.
Put cream into milk, yoghurt, porridge. Serve it without original container in a bowl.
Smoothies: Try and find out. You can do them with fruits and rapeseed oil or with full fat milk, ice-cream (look what is the brand with the most calories, here it was haagen daz), whatever she drinks will be fine.

Try to get all fruit and vegetable to a very small amount because that counts nothing. She will have enough vitamins with the smoothies.
The secret is to put most possible calories in a very small amount.

Can you buy "Benecalorie"? It is normally only sold in US but you can buy it through the internet. These are small container of 44 ml with 330 calories and no taste. You can add it to yoghurt, porridge, soups, sauces...

Fat and sugar are the most important things at the moment. The brain runs by fat (80% of the brain is fat) and it needs glucose to work well (all chemical processes in the body need glucose and the body cannot produce that himself). Forget all that you ever learned about healthy eating. She must eat more calories and a great variety of food. Try to bring her back to at least what she ate before AN started. If possible get her to eat normal meals. Cook what your grandmother would have cooked [wink].
"A lot of the foods mentioned she would never have eaten or had when younger and decided they were not for her."
The big question is wether this is fear food (that is food the AN does not allow her to eat, mostly food with fat and sugar, pizza, fast food etc) or wether these are some things she does not like. If she never liked peanut butter she does not have to eat that now. If she ate peanut butter before AN she should eat that again.
A lot of AN kids have been picky eaters before. The question is: is there more food she is eating or more food she is not eating? Is she restricting certain categories of food (vegetarien, vegan, no milk-products...)? Then it might be AN behaviour.
My d was a picky eater before AN and she is now eating even more than ever before because we dared to re-introduce things we have not asked her to eat for years. She tried it and now she likes it (like brokkoli with cheese, mushrooms, camembert). We did not force her to eat that, we just presented it again and she eats it now with pleasure. It is worth a try.

Tina72
kangamum

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Reply with quote  #19 
I'm also new to this forum and know how hard it is to get enough calories into each and every meal and snack.
One thing I would suggest is make sure you always buy the cheapest mince meat or ground beef, this has the most fat in it. And if you are frying anything, put the food in while the oil is still cool, it will absorb more as it comes to temperature and starts to crisp up.
If you are making a toasted cheese sandwich, butter both sides, whip up 2 eggs with cream, and soak the sandwich in that before frying it for French Toast.
Avocado in everything. Creamy salad dressings.
I plate things up like I'm a Masterchef contestant, cutting things in half and angling them to appear smaller. I often use a Jamie Oliver cutting board with a handle as things look small on it. Use a large diameter straw (I have a bamboo reusable one) in the smoothie so it's easy to drink.
I use pretty crockery or interesting plates, not the same every time as I think it's important she unlearn any food habits which ED love.
However.....
I always feel like I am weak & failing as I allow my d to not finish everything or substitute something. She often complains she doesn't like this or that as well and I often enable that. My h often feels stressed that I am giving her too much food, and I think this plays into my doubt that I am overdoing it...he has learned not to say anything in front of her though!

My d has put on 6kgs since we found out she was restricting in Dec 2017. Not fast enough for me, but she is now used to the feeding schedule. I think it's like when she was a toddler, firm and consistent, I don't always follow that. It's not for the faint-hearted that's for sure.

Good luck and thanks for this wonderful forum
toothfairy

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Reply with quote  #20 
Hi bbs1968
I would recommend that you buy Eva Musby's book.

https://www.amazon.co.uk/Anorexia-other-Eating-Disorders-compassionate/dp/0993059805/ref=sr_1_1?s=books&ie=UTF8&qid=1525162091&sr=8-1&keywords=eva+musby&dpID=41YkUIjBrhL&preST=_SY291_BO1,204,203,200_QL40_&dpSrc=srch


If you go through Eva's website you will find a lot of fabulous information.
Here are  some of her videos.



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Food is the medicine. Recovery is possible.
toothfairy

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Reply with quote  #21 
these videos really helped me understand

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Food is the medicine. Recovery is possible.
toothfairy

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Reply with quote  #22 

__________________
Food is the medicine. Recovery is possible.
bbs1968

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Reply with quote  #23 
Thanks again for all your replies and tips. So many ideas to try out. We had lasagne yesterday for the first time since ED and was an emotional 2 hours. I also gave a smoothie last night and that was a success so can't thank you enough for that hint.
Is there a taste off ground almonds? May be able to add them into smoothies. Also was wondering about Sunflower seeds in smoothies?
We are using flora (green one) on toast and sandwiches, We have never eaten butter and it wasn't tolerated in hospital even so Flora was given. Are there other spreads that have a higher calorie value than 403kal per 100g?
We shop in Tesco, Aldi or Lidl.
Alas didn't make it to school this morning as has tummy ache and feels sick but did eat all of breakfast.

bbs1968

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Reply with quote  #24 
Thanks Toothfairy I will look at those links later. I have a book on order atm.
teecee

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Reply with quote  #25 
What a great job you are doing! Just wanted to say well done - can’t answer your food questions but would try it and see re the seeds.
Stomach ace/feeling sick...normal responses, just keep going. You’re on the right path.
If it makes you feel any better we didn’t make it to school this morning either...hey ho, tomorrow’s another day!
Take care and hope today is a good one for you.
Xxx
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