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

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Hi - I am finally brave enough to come on here and ask advice. Our 14 year old son was began treatment for AN in September this year weighing 49kg/ 5'8". Our CAMHS team follows the Maudsley approach and we have devoured the Eva Musby materials. At first, he engaged with the process and accepted that he wanted help and that he would have to put on weight.
However, as the weight has crept up, he has become increasingly angry with us and is completely overtaken with his AN thoughts. He now weighs 52.8kg. He says ( his AN says!) that this is a 'normal' weight and he is right that this is not significantly below weight ( Weight for Height currently 91.23). However, as parents we acknowledge that normal does not take AN into account. He has an athletic frame and runs.We have allowed the running for 2 reasons: as leverage for eating(he does accept that he needs to take more calories for his running) and also because it has the potential to raise his self-esteem. However, I also worry that this is fuelling the eating disorder. 
This last week has seen a turn in progress. On certain days in this last week, he has point blank refused food to the point that he sat in his room with nothing for a whole day without food - he will take water. His anger has peaked and we could no longer engage with us. 
Having reached an impasse by mid week,  we needed to come up with a new plan if he were to gain our trust and continue eating.  We have abandoned the meal plan and are just giving him what I consider a balanced diet - which is less than the 2500 calorie that we have being trying - ( probably more like 1800). We do not discuss calories with him.  He has eaten without stress in the last 2 days and has been less angry with us. I am fairly sure that he will have lost weight at next weigh-in. However, the idea is to reduce the anxiety in food/ calorie counting with a view to gradually increasing.
During the last conversation I had with our clinical nurse, she suggested that we are in stage 2 of recovery, but I feel worried that this can't happen because he has not yet reached his target weight. Or is there a grey area where stage 2 can start as we are reaching the final stages of weight gain. I am aware I like to see things in black and white and that this may not work with AN.
Are we doing the right thing to take things at a pace that he can cope with, or should we have stuck to the meal plans and risked him not eating and faced hospital admission but then we could have worked up from this? 
Would really appreciate any thoughts. xxxx

Welcome to the place no one wants to be but is relieved to find when needed.  I am so glad that you realize that your son's weight is not where it needs to be.  He is still underweight and it is totally normal for the anxiety to go up as the weight does.

You need more calories and much less exercise. The longer he is underweight, the harder it will be for him and for you.  As hard as it is to hear, the more kickback you get shows that you are on the right track.  General rule of thumb is for no fluids 24 hours or no food 48 hours, head to A&E.

We have abandoned the meal plan and are just giving him what I consider a balanced diet - which is less than the 2500 calorie that we have being trying - ( probably more like 1800). We do not discuss calories with him.  He has eaten without stress in the last 2 days and has been less angry with us. I am fairly sure that he will have lost weight at next weigh-in. However, the idea is to reduce the anxiety in food/ calorie counting with a view to gradually increasing.

You might as well pack in the calories because you are going to have anxiety.  My daughter required a lot of calories in six meals a day with no exercise allowed for quite awhile before she really gained weight.  I know you have been allowing the running but I think you also realize you are just feeding his eating disorder.  2500 should be a minimum and even higher.  We went for high calorie lower density meals and there are some great threads on here for how to pack more calories in less food.  Since you ditched the meal plan, just go for it and push the calories as high as you can get them. 

During the last conversation I had with our clinical nurse, she suggested that we are in stage 2 of recovery,

Yeah.  Not.  Great thread here to check out:  http://www.aroundthedinnertable.org/post/stages-and-timelines-and-how-they-set-us-all-up-to-fail-7917698?pid=1293883839#gsc.tab=0

You are doing great but just have to keep plugging away.  I wouldn't worry about stages at this point.  Just get him weight restored and keep the calories coming.  It is great if you are able to do this outside of a hospital but if you need inpatient because you can't keep the calories up high enough, that is fine too.  My daughter was one that not eating was the most important thing to her so she ended up inpatient with a tube.  You sounds like you have a great grasp of what is going on and what you need to do.  Sometimes it seem counterproductive to push hard on the calorie level when they are struggling but the faster you get to weight restoration, the faster you get brain healing and normalization of eating patterns.

I have no doubt you will get really good advice too from the parents on here with sons who are struggling.  You already found Eva!!  Required reading in my opinion whether you have a son or daughter who is struggling.
Welcome to the forum. Sorry that you have had to find your way here. Stages of recovery for FBT are at best a flimsy guide as to how things are going. According to the manual stage two is reached when 1. the person with the eating disorder is more than 90% above expected weight for height and 2. is accepting of the need for ongoing weight gain and is able to take some charge of eating for themselves. It doesn't sound like your son is there yet. It really doesn't matter too much, after all what he needs now is ongoing nutrition. Unfortunately cutting back on his food intake may well appease his anxiety/ED but may not help him towards recovery. On the other hand going off meal plan so he is less able to gauge what is in each meal may be beneficial in getting him to eat what he needs to. 

Please come back and ask questions, and read widely around the forum and the site. There is lots of good information here. 
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.
Welcome, spicer.  

Abandoning the meal plan can be a good thing.  As mjkz said, figuring out how to pack the most nutrition into the least volume often moves things along.  I was amazed at how rapeseed oil (canola in US) can disappear into everything from casseroles and shakes to soup and (some claim) even orange juice.  I didn't believe it until I tried vigorously stirring a T or two into a bowl of soup and - voila - the only thing that changed was the caloric density.  Flavor and texture left unchanged.

Double cream (heavy whipping cream in US) is another friend. 

Some of the good folks here have found bread that packs a lot of calories into one small slice and of course full fat versions of milk, yogurt, cheese, ice cream can make a big difference.

Many require a smoothie each day, which can have up to 2000 calories all by itself.  Some find that waking Ed kid up an hour or two early ("Here, drink this.") makes it go down easier and then s/he can roll over and go back to sleep, already starting the day on a good footing.

Please feel free to ask all the questions you like.

Keep swimming. xx

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

Welcome.  You sound like an intelligent and caring parent.  Your son is lucky to have you on his side.

You ask if you made a mistake by dropping the meal plan, and my answer to you is 'It really doesn't matter.'  Try not to waste time fretting over that.  He is eating, and you see where you need to go from here.  It's not a bad position to be in.

You know he needs to gain, and you can see his thinking is compromised.  Your team sounds misguided (he is not ready to make decisions about food if he was refusing to eat at all last week, IMHO.), so you will have to drive this bus yourself.

You've been given such good advice so far.

What do you see as your next step and how can we help?

D in and out of EDNOS since age 8. dx RAN 2013. WR Aug '14. Graduated FBT June 2015 at 18 yrs old. [thumb]
Hi, another mum of a boy here. Yes they do get very angry and belligerent! The consultant told us its how they display the extreme anxiety they are feeling. We never did a meal plan as I used the ideas on here for high calories / low foot print and didn't share with my son the additional ingredients I added - usually ice cream, butter, oil, ground nuts or double cream.
Your son will need a lot more calories than less 2500 - more like 3500. You can do this by adding additional ingredients. Also would you consider moving to blind weighing? This was a game changer for us and we still do it now. He fought us on it so much at first but it really helped to control his anxiety so that the number didn't eat away at him. One time in a moment of extreme irony I had to eat the post it that the number was written on by the nurse to stop an unseemly fight at the Drs!! He doesn't care now, he just gets on backwards. He's 61.5kg and 1m 62cms and you can read my post in the thread above about what recovery looks like where you can see how he's progressed this last year.
If it's at all possible make a plan with your team for how you can handle the all day food strike as it's so very bad for his brain (and body) to experience any period of more than a few hours without food. There are some really useful YouTube videos made by the Maudsley on how to respond to some of the conflicts you can get into. In addition Tv can be helpful - anything undemanding and funny can be a distraction whilst they eat. Maintaining calm through the crazy where possible, we named his anorexia Eddie, and would even joke around with him that 'your Eddie is showing' or 'we didn't invite Eddie to this meal'. We also would take away his phone / turn off the internet in the face of complete refusal. I also used to boldly state to him that my love was stronger than Eddie could ever be (to which I'd either get Eddie is my best friend or I hate you!) but I do think it helped.
I'm so sorry that there is no way through the anxiety and anger without weight gain. We did/do find that Prozac significantly improved the anger for our son.
I do agree that the running will have to stop - it's too solitary an activity with the high coming from the feeling of pushing yourself through the pain barrier. Not good for ED. Could you try to segue to a team sport of some kind instead?
Wishing you the very best, it's so very hard and scary I know, xx
13 yr old son diagnosed April 2015 with Anorexia.
Dear spicer,

Welcome here. You have receive good info from others. The calorie intake to acheive weight restoration can often be quite high
ED Dad
I'm going to be brutally honest here with what needs to happen. I'm coming at this as a mom with a now 16.5 year old d who has been in 100 percent solid recovery for 3 years after fighting AN from 10.5-13.5. Not only did we fight anorexia, but we had to do it while dealing with massive growth and full puberty- as you are with your son. My daughter also had a severe exercise compulsion.

1) By backing down on food and calories the eating disorder gets empowered. It digs in deeper. Your son desperately needs you to REQUIRE that all food be eaten. He doesn't need to be a part of the planning or preparing. His only job is to eat it. He needs a large amount of fats. Use heavy cream everywhere you can, butter, oils. My d had a lot of oatmeal ( 1 cup heavy cream with 1/2 cup oats.add butter,brown sugar, raisins, dried fruits. Easily 1200 cals. A daily milkshake or smoothie or both. Pastas, rich soups,muffins. Look at high cal threads. He will need to keep gaining for years. He has a lot of growth to go. It's not uncommon to need 4,000,5000 plus cals. You may see his needs rise.

2) STOP THE RUNNING. NOW. The running is EDs way of torturing him. He will whine and cry and scream bc ED will make him. When I finally realized that the exercise was KILLING my daughter and actually causing her MORE pain and stress, it was a huge relief. Of course ED freaked out... but months later my D was able to tell us how relieved she was. Her joints and body ached and throbbed at all times. Your sons heart and bones cannot handle running/exercise. We had 3 strikes and then she had to drink ensure to replace burned calories.

3) NO- you are NOT in " stage 2". You are far from stage 2. Throw out the stages and the timeline right now. Your son is in absolutely no position to make any decisions related to food or exercise. He cannot eat on his own. He needs 3 meals and 3 snacks supervised. The stage concept does not work for kids this age. And yes- you are right-huge grey area. But there are some things that are black and white- he needs to eat regularly,gain weight, and stay at a solid weight and increasing for growth. Then and only then can there be any talk of" independence" which starts with choosing a snack,a meal, a flavor. Then plating his own plate etc. It is a long and slow process.

You CAN do this. You need to find that inner warrior and go to war with the ED. Running has to stop. This illness kills. Your son is being held prisoner by ed. You must ignore what comes out of his mouth a lot of the time bc it is the eating disorder. Separate it from him.

Much of what you have to do is contrary to your maternal instincts to comfort and make things " easy". Every time we back down, ED gets stronger and our battle gets harder and longer. You can do this. Trust your gut.
Persistent, consistent vigilance!
Thanks for all of this - have had a very calm and peaceful weekend with eating and very little anger. Will keep posting but really appreciate all advice and thoughts.x

Hi Spicer, Welcome to the forum. I, too, have a son; his eating disorder began in 2009 when he was 15. Today he is nearly 23, at university and recovered (which I hope will show you that there is a light at the end of the tunnel). We are UK-based as well and you might find my blog helpful?? Click on the link below for PDFs of my blog posts which date back to 2011.

We weren't fortunate enough to be offered FBT, but nowadays FBT is being rolled out in our city - I wish we'd had it back then!

Best wishes.
Bev Mattocks, mother of 24-year old male DX with RAN 2009, now recovered. Joined this forum in 2010 - it was a lifesaver.
Everyone's advice is really sound, I think. I just want to say that as my daughter fell ill at age 10, and she is now 14, we have had to feed through all those years of growth and start of puberty. Pretty much mamabear's story but my d is entering into puberty later than many, so the growth is going on till an older age.  She is still going through puberty as we are late bloomers in our family. We are plating her food still, after all those years-- we are approaching 4 years--, and any time I back off much from supervising and plating her food her weight drops. We were urged more than a year ago to let her plate her food, and tried that and wango tango, her weight dropped darn quick.

I have a theory that for most kids who have to get through puberty and manage ED, they need ongoing meal supervision till they are done with puberty because they just can't adapt their food intake to the extraordinary calorie demands of puberty without meal support. 

In other words, my advice is that you don't worry about getting him ready to eat without magic plate. Worry about getting him through puberty with a healthy body at his appropriate height and body mass and bone density. Meal independence can come later. 
With us, we had the problem of my son knowing virtually every food's calorie / fat content by heart and refusing to eat anything that wasn't 'diet' or 'low / no fat' etc. Would you believe that I even went through a phase of buying diet food alongsit its standard version, then swapping the packaging around while binning the diet version's contents along with the standard version's packaging in our local supermarket's trash bins (daren't do it at home for fear my son would rake through the trash bin...) I also cooked meals that would allow me to sneak in extra calories e.g. supposed skim-milk rice pud would actually contain cream and butter, curries would have added ground almonds and vegetables such as aubergines (egg plants) and mushrooms were fantastic at absorbing oils or butter. But I used to be petrified while doing this in case, on his regular visits to 'police' the kitchen, he would find out and all trust would be blown.
Bev Mattocks, mother of 24-year old male DX with RAN 2009, now recovered. Joined this forum in 2010 - it was a lifesaver.