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

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pip99
Hi,
My 15yo girl, has been an inpatient and now home, she has slowly reduced and then stopped eating. Now she won’t eat anything I make, she will go and get herself something afterwards, but smallest amount.  She will not communicate with us and just sits at the table, (that is if we actually manage to get her to the table) and stares into space, it’s as though you can see the ED voice talking to her.  We try all the encouragement words as described in FBT, but nothing.  Has anybody had this experience or any advise?  My fear is if I stop her getting something herself later on then nothing is going inside her.  We are under child and adolescent mental health team, but she won’t open up to them either. They advise just to keep trying and encouraging, the next steps are probably back as in patience, but even that threat doesn’t seem to make her try to fight back against ED voice.  I have had it all thrown at me that I don’t want her home and she wants to go back to hospital as it’s better than living at home.  
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melstevUK
Pip99,

I am sorry you are having such a hard time. This is due in a large part to the way the discharge from hospital. There should have been an expectation placed on your d that she would be eating at home according to the same rules and structures as were imposed on her as in hospital. If this does not happen the illness 'breaks free' and gets the upper hand.  If she ends back in hosputal which is quite likely if she is going back downhill again, ensure that when she comes out the second time that this structure is in place .
But the team should be telling her she needs to comply so ask to speak to them separately and ask them to do this. Just telling you to make encouraging remarks is not FBT. Parents out in charge of eating but with team giving the same message is what should be happening .
Believe you can and you're halfway there.
Theodore Roosevelt.
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Foodsupport_AUS
Welcome to the forum, sorry you have had to join us here. This does sound all very normal and not unexpected. I agree with you that stopping her from eating does seem to be counter productive, however I would also be insistent on sitting with her for regular meals as well. As Melstev has said it is important that ideally there is a plan to keep on eating at home in the same structure as previously. My D was unable to do this many times, the one thing that was different at home was no option for NG feeding if she could not eat - as a result she would just reduce her intake rapidly and be readmitted soon after. 

I would be insisting there is a specific plan that should be followed each day, with a goal that if she can follow that she will avoid admission. It will need to progressively increase.. If she can't follow through yes she will need readmission- all the fault of ED and not anyone else. My D afterwards said it was just too hard to fight and stay out of hospital, it took 15 months for her to get up the ability to stay out for more than a month. 
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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MKR
As Pip99 explained so well, the ED sees your home as a way back to loosing the weight gained as an inpatient. 

We dished our daughter same portions as anyone else around the table, because she tried to swap plates around, or chuck her carbohydrates onto another person's plate. I also wanted her to visualise what a normal meal looked like, rather than what the ED was telling her. 

Her eating her own ED-approved snacks is to be topped up by your food. This is what's for dinner, so this is what you'll eat first. Our daughter had stashes of own snacks hidden in so many places around her room. Every time I brought them out, she looked embarrassed and I saw it as another win over the ED.

Try to give incentives like, "As soon as you eat what I've given you, we can do xyz. Or, "If you finish what's on your plate, we won't have to wait that long to do xyz but we will stay around as long as it takes." The message to ED: There is no way out. We love this child and she will eat to get better!

I suggest you give your daughter a nice welcome,  something to look forward to during the week. Even if she won't admit it, she still misses the cosiness of home.

And you all need to be on the same page. I, too think it's crucial your daughter is told during the week that refeeding continues at home! 

In any case, the 3 meals and 2 snacks in between is the structure that should keep her fed every 3 hours. 

All the best, keep going!!

Z










Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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Torie
Depending how your room is set up, you may be able to seat her between two adults so she needs to stay there until she has finished. If she says she wants this or that instead, you might say she is welcome to have that as soon as she has finished what she has been served. If she escapes to her room, you can follow her with her plate. There is a great video by forum member Eva Musby. I can’t link on this borrowed computer but if you google anorexia bungee it will come right up. 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
Do you have an ED team that can support you with that transition? Are there consequences for not eating what you serve? How can she go and serve herself, is the kitchen open and different food available for her? Can you change that?
Has she already lost weight? When is your next team meeting? You need to ask for a higher level of care I think. Is there a FBT therapist that you can call?

Normally it is not allowed to go and feed yourself with FBT until they are WR. Is she WR?
Then you can give back freedom very slowly but that does not mean plating herself all day from tomorrow...
Do you still follow a meal plan after IP? That is necessary. They need to eat 3 meals and 2-3 snacks and high caloric food for a very long time...
Keep feeding. There is light at the end of the tunnel.
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pip99
Hi all, thank you for your feed back and advise.  When she was on home leave from IP she stuck to the meal plan, after a few days following discharge she just stopped eating everything, she was at 95% wr as that was the target they had set her.  She is still in the “healthy zone” and physical obs ok.  we have sat with her from 1 snack time to a meal time with nothing going down on either occasion.  We stopped her going back to school after a few days of restricting, and she has been told by ourselves and psychiatrist (via a letter as she refused to go and see him) that re admissions would be the next thing. In our area we don’t have a specialist ED team, they look after all young persons mental health issues.  Waiting to hear back from them for their advise.  Both ourselves and she knows what needs to go in her, it’s getting in her......
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MKR
Hang in there! 

Even though it looks from the outside that the ED got her to eat nothing, YOU guys won because you sat there .

The ED needs to see that you have more stamina and it will not win!  Your daughter will soon tire of following the compulsion and find it's easier to eat and get on with her day.

The 30 minutes after the meal were horrific for us, when the feeling of guilt at having eaten simply overwhelmed her. We had to stop her from disappearing to the bathroom or her room - so she couldn't spit out or exercise.  But the tantrums lasted less and less over time.

Just hang in there! The ED can see that you care, and your child can feel it!

Lots of love,

Z

Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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ValentinaGermania
pip99 wrote:
Hi all, thank you for your feed back and advise.  When she was on home leave from IP she stuck to the meal plan, after a few days following discharge she just stopped eating everything, she was at 95% wr as that was the target they had set her.  She is still in the “healthy zone” and physical obs ok.  we have sat with her from 1 snack time to a meal time with nothing going down on either occasion.  We stopped her going back to school after a few days of restricting, and she has been told by ourselves and psychiatrist (via a letter as she refused to go and see him) that re admissions would be the next thing. In our area we don’t have a specialist ED team, they look after all young persons mental health issues.  Waiting to hear back from them for their advise.  Both ourselves and she knows what needs to go in her, it’s getting in her......


So 95% WR is too early to give her any freedom and I would like to bet that her weight is not calculated right too. Do you have any weight charts from when she was a child? Do you know on what percentile she has been her whole life before ED moved in? If it was 50% she has to go back to that. If it was 75% that is your target. Please know that a lot of patients need to overshoot the target weight to get recovery started.

It was also too early to allow her to get off the meal plan after a few days. We are in year 3 and 2 years WR and she still sticks to regular meals and 3 meals 2 snacks a day and same amount as in refeeding just to maintain now.

Go back to plate all meals and snacks today and if she refuses to eat or drink for more than 24 hours take her to A&E / ER.

"we have sat with her from 1 snack time to a meal time with nothing going down on either occasion."

One day when my d had come home we sat about 20 hours at the table. Snack time, meal time, snack time and so on. We were all totally exhausted after that but it was needed too make clear we will sit all night if necessary and there is no other life but eating when she does not eat. She never did that again.
Keep feeding. There is light at the end of the tunnel.
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Mamaroo
Welcome from me as well. It does sound that you're d' s weight target was set too low. I've attached a weight height chart for you. If you have historical data of your d's weight and height, just plot it on the graph and find her weight.

As for getting her eating, tell her to start to take a bite, often the first bite is the hardest. Can you use incentives such as phone time or points towards arts and craft or another hobby? Ideally things that run out such as paint so that you can keep on using it as an incentive, so not a puppy.

My d didn't speak to the psychologist either, only after several months after WR did she talk to her and not about her illness, just general stuff. She doesn't need to talk now, she needs to eat.  Many kids here needed to go back several times before recovery, so don't loose heart. Sending you lots of hugs 🤗🤗🤗🤗


images.png 
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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pip99

Thanks all, she was born 2 weeks late at only 6.6lb. She fluctuates between the 9th and 25th percentile for hight, weight and head circumference throughout her life. If I plot her now, using age and height she comes in just over 25th.  

 

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ValentinaGermania
So this might not be a good weight for her body and not enough to recover from ED. Add a few pounds or kg and see what happens. My ds target weight was also too low and with just 2 kg more we saw great progress here. It is all about state, not weight. Increase weight until you see a good and steady change in state and mood and behaviour and you will know what a good weight for your d is.
Keep feeding. There is light at the end of the tunnel.
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Torie
Have you seen this video by forum member Eva Musby?  I found it really helpful.

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