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

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Hope42019
We are a year into this battle with anorexia. Our 15 yo D has been weight restored for at least 6 months and we continue to slowly move it upward. We have helped her get to this point with 3 meals, 2 snacks and a shake that we make at night to get her to her daily requirement. She needs 2800-3000 cal per day. We are working toward getting rid of the shake and have her eat/drink her calories in a variety of foods instead. This shake has 700-1000 calories in it sometimes depending on how she ate during the day or what her weight is. We have not told her the calorie count she requires because when we brought her home from the hospital last year a nurse said it out loud on our discharge day. Our D freaked out and it was a big set back for us. I have been terrified about her knowing the # of calories she is consuming (even though I think she has a good idea of what it is). How many of your kiddos know their calorie count need? Do they work with you at this point in meeting that daily goal? We are definitely in phase 2 and she makes a lot of her own snacks and breakfast with our oversight. We are supervising all meals and snacks right now. I don’t like that she counts calories at every meal and snacks but if she didn’t I know she would eat less and fall back. It keeps her accountable. Plus how do I ever get her independent with eating? I know this takes forever but I want to make sure I am helping her make the transition to independence the right way. 
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Barberton
Hope42019,

That's a tricky one. I understand what you mean by "It keeps her accountable", but why is she counting? The numbers keep them feeling safe and in control of this thing that feels totally out of control for them. I think the idea of the "magic plate" is that we parents take that control away from them, reassuring them that they are safe, and in doing so we help retrain them to not feel the need to count. Does that make sense?

In our situation, we have tried both ways and not discussing numbers for calories and weight have had far better outcomes than when we took the approach of asking our d to be accountable to a number.
D fell down the rabbit hole of AN at age 11 after difficulty swallowing followed by rapid weight loss. Progressing well through recovery, but still climbing our way out of the hole.
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Foodsupport_AUS
This is always a difficult point and depends a lot on the age and stage of the child, their requirements etc.. The one golden rule seems to be that they always need more than they / ED thinks they do. The natural tendency to decrease intake seems to be a part of the genetic make up of those with eating disorders - as per some of the research coming out from the ANGI study. At the same time I and many others feel uncomfortable adding in a counting regimen which probably reinforces anxiety and obsessions. Many of the adult programs do use counts nonetheless because otherwise the tendency to reduce intake, even if there is no deliberate or conscious restriction is just too great. 

Your D does need to know that if she is to replace the shake she will need a signficant increase to all of her other meals through the day. It is a downside of using such a large shake to support weight gain - it is fully 1/3 of her daily intake. Those meals and snacks will need to increase by around 50% in volume/caloric count for her to succeed. If she is in phase 2 she probably does need to know that she is being supported by a significant degree. Her  other option is of course to just continue the shake long term, perhaps distribute one of the other snacks between her meals in moving to three meals, one snack and a shake?
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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Hope42019
Yes, that makes sense. I really want to get away from calorie counting all together but it’s so hard. For so long now she will ask “how many more calories do I need?” when getting a snack at the end of the day or fixing a different lunch than the norm. Since the stay at home order it’s been easy to plate more of her food. She doesn’t ask how many calories are in the meals I cook. She just eats them. She mainly wants to know how many she has left for her snack at the end of the day. She won’t eat more than what she is suppose to of course. I know she is full at the 2800-3000 cal mark and she is just putting the work in to eat because she has to. You are right about the numbers being another thing they control. The good thing is the calorie number is a high number that ED hates and it is taking ED down. I hope we can find a way to return to normal eating without worrying about “is this enough”. I am terrified of falling backwards. 
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Torie
Hope42019 wrote:
How many of your kiddos know their calorie count need? Do they work with you at this point in meeting that daily goal?

We never discussed calories.  We moved into Phase 2 extremely slowly, and she learned to eyeball portion sizes as has always been how portions work in the Torie household.  (Apart from the re-feeding days of course.) xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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teecee
Personally, no counting calories...
These diseases appear to be number and rule driven so eradicating that is important. They become fixated on a number whether that be on the scales or the menu. 
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Enn

This is a challenging question. I see it in a few ways.
For one I don’t think that the child should know the calories at all. But, they are so smart that they know anyway, really. Unless she did not know the shake’s value. How do you answer when she asks how many calories are left for the day? How does she handle that if you don’t tell her? 

I also wonder as a way to stop counting ,
if you change things up daily if that may help. Say one day a lot more calories and the other day a bit less. But still a good amount. That may help with the compulsion to count. Then you need to teach her portions over time. Over
time d knows what a good portion of cookies is , or a glass of juice. There is always a minimum. My d still is on 3 meals and 2-3 snack per day. It has been three years and getting more flexibility only in the last 8 months.

 

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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MKR
Torie wrote:

We never discussed calories.  We moved into Phase 2 extremely slowly, and she learned to eyeball portion sizes as has always been how portions work in the Torie household.


Same here. Because ED gets stuck on numbers, even quantities.

Even portion sizes were a challenge, because we briefly saw a nutritionist at the start of FBT. The nutritionist had posters and pictures of meals on the walls of her office and those images were rigid in our d's mind for many, many months.

I suggest you give your daughter several options of pre-selected snacks for her to choose from. In time, she will hopefully remember what an appropriate snack is.

Eg, during lockdown a snack is a chicken wrap, hoping that she would buy something similar if out and about.
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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Hope42019
Thank you all for your responses and feedback! I really appreciate it. We sat down last night and had a good talk about increasing intake during the day among the meals and snacks to be able to get rid of the shake at night. She is on board. We are going to work on navigating any conversations away from calories. The good news is that we can now have conversations like we did last night and she understands and expresses her commitment to recovery. We saw true brain healing in Jan 2020 and she is fighting to recover now. I am always feeling on guard because I am afraid ED is trying to pull tricks on us again so me learning to trust her again is something I have to figure out. It’s going to take a long time and a lot of mistakes we are finding out. Thank you all! 
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PurpleRain
My D is 14, almost a year WR (back to growth curve), she still has a big shake as part of her breakfast and we still do 3 meals and 2 snacks, she still needs lot of food. We never discussed calories or portions, I still plate most of her plates (and everybody else's, it's normal around here), for snacks sometimes she chooses and serves herself with supervision. We, like Torie have been drifting towards phase 2 veeery sloooowly, almost imperceptibly (not to me, but to her), and she eats much more freely now. What I did is put less added ingredients into the shake, and added more (quantity or calorie dense food) to the other meals. It has worked pretty well, her shake is almost normal now, nothing she wouldn't put in if she need to prepare it (not yet). And for us it works because when things go back to the new normal she would have to get up so early to go to school (it starts at 7 am around here) that she would be having a shake for a long time, it's easier and quicker and she can have it just before going in.
Good luck to you!
13 yo d started to eat "healthy" September 2018, she had a growth spurt a bit later, followed by tummy bug. She started restricting breakfast and school lunch in January 2019 (that we know). We succesfully refed at home.
I have found inner strenght, patience and compassion that I did not know I had.
Never retreat, never surrender
keep feeding
 
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Barberton
Does anyone here have suggestions if it's a good idea to talk about hunger and fullness with your child at this stage? If so, then how? I have avoided talking about 'feeling full' because I don't want to highlight the issue. But is it important to help them recognise their hunger and fullness or is it best to let sleeping dogs lie?
D fell down the rabbit hole of AN at age 11 after difficulty swallowing followed by rapid weight loss. Progressing well through recovery, but still climbing our way out of the hole.
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Foodsupport_AUS
I think the biggest difficulty is that hunger and fullness cues are often not great with ED. In hindsight I realise that my D had terrible cues from well before the illness.  I had no idea when she was a baby whether she was hungry or not, and she didn't seem to know either. As she grew she ate to a schedule, but never asked for food outside of that schedule, she ate her meals rarely asked for more but if she liked foods a lot she may do so. Again this never followed hunger only desire. 

We are 10 years into ED, she does report hunger sometimes but mostly she still eats to that same schedule, she knows she needs to for her health. As for fullness it is a tricky thing. Many kids with ED often have significant gut sensitivity, there is a high incidence of things like irritable bowel syndrome and FODMAP sensitivity. It can be really hard for them to know what is causing the sensation. I think this is one of the last things that should be addressed, well after other ED behaviours and often only when they are able to eat regularly gain weight without undue distress. I have little hope that my D will truly be able to eat intuitively. 
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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Barberton
Thank you Foodsupport_AUS. I was thinking that intuitive eating might have to be left until later (if it can happen at all). I just wondered if there was any benefit of using it to shift the focus away from an obsession with counting calories. My d would say she 'feels full' no matter what she ate.
D fell down the rabbit hole of AN at age 11 after difficulty swallowing followed by rapid weight loss. Progressing well through recovery, but still climbing our way out of the hole.
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Hope42019
My D is “full” a lot too so can’t finish a plate, won’t eat the last bit of this and that. I know this is ED giving an excuse not to finish which has been a big ED behavior here. We are pushing to fix this. She also asks “haven’t I had enough” referring to calories in the meal plan. One of the issues with our D is that we did give her more choices early on entering phase 2 too early upon guidance from our team. It feels like we have had to battle that decision. Despite this she has gradually gained weight though so it did not set us back in that realm, but it has just made for more arguments with her. She is making good progress and trying to eat more daily. We have had 4 days without a shake because she has ate and drank her calories! It hasn’t been easy trying to come up with food ideas and eating more at various times through the day but we are working on it. Thanks again for all the input! This forum has been such a support for me since last summer and I turn to it frequently for help.
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