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

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EASL
good morning - we are making progress. Some weight back on and a complete acceptance of 3 meals plus a snack. Our CAMHS team seems to have messed up weighing as we were up on 2 weeks ago - then down (a lot!) a week later. At the down appt my D begged to come back in 3 days later to be weighed to see if our plan was working - a good sign I thought. 3 days later she was up (a lot) so I don’t have any trust in our weigh-in. Although the last time we weighed her twice and I saw the scale. 

So weigh in in again in 4 days - that should tell us something. 

The question - her pace of eating has slowed down - 45 mins/hour to finish a meal - linger if TV is involved. Do I ‘leave’ this for a few days or say something? Don’t want to upset the progress but am fearful this new tactic will become entrenched. 
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tina72
Slow eating is quite normal at the start and 45 minutes for a meal is not that bad to be honest. I would concentrate on adding a second snack first and then work on eating faster. It is more important that she eats very regular every 3-4 hours and that you get the weight on fast.
We watched short series like big bang or 2 and a half men so she managed normally to finish within one episode.

Just wanted to add that you are doing great and you can be proud of your efford up to now! Weight on and complete acceptance of 3 meals and a snack is really progress!
Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS
I agree with Tina that the first step is to get all the food in, then to work on other behaviours. Slow eating is very common. The worst part is it can make them feel fuller than if they  ate faster. Some have  tried something along the lines of - the TV is there to help you but if it is slowing down your eating we will need to turn it off for a while. You can use the remote to pause/stop if she is taking her time to pick up food and then restart as soon as she gets going again. We just tolerated the slow eating for a long time, we had so much trouble getting her to eat it was the least of the problems. 8 hours feeding a day at one stage. Once we go over the hump to get her moving I would try to arrange to do something after a meal - "when you finish we can do X"
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.
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deenl
EASL wrote:
Some weight back on and a complete acceptance of 3 meals plus a snack. Our CAMHS team seems to have messed up weighing as we were up on 2 weeks ago - then down (a lot!) a week later. At the down appt my D begged to come back in 3 days later to be weighed to see if our plan was working - a good sign I thought. 3 days later she was up (a lot) so I don’t have any trust in our weigh-in. Although the last time we weighed her twice and I saw the scale. 

So weigh in in again in 4 days - that should tell us something. 


Hi EASL,

When my son's weight was fluctuating like that he was actually water loading. He would drink large amounts of water before a weigh in. An increase in weight was actually simply more water. It is difficult for them to calculate it correctly hence the fluctuating figures at weigh in. There are a number of things that can be done. Firstly, supervise in the 3/4 hours before a weigh in. By supervise, I mean do not leave them alone for a minute. Toilet visits must be also supervised. They should go to the loo and empty their bladder before they are weighed. I believe that there is also a blood test that can show if they have been water loading.

The other possibility is hiding heavy things in their clothing and underwear. My son tried this too. Many ED clinics have a protocol of weighing a child naked except for a hospital gown. This was never going to happen with my son so we just frisked him.

Our poor kids are so terrified of weight gain and the bullying ED that they are driven to actions that are completely out of character. Perversely, it is less stressful for them when they know the won't get away with it. (after the first few rages, that is!)

Best of luck,

D
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, stable but no progress. Medical hosp to kick start recovery Feb 2016. Slowly and cautiously gaining weight at home and seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Building up hour by hour at school after 18 months at home. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. [thumb] 2018 growing so fast hard to keep pace with weight
  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal.
  • We cannot control the wind but we can direct the sail.
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Lildil
Hi EASL 
We went through this slow eating phase it lasted about 3 months we would give him time limits on meals and snacks and he would have to go to lunch early from class and was still sometimes late for the next class. We finally, councilor and I told him he can't be late for class any more you will be counted tardy. I also left some boosts at the school and told him if he didn't finish in the aloted time you will have to finish with a boost. That was the end of it, he just all of a sudden decided to start eating faster, now he eats like he likes it even though we are still only gaining 1/2 lb to 1 lb a week, so.e weeks the same weight, but at least we are past the up, down, up, down thing. Sounds like you are doing awesome, keep believing in yourself. Have a wonderful week end.
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tina72
I do not remember how old your d is at the moment but with younger kids it might be worth to introduce a point system: she gets one point or star for every meal finished in time and 3 points/stars mean a small gift or some internet time or something else she is keen on.
We got our d with driving lessons so be creative what might work with yours.

To add to Deenls post I want to say that it worked best here when she did not know about the weighing before and could not prepare for it. Some do water loading, some prepare clothes with extras that are being weighed in addition. Blind weighing by surprise worked best here.
Keep feeding. There is light at the end of the tunnel.
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toothfairy
Food is the medicine. Recovery is possible.
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EASL
Thanks for the support and the suggestions. I’m at a crossroads as we’ve had 3-4 weigh ins with CAMHS and they have been up and down by about a kg. I have directly asked my daughter if she’s water loading as well as watched her very closely prior to appointments. 

We’ve been managing 2300-2600 calories a day. She eats a wide variety of foods and has asked to try some previously forbidden foods. She’s been very kind with me for 8 days - allowing hugs/saying I love you/apologising when she is prickly. I attribute all of that to steady calories. 


HOWEVER, she is not engaged with CAMHS team and I am beginning to lose confidence in them as well. We can afford private care - live in London - I’m open to recommendations as well as guidance re CAMHS team. Today we had a disastrous meeting resulting in my daughter leaving the room as her anger/ED cloak had come out and I said to the team that it wasn’t good to push her when she was in that state. She left and they spent 20 minutes suggesting I was enabling too much (probably true) and that we were the reason therapy wasn’t progressing. I left feeling very frustrated and also feeling they still don’t ‘understand’ my daughter. We’re coming up on 3 months in their service. 

Any thoughts?
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Foodsupport_AUS
I am not quite sure, but from your posting it sounds like her intake needs to be increasing further to get more consistent weight gain. If weight is fluctuating, which it normally does, there is no consistent gain. Other than water loading of course the obvious things to look for is evidence of purging - both vomiting and use of laxatives both of which can cause rapid fluctuations in weight and fluid retention and are very dangerous. 

As for the trying to "get her to open up" with the team, this is a long slow road. For many kids it takes many months, with my daughter years, for good progress to be made. The important parts early on are support for increasing her weight and nutrition. I actually think it is great that the team pushed her and she walked out. It is a sign they are not afraid of the ED. ED will often withdraw / flee when challenged but that doesn't mean it shouldn't be challenged. 
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.
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tina72
EASL wrote:
Thanks for the support and the suggestions. I’m at a crossroads as we’ve had 3-4 weigh ins with CAMHS and they have been up and down by about a kg. I have directly asked my daughter if she’s water loading as well as watched her very closely prior to appointments. 
We’ve been managing 2300-2600 calories a day. She eats a wide variety of foods and has asked to try some previously forbidden foods. She’s been very kind with me for 8 days - allowing hugs/saying I love you/apologising when she is prickly. I attribute all of that to steady calories. 


So her weight maintains (that is 1 kg up and down which is normal for maintaining) and she does not gain any more. Normally if she is not secretly exercising or purging that means her metabolism has increased and that she needs more food to gain now. We had that 2 times before WR. Add 300-500 calories a day and see what happens. You need to increase until you see a steady weight gain again. 2300-2600 is not a big intake for refeeding. Go to around 3000 and see if that is enough.

EASL wrote:
HOWEVER, she is not engaged with CAMHS team and I am beginning to lose confidence in them as well. We can afford private care - live in London - I’m open to recommendations as well as guidance re CAMHS team. Today we had a disastrous meeting resulting in my daughter leaving the room as her anger/ED cloak had come out and I said to the team that it wasn’t good to push her when she was in that state. She left and they spent 20 minutes suggesting I was enabling too much (probably true) and that we were the reason therapy wasn’t progressing. I left feeling very frustrated and also feeling they still don’t ‘understand’ my daughter. We’re coming up on 3 months in their service. 
Any thoughts?


To be honest, my d never engaged into the therapy part of FBT and we just left it that way at some point and used the FBT therapist for ourselves. As long as you see weight gain and your d coming back in character she IS progressing. She might not fit into the CAHMS teams manual 🙂. Maybe it helps to give her a break and as the team to restart their therapy part when she is WR. It often does not help anything before brain recovery starts.
Keep feeding. There is light at the end of the tunnel.
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Mamaroo
Like Tina's d, mine never engaged with the team either apart from exchanging pleasantries or talking about things that interest her, no conversations about food or other underlying issues. When she didn't gain, our team would tell her that her meal plan was going to increase and she could choose if she wanted an extra snack at morning or afternoon tea. If they were really feeling generous they gave her the option of a muesli bar or muffin, otherwise I just chose.
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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