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WilliamWallace Show full post »
Enn
@GTAMom,
I would keep the same schedule like the hospital. There are a number of reasons for this:
1: Your will get all the meals in with the same schedule
2: My d likes routines and this allowed me to say "this is how it was done while in the hospital and so you can do it at home"
3: Going home will be such a big transition. My D felt as if when she got home it would be the same as before hospitalization: NOPE I could not let ED take hold again this kept me organized. Wake up was about 6:30 and then breakfast 7, then snack 10 am then lunch 12 noon, snack at 3 and supper at 5:30, pm snack at 8 and bed at 10pm
This really helped me. 
My d was a bit obsessive too in the beginning. She stood from waking to bedtime. She had to eat at the rigid times. She had to have her room a certain way. It got looser with more weight but the nutrition will always come first. When she would wake up late, there could be an excuse NOT to eat a meal/snack. Right now this is her chemo, keep a good routine and see how it goes. If you miss a meal/snack one day, ED loves it and will try to do it more often. "Well if I missed a snack yesterday how come that was OK but today it is not". Try not to get into those sorts of circuitous discussions- not worth it!
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
Hello @WilliamWallace and welcome from me as well.

Adding briefly to ample advice above, just 2 notes on different needs of family members and self-care.

We had a situation with a holiday visit by someone who needed to control their eating. I'd at first thought we would be dealing with two extremes, that would even trigger each other.

However, it turned out regular 3-hourly meals and snacks (including weekends!) kept everyone's metabolism steady. It worked really well.

For re-feeding, you will require "two of you". One to prepare meals and the other to supervise the eating and monitor for any exercise. I had both roles at once (every second week) and it was exhausting. So factor in some support and opportunity to recharge!

I wish you all the best,
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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salmy

Yes, a break from baking/cooking would be necessary here. Many kids with Ed have a fascination and obsession with baking. For our d, she would bake everything and watch us eat it but refuse to eat it herself. In the early days of treatment we made no food porn a rule- no cooking shows, food related instagram feeds, etc. Her therapist was supportive in this and antiheroes rule which is, if you bake it you just also eat it. Needless to say she did not bake for a long time. Just last week she made her dads birthday cake and has been eating the leftovers for days as a part of her snack. 😍
Laura Collins also talks about this needing to pull away from baking and her daughters obsession with food in Eating with your Anorexic.
D16 diagnosed AN October 2019 -25% of body weight, but still "healthy weight" per Dr.
Started FBT Dec 2019
July 2020 Fully WR + 10%
2 Months in to Phase 2
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WilliamWallace
Thanks so much to you all for all the replies - I wrote a huge long post this morning answering specific things but seem to have lost it!
Feeling much calmer today about starting tomorrow - partly because of some of the answers you lot have provided, or prepared us for. 
The main thing my daughter is worried about is that she’s going to get fat - and will gain weight. I’m hoping that she’ll become less afraid of this as it happens - but it just seems mindblowingly counterintuitive to her that the aim is to put on weight. I think she’s beginning to recognise how much she needs help, but I can see the fight going on in her mind all the time. 
Thanks so much. 
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WilliamWallace
Ok - next question - my daughter doggedly checks calories on google before or after she’s eaten. What would your advice be about this? Will she drop it when she relaxes into re-feeding, or do I need to say it’s not allowed?
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mfab12

My instinct would be to say it’s not allowed and We deleted all fitness apps or anything on my d’s phone etc. I think she’ll mentally be adding it up and It’s distressing so the less exposure the better. It does get easier eventually. 

for me the first 2/3 weeks were the toughest when starting, I did it hard from day 1, which led to more battling at the beginning but less negotiating after even the first week. 

 

 

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mfab12
Also my d found watching you tuber ‘what Mia did next’ really helpful - she had one about weight gain. I would check it out first and see if you think it’s something you’d want to Show her. My d has found that the you tubers (I watched them all before she could) has helped her the most. However she didn’t start watching them (mainly as I didn’t know about them) until she was weight restored - so I don't know how helpful she would've found them at the very beginning. But you can never have too many tools in your toolbox! 
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Foodsupport_AUS
I would absolutely stop her looking up calories before or after meals. It is an ED behaviour, and all ED behaviours need to be stopped. You will find many more. As her anxiety increases with re-feeding (which it will), you will see more resistance and she is likely to argue more about why she needs to do certain things. I guarantee her looking things up will make it harder for her to eat in the long run, though she is likely to argue otherwise. Although she needs to regain weight, her focusing on weight is again unlikely to be helpful. I always preferred to use terms such as nourishment, reversing malnutrition, restoring health  as they kept the light off weight and fat. Calories are fuel, energy. 
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
@WilliamWallace,

Information about calculating weight gain was discussed in a question I asked a while ago on this forum. Link here. But I suggest you print out the WHO (World Health Organisation) Growth Chart for girls and start plotting where she is. You and your GP will need to figure out where she sits based on her age, height and your family body-type. As an example, my d is around the 25th percentile in weight, but she started out in the 7th percentile. So I can use that data to make assumptions about where we want her to be as she grows.

I hate admitting I have this app on my phone, but the Calorie King app (from here in Australia) has helped me quickly sort out if I'm giving my d enough kilojoules every day.

Coconut oil is my go-to for getting kilojoules in without any taste. I recently discovered a Nestle product called Benecalorie. It has been very effective. Small volume, little taste.

Monopoly Card Game was a super distraction in our house. We tried a number of conversation starter cards, but a game was what it took to make everyone laugh.

My most important piece of advice - which everyone here has also said - get onto her weight gain as quickly as possible. It will be horrible, but just stay strong and make it your main focus. Good luck.

Barberton
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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evamusby_UK

WilliamWallace, I'm glad you say you have good CAMHS support. Scotland is a bit variable, with some GREAT places and others not so.
You asked

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 It seem reasonable to give her some autonomy, especially as her condition isn’t critical - but Is that counterproductive? Is the point that she learns to eat well again by relinquishing/abdicating ALL decisions?

and it's an important questions. 

The principle of phase 1 of FBT is you prioritise regular nutritious meals, rapid weight recovery, interrupting harmful behaviours. An analogy would be putting a plaster cast on a broken leg. Yes it makes your kid very reliant on you, but only for the things they cannot (yet) do wisely themselves.

Then in phase 2 (which is often rushed or bodged, so keep alert) there is a gradual systematic coaching / practicing / reinforcing / repeating of setting up little experiments in bits of autonomy, so that eventually your child learns and is comfortable with making wise choices again.

The 2 phases can dovetail into each other a little, in the sense that if you see she can handle small choices safely now, without it leading to arguments and manipulation, then you might as well allow those, in my view. But tiny steps, tiny experiments, as if you give too much choice too soon it can be hard to pull back, and also meanwhile you could have lost momentum with weight recovery.

hope that helps
Eva (also Scotland)

Eva Musby, mother, author, produces lots of resources for parents at https://anorexiafamily.com and on YouTube https://www.youtube.com/user/EvaMusby/playlists
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WilliamWallace
We’ve made it to the end of Day One!

@evamusby_UK, I read chapter 8 of your book last night and was so glad. Breakfast time was a riot of anger and swearing, but I was able to stay calm, not react. My husband whisked the 10yr old off for a dog walk. 

The rest of the food was eaten without too much resistance, but there was an hour and a half of sobbing this afternoon at the thought of how fat I was making her. It’s hard to imagine waking up and doing this all over again tomorrow. 

Thanks for all the ideas - I hadn’t thought to look on YouTube for helpful people to follow. Am going to bed!
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mfab12
Well done completing day one, its hard work but tomorrow you'll be able to do it again..

You got this!!! Sleep well 
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evamusby_UK
Day one, and you found you can avoid 'reacting'. That's a lot more than most of us managed in the early days 🙂
What a terrible sadness, for our children. You are doing the best we know to move her on as quickly as possible.
Eva Musby, mother, author, produces lots of resources for parents at https://anorexiafamily.com and on YouTube https://www.youtube.com/user/EvaMusby/playlists
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WilliamWallace
Day two has been much calmer, no resistance. We agreed with our CAMHS guy that moderate exercise could continue as long as all the food has been eaten, so she’s done her regular 45 mins but hasn’t upped it (and the weather hasn’t allowed for lengthy walks). She’s actually done less exercise yesterday and today than most of the last month. She seems a bit defeated by it all.

One question I had today was about calories. She’s badgering me to know that I’m calculating the exact calories for each meal. I’ve not confirmed or denied this (I’m not, although I have done some research about the rough calories of the ordinary meals/snacks we eat). Do I need to disabuse her of the notion that I’m calorie counting, or allow her to think that I am, so that she feels ‘safe’?


We had a horrible end of day last night after I’d posted - swearing at me and so angry that I’m making her fat. I’ve spend the afternoon filling in a million forms for CAMHS to do with ASD assessment. It doesn’t seem fair that some kids such seem to fit into the groove of life with an ease that others don’t. 

Older sister got exam results today - lower than she’d hoped. I’m finding it difficult to handle all three of them and their needs. Am I right in thinking that some of this will eventually feel a bit more ‘normal’? Or will I perpetually be on the edge of tears?!
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GTAMom
Hi, we are pretty new to this as well but from what I've read, I think it's good to avoid discussions of specific calorie amounts and say things like "I am helping you eat the right amount"  "i know what you need" etc and focus on reassuring them that you are in control and taking care of this for them.    I'm sorry that you had such a hard night.  I also have 3 kids and can appreciate what you are going through.  This is so hard and unfair.  I'm sure others on here will have some helpful advice and I also wanted to recommend a book that has been very helpful for us - "When your teen has an eating disorder" by Lauren Mulheim.  It has a lot of very helpful practical advice.
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mfab12
Well done on day 2. 

I'd agree and say it's best not to discuss calories, just reassurance that you are making sure you are doing it right and it's what she needs. 

My d used exercise to compensate and I had to keep reining it in... Probably helpful to be aware of this.

Try to be kind to yourself and I'm sure you are doing the best you can. I can't say when it will be more normal for you, we are still on the road through recovery with our d, but there are a lot less battles, more happy times, and less tears (although there are still some at times) 

Use all the support you can when you feel you need it. 
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MKR
Well done on making it through the first two days. 

That Why us? feeling is familiar. Only over time can we put it into perspective so right now, when things get tough, it's all about putting one foot in front of the other.

The one firm constant is your love for your children, which shines through from what you wrote 😀.

The tantrum last night is pure ED protesting, so you'd hit the target, yay. You don't need to negotiate with the ED, keep giving your neutral statements and change the subject.

I hope you managed to spend some time with your other daughter to support her with the exam results.

Sending you strength on all 3 fronts! ❤
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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Barberton
@WilliamWallace, Well done on getting through day 2. 

When your daughter expresses concern that she is getting fat, make sure you look her in the eye, say something like "I can see this is a real worry for you" so she feels heard and then leave it at that if you can.

So often I either ignored my daughter's expressed fear or tried to tell her that she had nothing to worry about. Try and avoid "BUT".
  • I know it's scary, BUT you need to eat.
  • I know you are angry, BUT you have to put on weight.
When speaking to my daughter I now try to say things like,

I can see eating this lunch is worrying you. Do you want to talk about it?
I understand that you don't like going to the clinic visits. You are working so hard at your recovery. I'm really proud of you."

Super hard to transition to this sort of language when you are so wrapped up in fear, worry and anxiety. But so worth the effort. Good luck.
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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