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

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WilliamWallace Show full post »
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)
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.

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
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. 
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?

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. 



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! 
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.

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.

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.

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

 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