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

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My 15 yr old daughter was diagnosed with AN jan 2019. Restricting calories. Rapid weight loss, signed off school, admitted to inpatient unit for 3 months. Gained 10kg in as many weeks as inpatient but since discharge hasn’t made any progress. Avoids sugar and fat. Every snack/meal tricky. Just don’t know how to increase her menu and introduce fear foods. Feels like we’ll be stuck like this forever. 
Any advice? 

Hi there, welcome to the forum. Transitions from IP to home can be very stressful and hard for them to keep the gains going. Many have found making sure that the home environment is similar with supervision and eating expectations helps to maintain the momentum.
Did she have the sugars and fat in the hospital? If so, then you need to challenge her on that. 
So when was she discharged from the hospital? what is she eating now? Are you adding in calories with cream and oils etc. to get the weight up. 
Are you under a specialist ED team? What are their plans if she loses weight? 
There needs to be very detailed plan about how you move forward, like if there is wt loss she may need admission again. 
We had a rule, that if she ate it IP then it was all fair game at home. My d was almost 12 at diagnosis and now 14.5. 
Please read around the forum as well. Many use incentives to get them to eat. Ie no food, no cell phone. 
Is there an external motivator you can tap into, to move her forward a bit? Sorry for all the questions, just trying to get a fuller sense of your situation. 
We all want to help. Please ask all the questions you have. 

I would suggest though to read a lot. 
Lauren Mulheim's book  https://www.amazon.com/When-Your-Teen-Eating-Disorder/dp/1684030439

It takes awhile after discharge to figure out what your child's ED needs. We can share our experiences and hope something clicks for you. There is a huge learning curve and please know you are not alone. We want to help- just ask for what you need.
I am sending a big hug!


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)
Welcome to the forum, sorry that you have had to find your way here. 
As has been mentioned transitions are tricky and continued gain can be hard to maintain if there are no consequences for not eating. In inpatient I am sure there was consequences for not finishing and completing meals. To get things moving again, I would try to head back to where she was at discharge in terms of eating. That in itself will be a challenge. Commonly there is progressive restriction from discharge. Rather than looking at challenge foods can you increase in quantity and slowly add in more fats?
As much as possible make it difficult for measurements to occur as regards food quantities. Early on my D wanted everything to be weighed and measured - I insisted on her being out of the kitchen and slowly but surely increased the quantities. 
Where do you think the sticking points are. The main trick is not to get your D to agree to this, it is to require her, or make it difficult not to do it. 
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.
Welcome from me as well. Eva has some great videos, I've posted them below for you:

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
As the others said, transition from IP is tricky. Best is to keep all rues from IP for a very long time...
A few questions:
Do you have a meal plan?
Is she still eating 3 meals and 2 snacks?
Do you already have a fear food list?

We had fear food day once a week and re-introduced that slowly one after the other. Others did rap the band aid off and served all fear food from day one There is no rule, no right or wrong.
But it is very important to work that down and eliminate all restrictive behaviour. She needs to learn to eat all that she ate 2 about 2 years before ED moved in.
There is no recovery without that fight.

Is she truely WR? Did her behaviour change already?
How can we help you?
Keep feeding. There is light at the end of the tunnel.
Thank you everyone for your thoughtful replies to my post. 
My daughter was discharged from IP at end of June. She is still not weight restored (approx 4 - 6 kg still to go minimum). Weight since discharge has fluctuated. If she gains even 200g it scares her and she often loses more the following week. She is seeing a psychologist once a week and also a psychiatrist (for weigh in) both are ED specialists. 
She doesn’t seem to want to recover, feeling safe the way things are. She is at school but not socialising. I go in to support snack and lunch. The whole family has been affected by the rigid routine. 
She has 3 meals and 3 snacks but the food types are v limited. She also has a v rigid approach to exercise. Walk at same time each day, same route, etc. 
I feel trapped. I know I need to challenge her and offer different foods/increase portions but I’m scared she’ll refuse meal completely. 
Am I being stupid? 
If she is not WR she should not be allowed to exercise at all. Did cahms allow that?
How does she know she gained? Can you ask for blind weighing to take that stress off?
How can she lose more in the next week? Can she regulate her intake? Is she skipping meals or snacks?

She does not need to want to recover, she can not in that state. She does not understand that she is sick, she has anosognosia.
You are not stupid at all. You just need some help to do that. Where is her team? They should support you with transition!

She needs to gain 500-1000 g every week to get WR asap. That is evidence based. If she does not gain enough food needs to be added to the meal plan.

Ask these ED specialists for more help! That is what they are paid for! Sorry, just ranting on your behalf.
Keep feeding. There is light at the end of the tunnel.
Hi AJW, If you would like to post a typical day's meal, we could offer suggestions how to add calories without increasing footprint.  Sometimes the additions can be invisible (for example, butter both sides of the bread when making grilled cheese).

It is so hard but please remember we are with you in spirit. And please feel free to ask all the questions you like. xx

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

All of the ideas above are spot on. I would also be demanding that her professional team support you in getting back on track. Think along the lines of them firmly saying that you know what to feed her and she has to eat what you prepare, an agreement that if she loses weight there is a consequence like an increase in appointments and weighing days, a trip to the ER for NG feeding or eventually readmission. If they can plan with you and everyone is on the same page, your daughter will come to understand that she cannot avoid eating enough.

Much, much easier said than done, I know.

Wishing you strength and courage,

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.