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

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My daughter has been in and out of the hospital, residential, and inpatient facilities since January. She came home last night to begin FBT with us at home. She refused dinner and snack last night. I tried following the rules--I was encouraging and supportive and non-judgmental. I acknowledged that this was difficult for her. I'd created incentives for compliance. I poured ensure as a fallback. She took in nothing.

This morning she ate half of her breakfast, most of her snack, and half of her lunch. She knows that if she eats all her lunch and afternoon snack she will be able to do a group FaceTime with her friends. But she won't drink her milk. She won't eat her chips. (She used to love chips. Love milk.) Even getting her to eat what she ate was a trial.

I feel like a failure. She ate everything at her inpatient facility and never needed the tube. She ate because she wanted to come home. Now that she's home, she doesn't care if she has to go back. (Not that there's room for her. There are huge waiting lists and she's now at the back of the queue.)

Please, I need guidance. All the medical people don't have time for me because of COVID-19. I feel like I'm failing not just my 12-year old but also her sister and father.
HiCat388 I really feel for you my daughter also came home today - totally inappropriately.  She managed her dinner tonight but I’m dreading what’s to come especially as there was no clear expectations of her at discharge meeting or adequate services in place. I know your feeling of despair when you think you are failing your children.  All we can do is our best.  My daughter also managed to eat in the unit this admission and the last one and avoided the tube. I wish I could give you more advice but I’m relatively new too this although the past six months feels like years!  Best wishes x 
The old eat to get home ED trick. I am so sorry that in these really difficult times this has happened. My D used it numerous times, but did require NG tube at times as well whilst in patient. 

One thing I found helpful was to understand what was likely happening inside her brain with her thoughts at these times. For my D the worst foods were those that she used to enjoy. She felt even more guilty about eating them, and worse felt bad if there was pleasure associated with eating. My D hated tinned tuna, but when ill at a lot of it. She loves mangoes but couldn't eat one at all. A second thing to be aware of is that many people with anorexia are much more sensitive to punishment than reward. They also tend to be very risk averse. There is a lot of neuroscience behind it, but it is thought that this is one reason that it is thought those with anorexia do manage to starve themselves when most people struggle enormously on a diet. 
For my daughter there was no carrot that could or would make her eat. Some can manage for rewards but many cannot. 
Sometimes there is no consequence/stick either but it may be worth considering this as an option. For example - if she can't eat she may be required to rest in bed without any other activities  including reading, TV etc. When she can eat those quiet activities can restart, she can do most things as normal. Don't bother trying to tempt her at this stage with things that she used to like. Just work on getting that intake in regularly - three meals three snacks. Whatever you think you can get in. My D coped with large volumes just to avoid those scary high density foods. Others find the smaller footprint shakes go in better. It is OK to experiment. 

In these hard times FEAST has organised for extra support to be on line and available for you. If you are getting really stuck in the moment there are help lines to call at the top of the page, these are experienced carers who can help you problem solve. 
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.
Hi @cat338,

Does your daughter see vegetables as "safe"? My d did and I made sure they were cooked with plenty of gravy or in a thickened stew. Salads had plenty of sunflower oil, that hasn't got a strong taste.

Even boiled potatoes can soak up oil (if butter is still a fear food). So a potato salad with onions will look "bare".

Stewed fruit can have butter mixed in. Yoghurt can be in low fat tub but you can replace it with the full cream yoghurt or fortify it with cream. You can then add it to an ice-cream and fruit shake and call it a yoghurt smoothie.

We started off with full variety meals (each food group on the plate, nothing allowed to be left out). It took a bit longer but the cooperation was better.

Just some ideas for you to try.
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
Hello and welcome.  It usually takes a while to figure out how to get the food to go in.  I will list a few things that have worked for some people (nothing works for everyone) that you may (or may not) wish to try:

I'm not sure what happens when she refuses her meal or snack, but if she throws it on the floor, rinse it off and put it back on her plate.  Or serve her another portion.  If she escapes to her room, follow her with her meal.

Some find that wakind ED kid up at least an hour before normal wake up time with smoothie in hand - "Here, drink this" - gets the day off to a good start.  It is almost as though ED doesn't wake up in time to kick up the usual fuss.

Spoonfeeding her (like when she was a baby) works in a surprising number of cases.

Rewards usually work best when they are immediate.  If she eats her meal, she gets the reward.  If she finishes the snack, she gets the reward. (A reward can be tokens or credits toward the item.)  When rewards are "bundled" (e.g, one reward for lunch + snack), the potential motivational boost is lost if the first part is not done.  If she doesn't finish her lunch, she might think why bother eating the snack since she can't qualify for the reward anyway.

This is a tough illness to beat, but it can be done.  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 
Thank you to everyone who wrote back. I feel less alone. Still terrified, but at least in good company. Since I wrote, my daughter has cooperated and is eating her meals and snacks. But she is eating the same thing every day. In a way, I am treating this first week home as a week of rebuilding trust. She is learning to trust that we are here to support her and want her to stay home with us. And we are learning that she will do the work and isn't doing anything to hide food to claim it has been eaten.

What has worked for us thus far: We promise not to spring changes on her that day. We tell her the changes that will happen with the next day's meals. (To be honest, we haven't changed that much.) We use a timer--30 minutes for meals and 15 minutes for snacks. When I need to spoon feed her at the end of the meal, I don't insist on bites that are too large. We give lots of praise and encouragement. And when she freaks out, I just hold her and tell her I know how hard this is for her and I love her.

What I fear I'm doing wrong: I am probably doing too much negotiating. I shouldn't be bargaining with her at all, right? And I'm not pushing more food or food variety. 

But I know I will do this. We have a virtual meeting with an FBT nutritionist on Thursday. My hope is that having this outside expert pushing us as a family will give me the kick in the pants I need to be more strict and will show our daughter that we are being advised by someone who knows what to do and will help us create realistic goals for the week ahead.

There are so many things I am freaking out about. Her guidance counselor just texted to ask if she was home. My child hasn't been doing schoolwork for two months now. I fear introducing schoolwork at this moment. School was a big trigger for our daughter's illness, and I'm scared about asking the kid to start up with pre-algebra and Latin (her most loathed subjects) right now.

Thank you again, everyone!
cat338 wrote:

What I fear I'm doing wrong: I am probably doing too much negotiating. I shouldn't be bargaining with her at all, right? And I'm not pushing more food or food variety. 

Looking back years later, I think the biggest mistake I made early on was in thinking that I was doing it wrong. You do what works. You discover lots of things that don't work, at least at that moment for your child, and you use that information to figure out was does work. Then it changes, and you figure it out again. 

It sounds like you might have already ready Eva Musby's book. If not, you might want to. It covers a lot of common scenarios, including the situation where you just can't seem to get it all in and decide to call it a day and try to get a little more in tomorrow. I wish I had read that when I was starting out. The upshot is, it's ok to decide you've done all you can at the moment--as long as you're the one who's deciding. Then you think about what you want to try next. Re-present the remaining food at the next snack or meal, or let bygones be bygones and get a fresh start? Mix it up and replace the uneaten portions with something else, either at the moment or later? Take a break and come back to finish the meal, or stay at the table until it's finished? Either way might work. 

As for pushing quantity and variety, I would recommend starting with what you think you can get her to successfully complete, then gradually increase the quantity. That's what they've done in the 2 hospitals and 4 residential programs I've had experience with. Variety can wait, as long as she's getting proteins, fats, and carbohydrates. Right now what you need to do is to build up her confidence and yours to the point where she is at least getting adequate nutrition to start restoring weight. That's a big enough job for both of you. 

There are so many things I am freaking out about. Her guidance counselor just texted to ask if she was home. My child hasn't been doing schoolwork for two months now. I fear introducing schoolwork at this moment. School was a big trigger for our daughter's illness, and I'm scared about asking the kid to start up with pre-algebra and Latin (her most loathed subjects) right now.

Don't worry about the guidance counselor and the schoolwork. Just text back let him/her know where you're daughter's at. They have a responsibility to check in with you and provide any academic support your daughter needs. The last thing they want to do is to make things harder for either you or your daughter. I think most guidance counselors have a pretty good understanding of how serious eating disorders can be, though they may or may not understand much else about them. 

You might be able to arrange for your daughter to begin doing online schoolwork and maybe having some check-ins with the teacher in just one or two subjects of her choice, if you think that might be rewarding or helpful. For my daughter, the opportunity to go to school was at one point the biggest (really, the only) incentive for her to complete her meals. The structure can really help, and it's good for her not to start feeling isolated and dreading going back to school. There doesn't need to be any pressure to complete work, though. When my daughter was in 8th grade, she left school in February and did not return until the following fall. There was no discussion of needing to make up any work, and she was placed in the same courses (honors level) she would have been in had she not missed any school. It was a non-issue. I'm guessing that would be the case for yours as well, especially since all the other kids are now not attending school in person. You could discuss some "what if"s with the guidance counsellor.
cat338 wrote:
But I know I will do this.

That's all I need to hear to know that you will, indeed, do this.  You will show your d that you are stronger than ED, smarter than ED, and more determined than ED.  You will win, end of.

In general, the less negotiating the better, although I doubt that anyone here can say they didn't do any negotiating at all.  If you give ED an inch, he will take a mile or two - that is the problem.  But sometimes, well, stuff happens.

I agree that school doesn't matter when you are fighting for your d's health.  (And I say that as one of "those moms" who prioritized academics in my previous life.)  It does matter that she is stressed about it.  If she is in pre-algebra at age 12 in the US, she must be at least pretty good at math.  If there comes a time that a gentle tutor could help with a topic, you could give me a call.  A lot of people don't believe a telephone tutor can help with math, but that is incorrect.  I have helped many on the phone with pre-algebra topics, and I would be glad to lend a hand with your d if that might reduce stress.  Do you know if there is a particular topic that is worrying her, or is it a general thing?  Sorry, I don't know Latin so you're on your own there.

I can tell from your post that you are making great progress in figuring out how to beat ED out the door.  Good for you!  Please keep posting. xx

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