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

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cmclaughlin223
Looks like I joined just in time.

So we saw our pediatrician today and to my shock, my son's weight was unchanged from last week. He gets blind weighed in so the doctor discussed this with me. Since he was already "doing so well at a high meal plan" (her words not mine) she thought we could wait one more week before increasing.

On one hand I agree with her-my son has done remarkably well and we have yet to experience too much resistance after the first week. Maybe it is just a blip? On the other hand, his BMI is still 17, and I don't want to waste time.

I've gone over what I've fed him the past few days and I am consistently hitting 3000-3200 (a little less than I thought somedays-back to strict counting). He eats everything, spends 1h+ after meals with me, and is not exercising (thanks to the advice on here I've done several checks the last two nights-thank GOD sound asleep everytime).

I am apprehensive to take the wait-and-see and the ED was so fast and aggressive in dropping his weight I don't want to lose time. I was going to do a modest increase to 3500 just to keep him going. Does this seem reasonable to members? Is that an amount that your child has required in recovery? He is shorter (5'8) and prior to his weight loss had stopped growing around 16 (will be 18 in september so almost 2 years) so I don't think he will be growing more-but maybe I am underestimating how many calories he needs?

Thoughts/advice/opinions appreciated.

Thank you all for keeping me sane and giving me hope.



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mdmama

Short answer: Yes! Feed him more! 500 calories more each day is great; more is even better. I'd aim for 1,000 more calories a day (I know, that sounds crazy).

Long answer: I said YES because you are exactly where we were at the one-week point-- one week after our first meeting with the dietician and ED therapist, that is. (A diagnosis from our pediatrician had preceded this, but we didn't start refeeding in earnest until our first visit with the ED specialists.) We spent that first week doing everything you were doing-- supervising during meals and after meals, plating all food ourselves, insisting D finish every bit of every snack and meal. She was very compliant. We thought we were doing great at 3,000 calories a day!

(She had just turned 12 and was only 4'9", by the way, and was getting as many daily calories as your son who's nearly a foot taller. Caloric needs for weight increase vary greatly child by child; just ask mamabear on this board, whose girl needed 5-6,000 calories a day at age 10.5!)

But one week after THAT, we came back for a weigh-in and check-in at the ED clinic and discovered that D had LOST a pound and that that D's heart rate and B/P were really, really low. Like, scary low. (They had been fairly low the preceding week, unbeknownst to my husband and me, but no one had told us the numbers were concerning; they were hoping for a turnaround after one week of refeeding.  Hmmm.) And within two hours of the meeting at the ED clinic, we were in the ER. My D was admitted and required a six-day stay at the hospital-- nasogastric tube, new feeding protocol, etc.-- before she could be released with a safe heart rate and blood pressure.

In retrospect-- I would have fed her more from the get-go. I would have pulled out all the stops (as I did once we got home from the hospital). Adding calories EVERYWHERE that I could, and then finding even more places to add calories. Is your son having a caloric beverage with EVERY meal and EVERY snack? That alone can easily add 1,000 calories a day. A cup of "milk" for my girl was one quarter half-and-half, and three quarters whole milk. A smoothie was full of oil and heavy cream. Big cups of juice, Naked Juice bottled smoothies with lunch, etc. 

You are doing a great job feeding him; I just don't want you to end up where we did after all of these efforts. 



_______
D diagnosed with AN November 2015 , the week she turned 12. Gaining slowly but steadily, fingers crossed...
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Foodsupport_AUS
Absolutely increase. What could go wrong? More kick back from ED, but to be honest that is likely to happen as his weight goes up any way. Resistance often increases during re-feeding. 
It is normal for there to be a need to increase food intake during re-feeding. Mamabears 10 year old needed 6000 calories per day, so you have a long way to go. If you do increase I think it would be a good idea to add it in small foot print foods, that is calorie dense. It makes it easier to get through. 

You are doing a fabulous job. Keep going. 
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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Torie
cmclaughlin223 wrote:
I am apprehensive to take the wait-and-see 


Right-o! Trust your instincts on that and up the nutrition especially fats. You're his mom, you've fed him his whole life, and if you think he needs more now, he does. I always wished the grocery store had a "high calorie" aisle because it took me FOREVER to look at all the labels on all the various foods, but higher calorie everything makes such a difference (bread, cheese, yogurt, ice cream, etc.). I agree it's best if you can increase the calories without increasing the volume any more than necessary.

You're doing so well. Keep going. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Trytrytry
Yes, I don't understand the wait and see option as the worst that can happen by increasing food is - nothing, hopefully gains. If you wait likely outcome is he will lose more and now you have even more weight to gain on him. Especially a male at his age, they need to eat lots of calories.
I want a realistic dr and team, not someone who says what I want to hear and not a 'touchy feely nice' dr that doesn't have success.
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trusttheprocessUSA
My son needed enough calories to support his body's recovery from starvation AND all of the lost months of growth..and his daily caloric needs. It was 5,000 + per day to gain and grow.  Every day,week after week, year after year for at least 4 years - from 13 - 17y years old. The scale gave me the info I needed. He was blind weighed every 2 weeks. If he didn't gain weight after 4 weeks I upped the calories.

Don't be afraid to feed your boy. Crafting his meals so that he can grow into the man he is genetically meant to be is hard but you can do it and we can help. 
Son diagnosed @ 12.5 yrs old with Severe RAN 2/11. Co-morbids - anxiety, Active restriction for 3 months. He stopped eating completely 2x. He needed immediate, aggressive treatment from a provider who specialized in eating disorders, adolescents and males. We got that at Kartini Clinic. WR since 5/11. 2017 getting ready to graduate slipping lost 8lbs. Fighting our way back.
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mamabear

When to increase?

NOW, TODAY/ THE NEXT MEAL

Your son needs way more calories. a 17 BMI is far too low. Honestly- I would aim to get him up to a BMI of at least 22/23. That means he still needs to gain substantial weight. I say that because the majority of the people that I know who have kids in recovery seem to need to hit that area of BMI to have ED truly defeated. Although your son is 18- and you say he has not grown for a couple of years- that is very likely related to his ED and once his body gets more weight on him, he just may grow. When the body is starving and calories restricted it shuts down all unnecessary operations, like growing. Someone just said their son grew 2 inches at 19 on another thread. 

As stated above- my daughter holds the record here needing 6000 a day for 2.5 years at age 10.5-13.5. She was growing and had to go through full puberty. It was insane the amount of food and specifically fats that were needed for her to keep up. And it worked. SHe has been incredibly stable in a solid recovery for over 2 plus years now. 

Add oil and butter and cream everywhere. To oatmeal, soups, chili, scrambled eggs, pasta.  

I highly encourage you to institute a daily milkshake for your son. My daughter had a large shake every day (like 22 ounce) that was a whole container of Haagan Daz or Ben and Jerrys, a cup of heavy cream, and 1/4 cup of canola oil. Every day. It was I think the only way were able to get in the amount of fats and calories that she needed. You could cut that shake in half and it would still be over 1000 calories and be VERY DO-ABLE. And frankly- they are delicious. 



Persistent, consistent vigilance!
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cmclaughlin223
You're all right! I think the worst that could happen-he gains a little faster-how horrible [wink]

I have to admit I slept very little last night because I spent half the night going through the very high calorie recipe thread. I made the 1000 calorie muffins for breakfast and my son, who eats and says nothing, told me it was his favorite breakfast since re-feeding. Win!!

Thanks all for the support
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trusttheprocessUSA
Win!! Hooray! He's on his way keep going.
Son diagnosed @ 12.5 yrs old with Severe RAN 2/11. Co-morbids - anxiety, Active restriction for 3 months. He stopped eating completely 2x. He needed immediate, aggressive treatment from a provider who specialized in eating disorders, adolescents and males. We got that at Kartini Clinic. WR since 5/11. 2017 getting ready to graduate slipping lost 8lbs. Fighting our way back.
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WTadmin