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

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Tahirua27
Hello - My youngest daughter is 13 and in the early stages of anorexia - it has been building via a whole lot of restrictive, picky practices but is now pretty clear (we have another daughter 3 months earlier in). She lost 6kg or around 15-20% of her body weight very quickly and is around 80% of her expected BMI. She looks incredibly thin and we are feeding on FBT principles - 3 meals and 3 snacks per day - but have been 2-3 weeks now with very little weight increase (we can't start proper supervised FBT for another week as the therapist is away). It is very hard to get enough calories into her to see any weight gain - it was much easier with her sister.

My question is whether I should push for her to be admitted to hospital (as her sister was after complete refusal for 56 hours) to try to get her weight building up again as fast as we possibly can - it is almost impossible to feed the volume of food at home as at hospital. She is not currently medically unstable and does eat about 3/4 of her meals & snacks a day.

I am so worried that she is stuck at this very thin weight and I am seeing her mental challenges get worse and worse. I'm in NZ and not even sure that I will be able to get her into hospital if she is not medically unstable, but I could have a good go!

I'd really appreciate your thoughts and experience.
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Foodsupport_AUS
Every child is different as regards re-feeding. Ultimately what is fed in hospital is what should be fed at home. The main difference will be that in hospital there are other options available such as NG feeding and the nurses doing the feeding are often not emotionally involved with the children. That being said my D only ate in hospital because of the NG tube. 

If your D is not medically stable and you can manage to get some weight gain happening I would not push for hospitalisation. There are some distinct disadvantages, including learning other ED tricks from those in hospital. Ultimately we still need to feed them when they get home, and in NZ like Australia they are never going to stay in hospital till fully weight restored. 

So can you add a high calorie supplement? Can you add extra to her meals? What can you do to make sure she is completing 100% of her meals-which is of course what is expected in hospital. I know you have your work cut out for you with two daughters ill. Can you insist on feeding them together?
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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tina72
"we can't start proper supervised FBT for another week as the therapist is away"

Why? You can start to supervise her meals and make her eat magic plate today. You do not need a therapist for that. The therapist will not sit with her at the table and feed her anyway...

Signs for hospital/ER:
Fainting
Low heart rate
not eaten for more than 24-48 hours (depends on state of underweight)
not drinken for 24 hours
Keep feeding. There is light at the end of the tunnel.
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Mamaroo
Our hospital would not take back my d while she was still medically stable, so we had to get the calories in ourselves (with their super support of course - we had a great team).  Do you know how much calories a day she is having? Some of us had to feed in excess of 6000 calories (that is more than 25 000 kilojoules) a day. A day! That is a lot of calories and I don't even think that is an amount a hospital could manage. If you are getting 3 meals and 3 snacks in a day, you are already doing very well. Now you just need to make every meal and every snack count. At first  you don't even have to change what you give her, just give her the high calorie version. Look for Greek full fat yogurt and mix in flavoured yogurt. Look for the highest calorie bread (or better still make your own). If your d would take supplements, I would add ensure plus as it has twice the amount of calories than the same amount of Up&Go for example. Look for high calorie muesli bars, there is a wide variety (I love Carmen's range). Or you could make your own protein bars. At this stage your d does not need fruit of vegetables, so I would replace fresh fruit with dried fruit or avos.  If you could tell us what she eats, we can give you high calorie alternatives.
D became obsessed with exercise at age 9. 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. She is back to her old happy self and can eat anything put in front of her.
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Tahirua27
Hi Mamaroo - That would be fab if you can give me some high calorie alternatives to what we are already doing! Thanks so much.

Here goes:

Breakfast - We have been avoiding porridge (her former go to) as she gets anxious about quantities and how it is made. We're just doing rice bubbles but I might try my home-made bircher muesli tomorrow and add lots of dried fruit and full-fat yoghurt and a bit of cream. Then we've had 2 x Vogels bread toast with butter and peanut butter and 3 strawberries.

Snack - Fortisip plus One Square Meal bite (small muesli bar)

Lunch - 3 x scrambled eggs with cream; small multigrain roll with butter; 2 strawberries and 3 slices of cucumber; one Toffee Pop; one small glass of milk

Snack - Chocolate banana muffin plus glass of milk OR 2 x One Square Meal Bites OR one Fortisip

Dinner - 2 x crumbed chicken tenders; oven fries, cucumber, carrot sticks, pineapple

Supper - Chocolate muffin OR ice cream and fruit

We are not getting all that eaten every day - today she crashed out and slept after refusing her afternoon tea (there has been a lot of screaming today) - but we are hopeful for dinner and supper 🙂
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tina72
Breakfast: It is normal that they are anxious about recipe and quantities but if you get that you can do a lot with that meal. Try to say your mantra "I know what you need, that is exactly what you need for breakfast and nothing more".
Muesli: you can add cream, nut flour, Benecalorie, agave nectar or honey. Check brands for toast. Another brand or a slightly bigger toast slice can change the number of intake.

Snack: Check the supermarket for another small muesli bar brand with more calories. Sometimes it helps to check another supermarket, too, as they not always have the same brands. A change in brand can give you 50-100 calories extra.

Lunch: Buy 3 different size but same look glasses and change them secretly to the bigger ones. Another idea: Fill bigger glasses only half, that looks smaller size although it can be more than now.

Same for afternoon snack. Bigger glas. Try to introduce a milk shake here. If you can melt a small hagen daz ice cup in the full fat milk it gives you another extra.

Dinner: Serve fries that you fryed in the oil directly. Oven fries have not enough calories. If she sees it fry them before dinner when she does not see it and put them into the oven for some minutes so she sees that they come from oven 😉. Instead of pineapple offer some apple sauce. You can add rapeseed oil in it and agave nectar. Offer vegetarian patties instead of chicken once or twice a week. You can fry them in a lot of oil and then leave them in the pan and all the oil will suck in. Just rewarm them before dinner is served - an extra of about 500 calories for 2 patties.

Supper: Also check supermarkets. Here hagen daz and ben&jerrys are most caloric brands. Can be different in your country. Changing brand can give you also about 100 calories extra.
Keep feeding. There is light at the end of the tunnel.
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debra18
Add chopped nuts into muffins and blend into the milk or milkshakes.
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Foodsupport_AUS
I would add a caloried drink preferably full cream milk at every meal, she can of course have flavoured if she prefers. One of the respected dietitians here Michelle Roberton recommends three generous meals and snacks. She has a great pictorial representation of this, but I am struggling to find it. Dinner contains a dessert, and then there is an evening snack as well. 
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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scaredmom
Here is a high calorie thread that you may find useful:
https://www.aroundthedinnertable.org/post/high-calorie-suggestions-696425?highlight=high+calories&pid=1306398245#gsc.tab=0
Adding in high calories drinks is great! If she does drink juice,grape juice has higher calories per glass (250 ml) of 180 cal vs 11-120 for OJ or apple juice.

Does she eat pasta? If so, add oil to the sauces and make cream sauces with cheese butter and heavy whipping cream.

Whatever she does eat, please do check the grocery store and see the higher cal versions of things like breads, cookies, baked goods, yogurts, muffins, bagels. I have to go to one store to get their bagels and the other store to get their muffins and the third store to find the right bread. We get really adept at navigating brands and calories, places that carry what we need. 

There is another thread by Kali, asking for recipes, please look that up.
Yes to the 3 meals and 3 snacks per day. I aimed for 1000 cal meals and 400-600 cal snacks.  Add cream to the milk, you can add an extra 100 cal per glass and if she has three per day that is an extra 300 cal right there. 
It does take awhile to get used to the new cooking style but then in a few weeks it is just second nature. 
All the best.
XXX
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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scaredmom
Oh for fruit,
The "higher" calorie ones are 
100 cal per serving
  • one cup blueberries
  • one large green apple
  • one large pear
  • one cup pineapple
  • one cup mango
  • one large banana
Other fruits not so much. Usually "green vegges" ie green pepper, celery, and cucumbers green beans, broccoli,  (Peas are good though by the way and have more calories) are just "fillers" and really do not have caloric impact. So I would get rid of those. 

Cook your veggies in butter. Ie carrots, steamed with butter and brown sugar.
Broccoli with butter roasted, Sweet potatoes have more calories than white ones. 
Also increase the volumes a bit ie one more spoonful of rice or potatoes etc to get her used to "bigger" food.

XXX
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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Mamaroo
It looks like you have a high calorie menu, well done. If you want to change breakfast, I can suggest toasted muesli, usually the homebrand muesli has a lot of calories. 

With the leftover rice bubbles you can make the following Krispies:
6 cups of rice bubbles (180g)
1/2 cup nuts, chopped
1/4 cup butter
250g marshmallows
1/2t vanilla (optional)

Mix rice bubbles and nuts together
Melt marshmallows with butter, add vanilla.
Combine wet and dry ingredients and place into greased baking dish.
Place in fridge until set.
Cut into slices.

If the mixture is too dry, add more melted butter. You can add more nuts to increase the calories as well.

I hope dinner and supper go well 😊
D became obsessed with exercise at age 9. 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. She is back to her old happy self and can eat anything put in front of her.
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WTadmin