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

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Scaredmom2019
So my D is almost 18 and has done great putting weight back on from RAN. 

We never could follow the 3 meal, 3 snack routine.
1. AM snack was always left for her to do on her own. She probably eats 50% of the time and is always honest and tells me if she did or didnt.
2. Breakfast has ALWAYS been a challenge since like age 4. Shes just not hungry in the morning - I think this has always been related to school anxiety but has never changed. "Breakfast" these days looks like a large nutrition drink (about 300 calories).

I'm starting to worry that because we don't, never have, had strict supervision on the AM snack and have been lenient on the breakfast that we havent followed the FBT plan closely enough to achieve long term success? 
We have put on great weight on the plan above and I'm not going to change it BUT we never have been able, due to work etc, to supervise everything. 

Since we have made great gains and we will continue on with same plan...do you think it's "ok" that we havent ever done the 3 and 3 plan? I'm obsessing and anxious about this as we step down from ED intensive day programming.
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Scaredmom2019
I didn't even get to my question!! Ugh!! 
I dont need her to keep gaining at the rate she has. I think we are getting to a point of leveling off a bit... I'd like to see more buffer on weight so will keep heavier feeding for a while but at what point can I back down a little on "every bite", hiding fats in things etc...
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Foodsupport_AUS
Great job on getting the weight up the way you have. I don't think it is necessary to use three meals and three snacks for recovery, but regular meals are important and many people seem to get more irritable and mood changes without regular meals. 

As for how to wind things back, many kids need increased calories for sometime after weight restoration, often six months or more. I would still be insisting on every bite for some time but if you were going to wind back would do so with the 'hidden' calories. She won't therefore know that it is happening but her weight gain could then slow a little. Many kids do naturally slow in gain once they get close to where they need to be, so if you are doing that I would do it really slowly. 
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.
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Scaredmom2019
Great advice. I'm so scared taking her out of PHP but I think we've gotten what we can from there.
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Torie
Scaredmom, do you have a guess where your d will be next fall?  If the hope is to go away to university, this is a good time to start thinking about that transition and discussing with her what is required for that.  If she will be staying home with you next fall, that can wait.

I agree with Foodsupport that diminishing the fortification (slowly) is a good place to start.  As she starts taking more responsibility for her nutrition, it will be less confusing without that complication.

So impressed with the Scaredmom team!  Wow! xx

-Torie 
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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ValentinaGermania
In my experience stepping down from the program and working on fear food and very slowly more freedom with meals and snacks often goes with weight loss and very rare with weight gain. So I think it is best to keep the routine and the same food intake for a long time until you see that she can do that alone.
And they often have a very high metabolism in recovery. My d is in year 3 now and still needs to eat the same as hubby just to maintain her weight...so no adjusting of intake possible here up to now (nearly 3 years after diagnose).
Keep feeding. There is light at the end of the tunnel.
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teecee

I agree that handing over more control may result in bigger fluctuations (usually loss) and as a result I always insist on her eating a substantial evening meal with us wherever possible and she always has a supper with us too. She’s nearly18 so we’ve taken the view that allowing independence was important to give her a chance at fulfilling her dream of going to university. She’s had to learn what it is to look after herself but as you can expect that has come with some setbacks but not as bad as I thought to be fair.

she supervises her breakfast and lunch. She generally has porridge with fruit and yogurt in the morning and a sandwich at lunch. I have gently encouraged more at lunch but she struggled to have more than a sandwich. This changed recently and she started to introduce extra at lunch which seemed a huge deal for her but she managed it. She overcomes little hurdles in her own time slowly but surely. We are patient and are happy to do it this way as long as we keep seeing progress, which we are.  

We never sneaked things in to meals but after refeeding cooked whole foods as I had always done prior to ED. I tend to cook on the hob with butter and olive oil (as I’ve always done) so I’ve just continued to do that. 

You have to do with what works for your family and before ED you were able to feed your child well so have faith in your abilities. 😊

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Aggie

We are a bit more lenient with things like eating out with friends because I truly believe that that has been a big part of recovery. Our D is so much more sociable now and I’m willing to take the risk that she won’t eat everything, overloading the following day -   You so obviously have this, you have gained though you haven’t followed the 3/3 meal snack so if it’s working for you don’t stress it. We don’t follow it strictly, no am snack (as she’s in school and was throwing it away). My d has am snack at 3.30, afternoon snack at 8pm! but we’re doing fine and still moving in the right direction. 

Just to say if you are worried about not having support in place, we lost ours six weeks ago after three and a half years, best thing ever happened to us. This is us working through it without her stressing about appointments and it has made the world of difference xx

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MKR
Hi @Scaredmom2019,

You have done great with your rhythm of meals/ snacks.  I guess there is not much point in rocking the boat that seems to be sailing so smoothly. 

You are not the only family who have work obligations so have to trust that something is eaten during school and rely on meals at home to bring progress. 

I guess if things slide at first in any way, you can then insist on 3-hourly snacks, to keep the blood sugar steady.

Also when she starts Uni one day, you can expect her to be hungrier in the first weeks (or at least requiring more), purely from the exertion of finding her way around and meeting new faces: a lot to remember at once.

You have a keen eye for your daughter's state of health. So keep watching her!
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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Scaredmom2019
Grateful for your words of support and what to look out for as well! Noted for sure!!
I feel the same - the PHP and constant food intake has been great but I think we're ready to break free of that or step down. 
I mean tonight she had a half a sandwich and soup (900 calories) for dinner- we were out and that was her own selection. Would  I have preferred a full sandwich? Yes, sure. But then she would have felt sickly and over full and possibly even got sick...so we will make sure to get a PM snack in and carry on. She is WR so I'm letting her eat (with supervision) what a normal kid her age might eat. Fingers crossed and im watching like a hawk!
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