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

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cnkinnh

D has been on the honor system in regards to finishing her lunch at school, but we are starting to think she needs checking up on. We've been on a cycle of weight dropping over the course of the week, only to have it go up again over the weekend.

She is technically WR, but we are trying to get another few pounds on her. As of this morning, she is only 1lb shy of the new minimum that H and I have set. So we're almost there. But I think we're seeing some extinction burst because the past few days have not been fun.

I had a chat with her late last week and told her that if her weight keeps dropping over the course of the week again this week, we will get the school involved. She has a 504 plan in place, but we have not asked for any actual accommodations from the school yet, other than once or twice they have peeked in at lunchtime and they have always confirmed that they've seen her eating. But they have never been able to confirm whether she's actually finished her lunch.

D admits that she has trouble finishing within the timeframe of her lunch period, but she swears that she is finishing it eventually, even if she has to take it home and finish it after school.

We have no evidence of her ever lying to us about anything over the course of this illness. She certainly skimps and tries to bargain down on portions and food choices, but no outright lies that we're aware of.

So, I am really struggling with what to do. If she is telling us the truth, then it will be a horrible betrayal of trust for us to step in. But I have no illusions of what this illness can do; I know it's entirely possible that she's lying. I'm thinking that if her weight drops again this week, we can give her two choices - both of which she will absolutely hate, but at least she'll have the power to choose: 1) she starts eating lunch with the nurse, or 2) we get her friends involved and have them let us know what/how much she's eating during lunch period.

The friends she eats with do not currently know about her illness and I know she doesn't want them to know.

I think we also need to deal with the timing issue - the fact that she freely admits she's not finishing during lunch period. This came up in a therapy session but her therapist didn't seem concerned. The more I think about it, the more wrong this seems.

15yo D, first diagnosed 2015 with RAN. Diagnosis changed several times along the way, they are currently saying lifelong mild ARFID, complicated by major depression and AN starting age 13. Everything is atypical with her. FBT less and less effective after 2+ years. 
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Psycho_Mom
Hi,

It always seems like it's going to be a "horrible betrayal of trust" , doesn't it?
Sigh, I remember.

What helped my d and I was to do a reframe. This is not about trust. This is about how much support d needs. If your d cannot eat a full lunch during lunch period, then she needs help to do it. I agree that it makes no sense at all to save lunch for later. Lunch is needed at lunchtime. Especially if she's not yet wr. If you don't show by your actions that this is important, then d won't (re)learn it, and will in fact think that blowing off eating everything is OK at other times as well...

Our therapist also really valued getting back to normal eating experiences, such as eating with friends in the lunchroom, and she was right to push for that sometimes, but when full nutrition was at stake, I sometimes had to push back. 

You can go back to full lunch support (I caution against putting her friends in a position to "tell on her"; that can strain a friendship and also get you some inaccurate reporting) and when her weight is good, have her try lunch on her own one day a week, and then go from there....

best wishes,
D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
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skechers
I think your plan about having her eat lunch with the nurse if her weight drops is a good idea. Not so sure the friend reporting is.

Another option someone else once posted on this site that I thought was a great idea was using Facetime with the iphone at lunch. I've never actually used it myself as I don't have an iphone, but if you and d both have one you could Facetime during lunch to see that she is eating.
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Psycho_Mom
Hi again,
Yeah, that was me I think. D and I facetimed for snack at school. It was just a measly tiny bar, but she coulnd't eat it consistently at school because "no one else had snacks." Whereas, everyone ate lunch at school, so that wasn't a problem. Ed is irrational. 

Anyway, it sounds like your d is not prone to hiding food or slipping it into pockets or other sneaky behavior, so this might work. (You don't really get a good view of what's happening on the little phone video). Our d ate in the counselor's office when facetiming. I have to say, she hated doing this. "No one else facetimes with their mother." This was of course true and a valid point, but.....

I told her if she didn't facetime me I'd come to school in person and eat with her, so that was her motivation.


D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
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cnkinnh
I knew people here would be helpful, thank you so much!

So - instead of accusing her of lying or getting into anything ugly like that, we can work with what she's already telling us (that she's not finishing lunch during lunch period) and go from there. I'm thinking that first we need to simply insist that lunch needs to be finished during lunch period. (I need to double check how long that actually is - I know it's not that long, maybe 25 minutes?) If that's going to be an issue, we will enlist the nurse for support, or look into Facetime or some sort of contact via electronic means.

When we spoke with the school earlier in the year, they hinted at some reluctance of having her eat with the nurse - I think they were basically saying that the nurse doesn't have any real power to ensure that D actually shows up or finishes eating, all she can do is supervise and tell us what she sees. But my D is pretty compliant so that might be enough.

Or we might investigate the Facetime option. I do not have a smartphone, nor does D, but H does and certainly the school should have some way for them to talk or Skype or do something. Even just a phone call might be enough, coupled with the threat of Mom or Dad coming to school if electronic contact doesn't work.

Thank you so much.
15yo D, first diagnosed 2015 with RAN. Diagnosis changed several times along the way, they are currently saying lifelong mild ARFID, complicated by major depression and AN starting age 13. Everything is atypical with her. FBT less and less effective after 2+ years. 
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Psycho_Mom
Hi,

No, the nurse can't make d finish lunch. What usually happens tho is that the nurse reports to you. She could just send an email or text you after lunch. And if you don't like the report, then you come immediately to school and have lunch with d (if that's possible), or d needs to have lunch with you the next day, or some other escalation of support. D therefore knows that unless nurse sees her eating everything, without fuss, there will be a consequence. 

School lunches can be unreasonably short. If this is the case, d should be able to arrive late back to class. You may have to talk to the teacher and let her know that if d is late, it is for a health reason. You might make an arrangement, like d checks in with the teacher after class if she missed something, but there should be no penalty for missing class for a health reason. Lunch is more important than class.
D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
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anotherbite_CAN
There is a wonderful older thread on 'lying'. The whole thread is a great read but this bit by Laura Collins is  gold: 

"So much wisdom on this thread. 

We all have a point at which we would be dishonest: a gun to our head, to save the life of a child, to protect innocent people. Our children are subjected to such incredible pressure and confusion and fear in their own heads - mostly invisible to us - that they are driven to behaviors and thoughts that would challenge the most moral and brave among us. 

The day I realized "this is not a moral issue" was a big step in our household. Up until then I had measured not only my daughter's morality but my own parenting by the fragile thread of "complete trust." When I realized how ED used that to hurt both my daughter and my own credibility I became a better parent. *MY* parental job was to remain honest and trustworthy to the best of my ability, but not to expect it of others. It was also my job to see that breaches of honesty were a sign of the extremity to which ED and anxiety pushed my child.

We let our daughter down when we used "trust" as a bargaining chip. The kindest thing we did was to forgive everything unconditionally and to make it our job to leave no opportunity to betray trust - until she was ready for that."

Thread link:
http://www.aroundthedinnertable.org/post/lying-3614036?highlight=lying&pid=34855934#gsc.tab=0
D dx at 10 years old in June 2011. She is now 16 and happy and healthy.  We were IP for 8 weeks and then refed at home for what felt like forever.  We chased vertical growth for years...as is typical for the age.
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Colleen
Hi cnkinnh,

We used the school nurse when my d was ill.  She had a private office where my d couldn't be gawked at which was nice.  I would text the nurse the contents of d's lunch bag every day, right down to the number of slices of cheese on her sandwich (cheese had a way of getting dumped).  It might help to staple her lunch bag shut--wish I'd thought of that.  Anyway, the nurse would email or text me if d couldn't finish, and d knew that.   D actually ate very compliantly in the nurse's office and they had nice chats over their meal, none of which my d remembers.  I think d was afraid to act out in front of a teacher or nurse.  Also, she knew that Plan B (if she were unable to eat with the nurse) was me coming to school to eat with her in the parking lot.  She was (let's say) not in favor of that option.

I love our school nurse and sing her praises for helping us so much!!  She was an angel of mercy when we needed one.

I love the attitude that you aren't punishing her for not eating and you're not putting her into a situation where she has to lie.  It's just a matter-of-fact acknowledgment that she needs more support to get finished, and that lunch (and all eating) is really important.
Colleen in the great Pacific Northwest, USA

"What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease."
Alexander Pope, 1688-1744
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Juno
I'm sorry that lunch is going well Cnkinnh.  I'll give you a bit of our story in case it is helpful.

For the first part of this school year, I discreetly entered a side room in the school and my d met me there for lunch every day.  It was tedious on my part and potentially embarrassing on hers but we made it through.  Before we began letting her eat lunch with her friends, we did pare down lunch and add more to the afternoon snack.  If she does not finish lunch, she eats what is left at the same time as her full afternoon snack.  Her most common lunch is a peanut butter sandwich (about 450 cal) and a fruit but we do try to mix it up when possible. 

We do not have a 504 plan yet but I did need to ask her counselor to send a note to her teachers to clarify that her lunch time is for lunch only.  She's in 8th grade and often teachers will ask students to stay late for extra directions, help, make-up work, etc.  She is not yet able to advocate for herself so she either got to lunch late or was mysteriously blowing teachers' requests off with no explanation.  The intervention by her counselor seems to have helped things.

Hope this helps some and that you find a way to increase your d's supervision in a way that works for both of you while you get through this period.
Mom of a younger outpatient
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