Support thread 11 for parents of young people with an eating disorder

[GrannyRoberts]

Hi all, here is our new thread. I will attempt to post a link on thread 10.

@GrannyRoberts The sinking ship analogy is really helpful actually, I know I’ll be thinking about that.

Thank you to everyone who has said hi to me and offered support. I’m slightly more positive tonight and am regaining some strength. It’s a bloody horrible thing to be battling.

Can anyone share a meal plan?

I spoke to someone yesterday who said she can help with a meal plan -

consultation is around 45 mins which costs £165 for a personalised nutrition plan.

It will be going on the credit card so as much as I don't want to help her is this necessary?

I just feel I'm struggling with getting calories in but she is doing 3 meals 3 snacks but it's a battle for her to even eat and I'm constantly checking packets for size etc

Thank you

I also found a counsellor online who charges £180 for the first session then £85 after
She is the one who gave me the details for the meal plan lady

@summertimesadness24 with mealplans we do 3 meals, 3 snacks. Each meal to be a minimum of 500 calories (but usually much more) and snacks at least 300 calories. The hospital aimed for 2,500 calories per day but gain was slow on that. I haven't really calculated but would guess we get about 3000-3500 in each day. They are all different though in terms of what they need so it's really a case of adjusting until they are gaining at least 500g per week..easier said than done but that's the theory we're working to. The problem I find with prescriptive mealplans is they aren't necessarily realistic in the context of family life. E.g. one day we might have a fish stew with bread, which is maybe slightly lower in calories, so then the next day it will be macaroni cheese or lasagne. I make cheese toasties for lunch that I calculate to be over 700 kcal for a single (2 slices) toastie. Add in a glass of OJ, a yoghurt etc and you're up to 1000. Small but mighty!

I don't think I really answered your question there. I guess what I'm saying is we don't have an actual mealplan. Although the snack options are mostly ones that were established in hospital (e.g 2 bags of mini cheddars and a glass of milk / a 200kcal Cereal bar (e.g. nature valley) and a glass of milk / 2 bags yoghurt raisins and a big glass of OJ). Nothing served out of the packet- decant everything into glasses, bowls etc, ideally not always the same glass/bowl.

I'm doing something very wrong if I'm only getting to around 1,100 calories a day ?
I have an app and it's on average 1,100 a day
I think I'll sort this out before going on a meal plan that's what I'm thinking

So for us a typical day might be:
8am large bowl of cereal, 200ml whole milk with added cream, large glass OJ (I'd like breakfast to be bigger but this was what she had in hospital and she refuses more)
10.30 snack - 2 bags yoghurt raisins (200 kcal), large glass OJ
12.30 - cheese toastie made with a ton of butter (thickly spread onto the outside of both slices then fried), buttered peas, bowl of fruit, large OJ. Or might be chicken nuggets and chips, or pasta with sauce and extra olive oil..etc
3.30 2 bags mini cheddars/nature valley cereal bar, large glass milk with added cream
6 - family dinner e.g. macaroni cheese, salmon with buttered noodles, chilli with buttered rice. Side salad with oil dressing, or buttered veg. Pot of thick and creamy yoghurt. Large glass OJ
8.30 2 slices toast and butter, large glass milk with added cream.

You're not doing anything wrong @summertimesadness24, it's so so hard. But my experience is that 1,100 is likely to fall below what's needed. It depends on your situation but if you're struggling to increase calories, would a mealplan imposed by an "expert" have a bit more clout in terms of being able to say with confidence "this is what you need". One problem with mealplans that I, and @Curlyhairedassasin have certainly found is that for rigid thinkers they may not ever be able to deviate from it, and if the plan is set too low that can be problematic in itself. I've got round that by adding fats where I can, but we're frustratingly stuck with the snack options and timings.

I may try give it a go by myself - I'm not sure if like the set rigit parts but I do need to increase so I'll take some of your advice thank you.

Hey @summertimesadness24 you can definitely create your own meal plan, that's what we did with advice from this group. My approach has been to give my dd meals and snacks that are as calorie dense as possible, while being small in size and easy to eat. Some of the things I read basically said that they are going to struggle to start eating more, so it's as painful if you give a 100cal meal as it would be with a 900cal one, so I just decided to go hell for leather and try and get her back to a reasonable weight asap. So here is what a typical day might look like:

Breakfast - porridge made with 100ml double cream, heaped teaspoon of cashew nut butter, 55g oats, splash of milk if needed, heaped teaspoon of salted caramel sauce +Glass of juice.

Or - Greek yogurt with 80g double cream whisked in, 50g highest calorie granola I can find, handful of fruit, glass of juice.

Morning snack - Quaker porridge bar (this is one of the highest calorie pre packed bars) and glass of milk with cream added

Lunch - she often has a 'poke bowl' with salmon from the supermarket, today she is having beans and sausages with buttered toast.

afternoon snack - i make a smoothie with a mini carton of haagen dazs (about 250 cals) + 110g double cream (500ish cals) + teaspoon sunflower oil + small bit of fruit+ splash of milk if needed. this comes to more than 800 cals and is a very small glass that is quick to drink

dinner - family meal like curry & rice + naan, pasta and sausages + garlic bread, chilli etc. i use lots more oil to cook than i would have in the past, and anything pre made like sausages or pasta sauce I choose the highest calorie ones.

Evening snack - tends to be pudding so could be another small tub of haagen dazs (has many more calories and fat than other brands of icecream).

You can easily tailor it to what your dd would usually eat.

The other thing to say about counselling is that it's generally thought that until their weight is restored, and their brain has been able to recover from the effects of starvation / not enough nutrition, that their brains can't do therapy, so it's best saved for later on in the process. Not believing they're is a problem is a diagnostic feature of having anorexia...

@greydoor love these ideas! Thank you I shall definitely give this a go!

Thank you also to PP for the meal ideas

It sounds brilliant - love it the smoothie idea
Do you make it with a blender ?
I definitely need to get some of these ingredients in so I can start making some higher calorie things for her

I like your idea - if it's that high in calories it will make me feel better

So she's skipping lunches at school - how do I get round this?

@summertimesadness24 currently I have to go to school every lunchtime and sit with DD in a side room while she eats. I'm fortunate that I wfh and only live 5 mins away so for me that is just about manageable. I think others have been able to organise the school "keeping an eye" and reporting back but if you already know she's skipping lunch then that might be pointless.

Ah good I'm glad it's helpful. I've got a smoothie maker that I use for the afternoon shake, but you could do in a blender too. I microwave the icecream for 30 seconds first so it's more liquidy and easy to just drink... You can definitely make a meal plan that works, and although the teams often tell you not to count calories, I do so I know when I weigh her (blind) whether I need to add in anything the next week, or whether we can carry on doing the same thing.

Difficult one about school lunch - my dd was off for a while, then only back in the morning, and has just gone back to full days but I collect her and give her lunch at home, then take her back for the afternoon. It's very stressful... my dd isn't able to eat unsupervised, and even supervised she can be quite sneaky about hiding or discarding food. I just assume whatever she is supposed to have had away from the house that she hadn't had it, and I build in those calories elsewhere.

I don't ever let her see me making her food, that's one important thing...

I'm going to invest in a smoother maker as it will encourage me to use it for fruit and veg and be healthier - ironically I need to lose a stone but I obviously won't be telling her this - just being mindful more than ever about food

I've made a list for the supermarket and I'm going to up it drastically
She doesn't eat lunch at school so I've tried to make up for it at home but I am thinking of keeping her off school if things don't improve
She's now refusing food altogether so the 45 min timer suggested from the clinic didn't work so now we are doing eat until your finished
The first night she eat in 20 mins ( best yet ) even though we said there's no timer and then last night was 1hr 45 - but she did finish and has pudding
Tonight it's jackets cheese and beans which she loves so I'm hoping that will be ok but we are being consistent with not leaving table until finishing

Gosh those meal plans are a lot and actually quite pertinent to me and DD.

She's on a "restorative meal plan" and it's pretty low intake still. She managed all of it yesterday for the first time (as the imminent hospital idea looms large in her mind) and was talking about what our Care Coordinator was saying about it being half of what she was meant to be eating. She said "surely I can't be expected to eat six meals and six snacks?!" and I said a non-committal noise. But actually looking at your meal plan @greydoor sneaking in double cream and ice creams is genius. Although I don't like to use the word sneaking. But you know what I mean.

@SicilianOrange I think of it as "supplementing" rather than sneaking, basically trying to get as many calories and fats into as small a package as possible. I add fats at every opportunity and often shove in an extra glug of double cream or an extra knob of butter as an "up yours" to the ED on days when it's particularly vociferous. I know what you mean about it seeming like a lot of food, at the start of all this a neighbour whose dd was diagnosed a year ahead of mine, shared her mealplan and i couldn't image getting mine to eat that much, but we did get there (for us it took 4 months in a psych ward but many other amazing warriors on this thread have got there without that level of intervention).

It's kind of funny as I know I would try putting courgette or cauliflower into things back when my children were toddlers. but I never needed to with DD, she would try everything. Right up to maybe two years ago.

But a way she IS like she was when she was a toddler is when the ED has a tight grip and she's been asked to eat dinner and she goes rigid like when I'd need to put her in her pushchair. And then there's the smoothie throwing which was very similar to when she was poorly and would knock the calpol out of my hand.

I think about things like that a lot these days, the way she was when she was little and the way adolescence has changed her. I really want her back.

I know what you mean about sneaking food in and it feeling a bit funny. It's not the kind of parenting many of us are used to, but it's kind of necessary. I think of it similar to granny that I'm fighting something, and my weapon is fat and calories. I feel justified because there is science behind this about what brains need to recover. When one of my other kids was small they had frequent tonsillitis and had to have a really grim antibiotic, and so we did a 'jelly baby sandwich' (jelly baby in first to make the mouth taste nice, then antibiotic in and quickly swallowed, then another jelly baby). I sort of think of sneaking calories in the same kind of way - make as many calories as possible as easy as possible for her to get in - I can use my skills in the kitchen to make that one a bit easier by fortifying what she has.

@SicilianOrange - I really am with you on wanting my dd back. I think parenting a teen with ed is very very like having a toddler again, in the fact that you have to be on duty and alert the whole time, and you find yourself having mind boggling total nonsense conversations with them ("no dd, you don't have a tummy that looks 9 months pregnant at 85% wfh" "why are there prawns in the washing machine?" ...). It's really upsetting to see them like this too, and that takes its toll.

I'm just perpetually knackered at the moment. My dd is really up and down - we are seeing glimpses of her at times, and that makes me hope we are turning a corner, and then there are absolutely awful days and I feel like we will never be rid of this awfulness. It was really good to hear from folks who have recovered as adults - thank you @EDx and @Girliefriendlikespuppies for sharing. I want my dd to live a life free of this hanging over her, and I'll fight for it.

@summertimesadness24 i thought might also be useful to share my DD eating plan (this is for weight restoration and she’s 173cm so will depend on the child).
breakfast: porridge with barista oat milk (she won’t eat dairy) plus glass of OJ and 2 vegan croissants.
morning snack: eat Natural bar (they’re vegan and high cal) plus if at home glass of juice.
lunch: our plan is a 5 piece lunch eg sandwich (always vegan cheese and vegan ham she won’t eat anything else yet), packed of crisps, juice, piece of fruit and chocolate (vegan obviously - so usually coconut collab choco pot)
afternoon snack: hot cross bun and hot chocolate (this is the hardest snack oddly)
dinner - family dinner plus desert usually the Gu pots. We stir olive oil through anything we serve to DD in the kitchen before taking to the table (which she doesn’t know).
evening snack: nuts.
Also we’ve never yet hit 500g weight gain in a week despite this, but our trend line is upwards, so for now I’ll take that.

Private therapy. We’ve been really lucky I think with our CAMHS provision, we have weekly FBT and I also have a weekly parent course to guide with how to support DD (very EVA Musby focused) We asked our FBT lady about supplementing with private therapy and they said not to as you end up with mixed messages (eg when to start fear food etc) also that initially it is all about weight restoration not therapy, certain our FBT sessions at the moment are weight and Obs plus discussion of what has been hard etc and any wins and reminding DD and us that we’re the ones who determine what she eats but at some point once weight restored we’ll gradually pass control back to her. Also intro of fear foods and making lists so we can tackle. Not sure if this is helpful but like lots of parents we considered throwing money at the problem (or money onto credit card) as we just desperately wanted her to get better quicker. We were told the programme CAMHS follow here is; weekly FBT until weight restored then 10-20 sessions of ‘therapy’ looking at body image/ other counselling roughly fortnightly then finally 5 sessions of relap prevention. We’re on their ‘acute’ pathway, I know they also have a less intensive pathway.
sorry longest message in the world but hopefully some of it is useful.

Summertime** I would urge against a private nutritionist, you know exactly what your dd likes and needs. The perfect diet for your dd now is the one with the highest calorie and fat intake possible and unless the nutritionist has experience with treating anorexia I suspect it will lack the calories and fats your dd needs.

Therapy at this stage is completely pointless so save your money.

At the refeeding stage I aimed for 3000 - 3500 calories. I managed this by adding double cream and butter to everything my dd ate, an example of her meal plan was;

Breakfast porridge made with double cream and a smoothie (approx 800 cals)

Snack piece of cake 300cals

Lunch large tuna Mayo baguette with crisps or scrambled eggs (with double cream) and thick sliced buttered toast or soup (homemade with lots of cream) and thick buttered toast etc 700 cals

Snack cereal bar 200 cals

Dinner any normal dinner but I added in things like garlic bread, cream and butter where I could. Aimed for 1000 calories.

Snack pudding ice cream or tiramisu or sponge pudding and cream 500 cals

Drink milk 100 cals ish

If your dd likes smoothies these can easily be made to 800 calories using fruit, ice cream and double cream.

Notallgood I hate to say it but I think you'll struggle with no animal fats, was your dd vegan pre ED? I'd really push back against that as the animal fats have been shown to really help the brain recovery.

I used to add another glug of double cream if dd had been particularly vile as a big fuck you to the ED as well 🙈😂

Fwiw my dd has had no therapy, all she's had is the above meal plan and time. Although we're not completely back to normal (some small behaviours remain) she is an otherwise very typical teen now, enjoys college, is learning to drive, has a PT job etc. She is independent with breakfast and lunch and tonight made dinner for the both of us! Ystd she said 'I'm still hungry mum' after dinner and got herself a crème egg 👏🏻

Getting the food in and the weight up does work and for a lot of teens is all they need.

@Girliefriendlikespuppies she has been pescatarian (fish eating veggie) for years, massively regret ever agreeing to that. Only dropped dairy earlier this year, and we’ve discussed at FBT we think it is ED related, DD doesn’t agree. FBT want us to try cheeses which are low lactose (as part
of fear foods) as DD says she is lactose intolerant, so clinic have said there are low lactose options she should try, but we’ve not got to those yet. Apparently it is dealing with a fear food through ‘chain - approach’ eg we prove to her she can eat low lactose, then gradually reintroduce dairy, as it is one of her bigger fear foods. There had been liberal use of olive oil into food but would love to be able add cream, but a little bit of me wonders if perhaps she does get stomach ache from diary, but mainly I think it is the bloody ED.

Notallgood it will 100% be the ED, personally I'd be too impatient to do the staggered approach and I'd just say this is what you need.

Can you stop buying the vegan bars/versions of other foods? I'm assuming she eats eggs?

Id also be sorely tempted to start adding dairy to foods to see if she does suddenly get a stomach ache.

Did she ever have any signs of being lactose intolerant pre ED?

It's another way to conveniently restrict the exact foods she needs to recover and the ED knows it.

Hello battlers it's been a while. I am still reading along and wishing well for your young people. We are now 7 months into my DDs treatment. Sadly the early days of toddler like mood and dependence are still a v v painful memory but I do want to let those of you at the v beginning that the unbelievable can happen and you can start to recognize your child again. My DD has now been back at school for a term and a half and is eating something other than chicken wraps every single day. She still has high anxiety which means still more input/support around managing meals but we have experienced things we never expected to...choosing a Birthday cake, having a holiday abroad again.
It is another stage to navigate when weight has been restored and to outside eyes all seems well. We still have days in hell but I think the relationship is repairing after the unbelievably gruelling first 4/5 months. I found it difficult to believe things would ever shift, I hope you can hang in there if you are in those early days, the uncertainty is terrifying.

@NotAllGood My DD also claimed to be lactose intolerant and did have symptoms - diarrhoea etc. when she had dairy in hospital. But I discovered that anorexia can actually CAUSE lactose intolerance. If she didn't have it prior to the ED, it should clear up if you persist (unless doc advises otherwise ofc).