DD14 not eating. What now?

[sammyspoon]

We've only just started picking up on the signs. She's always been such a great eater. Started with noticing her lunch wasn't being eaten. Then she stopped eating breakfast. Then said she couldn't eat lunch at school because of the canteen atmosphere. She was still snacking after school and eating dinner but that's all changed over the last 6 weeks. She’s struggling to eat anything at all. I realise now there are plenty of other signs. She looks terrible.
It came to a head last night and she admitted she needs help. I already have a GP appointment for her on Monday but should I do something sooner? I feel so guilty and out of my depth.

Hey sorry you're going through this. I would try and get an appointment today. Have you got the online booking system at your practice? If so use that to save being in a queue.

Please try not to feel guilty. Its not your fault. We had a similar experience, different issues but the feeling of guilt was horrendous. I get why you're feeling guilty but it really isn't your fault.

When you say that she’s struggling to eat anything at all, do you mean she is eating almost nothing or very little? If so, you should take her to ED rather than wait for the GP on Monday. You can still see the GP on Monday but she very likely needs urgent observations before then.

Do you mean A&E? Really? Would they see her?

Sorry I didn't answer your question. She's having a yakult thing in the morning, takes some chopped up peppers, cucumber in to school. Has a few mouthfuls of dinner. I try to make it really healthy with veg and protein like a chicken stir fry. She completely refuses carbs like rice and pasta.

My 17yo dd struggles with eating, it wasn't full blown anorexia but nearly so, back when she was 12/13/14. It was very scary, she was self harming in other ways too. I took the approach of being very, very calm about it, and focused on what she could manage rather than what she couldn't. She could still drink, so to keep her hydrated and her stomach full, I bought her a variety of teas, soft drinks, cordials, coconut water, etc, and some new cups, water bottles, etc. She also learned some self care activities that helped her learn the importance of looking after herself- at the time she could only manage to wash her face and clean her teeth every day, she was very, very low.

During lockdown she started experimenting with baking, so she would try new recipes a lot (not necessarily eating the cakes, but sometimes).

I made the choice to refuse to battle her over eating, and told her as long as she was staying hydrated I didn't have a problem- the human body can survive a long time on little food, but not water. So it wasn't an emergency as far as I was concerned. (Of course I was constantly worried, I just stayed calm with her)

I did my best to keep lines of communication open, and she would tell me when she was eating less or self harming more, and we would discuss what we could do to help her feel better or what her triggers might have been. School was a huge trigger for her, and I ended up home educating her for a year and a half, including lockdown time.

She's much much healthier now. She's got a job, she's in college, and her eating habits are better. She still can't eat if she's anxious about something, but sometimes a glass of water is all it takes to get her back on track. When GCSEs were on the horizon, we talked about how she would spot the signs of slipping back into old habits and how we could help if she did, but she managed really well in the end.

There were times I felt like I was taking a huge gamble with this approach, and I felt scared a lot. But I forced myself to trust her and she told me more and more what she was going through, as well as therapy. That calm trust built up between us and she found a way through it.

This is so hard op. Don't beat yourself up. Hold your dd close and tell her through your words and actions that you are on her side every time.

Im not sure about a and e. A very long wait and potentially unsympathetic response might feed the whole guilt/ shame/ fear cycle. I would keep an eye on her fluid intake though and try and get a more urgent gp appointment.
How about calling Beat or similar for some advice?
https://www.beateatingdisorders.org.uk/

I'm trying this. Thanks

No problem. Hope it goes well. The fact that she is wanting to engage in help is positive.
GP / clinician will probably want to weigh your dd, take bloods and possibly do an ecg.
This is so that support can be clinically triaged.

MH nurse here. If she’s eating less than 500 calories a day, and has been for a few days, then you need to take her to A&E. Very low calorie intakes can cause electrolytes (sodium, potassium, magnesium etc) to go out of whack. This is extremely dangerous as electrolytes are needed for proper heart functioning, amongst other things. It sounds like she needs bloods and an ecg sooner rather than later. I don’t want to scare you too much, but eating disorders have the potential to make someone very sick very quickly and she may be iller than either of you realise.

She’s not recently started ADHD meds has she? Sounds left field but methylphenidate and others can significantly reduce appetite.
I had a similar issue with DD3 around 2 years ago. I couldn’t get a GP appt so took her to the practice nurse. She did her height & weight (no HR, BP, bloods or ECG done at that stage but should have been apparently), but referred DD to an Eating Disorder clinic and we were seen the following day! We were there a couple of hours. Chatting to DD and I together, her on her own, me on my own. Height, weight, and other obs. She was very low weight. She was keen to eat but not hungry so couldn’t manage much. She had bloods and ECG done & had to have 2 weeks off School and eat bfast, snack, lunch with pud, snack, dinner with pud, snack! It was a lot and she didn’t manage half of it. I had to sit with her and ensure she ate it. Hard work. Because she was off school anyway we decided to stop the methylphenidate to see if that made a difference. It did. Her appetite improved and she gained a decent amount of weight. After the 2 weeks the ED clinic saw her again - another few interviews and probing questions. They put it down to the methylphenidate & discharged her, with a caveat to keep up the high cal intake. She’s changed her meds now. Her appetite isn’t great and I still add cream and butter to everything as she’s very skinny and still underweight. But she eats what others would call unhealthy - pizza, pasta, pastries, risotto, donuts, an awful lot of chocolate and if a menu has the calories on she chooses a high one, so not the actions of an anorexic. Just a kid with a very small appetite. Despite all the junk she’s still underweight!
Don’t let the GP fob you off. Demand a referral to the ED clinic regardless of her weight as this needs rectifying now! I don’t think it’ll get better in its own.

@sammyspoon my DD was having more than 500 cals a day as although skipping lunch she was having a small bfast & a very late dinner.
@JennieTheZebra if she goes to A&E does she need to know the protocol? It sounds like marzipan or something? Our local A&E is shocking and has turned my friend’s DD away when she’s been in crisis and not eaten for days. She has anorexia and has done for several years. So she takes this ‘marzipan’ protocol print out with her.

@NotDonna MARSIPAN (Management of really sick patients with anorexia nervosa) has been replaced by MEED (medical emergencies in eating disorders) but in practice it’s pretty much the same. You’re right that a checklist/protocol can be helpful. This is the new MEED protocol https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr233---annexe-1.pdf?sfvrsn=1ba7e785_18

@sammyspoon this was my daughter last year. Started stopping eating breakfast, then lunch and eventually lost enough weight for it to be a worry and for me to get help. I self referred to CAMHS in December and she’s now doing 3 meals and 3 snacks a day. It’s not been easy but she is gaining weight and is physically better than she was but we still have a long way to go. Eating disorders are tough on everyone but if you’re worried act now as I wish I had sooner.

Just had a discussion with her and she's lost 5 kg in about 8 weeks. She's agreed to go to A&E in the morning.

That’s good she’s being open with you and recognising something isn’t right. Sounds like you’ve caught it early which is positive too. Hope it goes ok tomorrow.

Wow @colourfulcrochet, as someone who suffered the same types of issues as your daughter through my teens and early twenties, you sound like an absolutely wonderful mother. Well done for holding space for her in this way, she’s a lucky girl to have you.

Not to dismiss @colourfulcrochet, who does indeed sound like they did an amazing job, but you do have to be careful with the “the human body can survive without food” thing. Anyone eating less than 500 calories a day for more than a few days is at risk of acute heart failure, amongst other things, due to electrolyte imbalance. Severe calorie restriction is in of itself a medical emergency due to this. That’s why eating disorders are so dangerous-it’s not just a MH crisis but a physical one too. I’m glad that OPs daughter has agreed to go to A&E, I was a bit worried.

I don't think my dd was at crisis levels with her calorie intake, but I hear what you're saying and defer to medical professionals of course.

And thank you @Ecstaticmotion I hope you are out the other side of it now. 💐

Oh I’m so pleased she’s going to A&E tomorrow. Huge well done!

No advice but sending love and good luck.

Just got home. A&E were great. They did all the checks on her. She's ok for now and they referred her to the ED clinic. Just hope we hear from them soon.

Oh I’m so pleased! I’m sure the ED clinic will see her quickly. They’ll be very keen to catch this as early as possible. Did they give you a height for weight percentage?

You did the right thing. We were struggling to get any help from Gp/CAMHS then DD (14 at the time) stopped eating completely. I took her in to A and E after 6 days and that's what kickstarted any sort of proactive/ positive action (therapist, antidepressants, crisis team visits). It was seen and treated as seriously as self harm - which she was also doing not it was the a and e visit that got us on the right path to deal with all of that. Good luck

No they didn't but I noted the measurements and just used nhs calculator which gives 12th percentile