DD14 not eating. What now?

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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.

Is she willing to make an effort? If so encourage high calorie dense foods. Don’t try to be ‘healthy’ with fruit & veg, salads etc. Avoid all that and push high fat; nothing low fat or ‘diet’. Add cream and butter to things like mash etc. There’s an ED FB group which can also give you food ideas; albeit it’s a bit scary. I’ve a nutrition booklet pdf so I’ll post it here - may help with ideas.

https://www.hse.ie/eng/services/list/2/primarycare/community-funded-schemes/nutrition-supports/making-the-most-of-every-bite-cookbook.pdf

She seems interested in making an effort but won't touch dairy or carbs. Maybe I'm going wrong. I'm going with healthy stir fry veg , turkey etc. because I think she's more likely to eat it.

@NotDonna this is so useful. I think it just what we need. Thank you!!!

Avoiding carbs and fats is a huge issue! I’m hoping the ED clinic call you soon as you’ll both need support with this. Meanwhile try to work on the bfast, snack, lunch with pud, snack, dinner with pud, snack. Everyday. It’s constant eating esp if she’s not hungry and takes ages to eat things, but even if it’s stir fries for now it’s something. I’m just a mum btw & this isn’t medical advice but just what I was told by the ED clinic.
Im really lucky that although DD’s BMI is on the 7th centile she is a carb monster.

After having ds I suffered from an eating disorder and I remember the psychological struggle with beginning to eat again. I'd be really trying and go to put food near my mouth but my hand would start to shake and my body would tense. The starting to eat again it a really tough part
My dp (who was so worried / bless him) bought me protein shakes to keep in the fridge so if I ever couldn't face eating food instead of going without anything I could grab a drink and would be much easier to swallow in just a few gulps. Just some advice as the first few days my be tough for her

I'll try this but I think she'll just say "I can't" ... do I force her? Get angry? Bribe? I don't understand how I get her to eat if she says she can't.
This is also incredibly upsetting for my 12 year old daughter. Should we avoid family mealtimes to protect her from seeing her sister like this?

Oh I’m not an ED specialist.
Try not to get angry. A lot of people swear by Eva Musby’s approach. The ‘BEAT’ link above will be useful and they may have a helpline. I’ve read (and have knowledge via a friend whose DD had anorexia) that the ED takes over and their behaviour can get quite nasty but it’s not the child it’s the ED wanting control. My DD was only 12 and quite compliant, thank heavens. Wanted to get better etc. I used to sit with DD until she’d eaten what I’d given her - it could take an hour to eat a quarter of a sandwich. I’ve two older DDs but they were at school when I was off for two weeks with DD. Dinner times, we’d all finish, they’d leave the table and I’d just sit with DD2 til she finished. We’d watch TV as a distraction. It’s incredibly frustrating and it’s very very difficult not to get annoyed. DD is a gymnast/dancer and was desperate to get back to it so the ED clinic saying no sport til 85% wfh gave her the impetus to eat. She was around 75% at the time. Plus we changed her adhd meds, which made a difference - not huge but definitely better. She’s never been 85%; I think we got to 80%. She’s probs around 77% atm, which isn’t good esp as she does at least 10 hours a week of gym/dance! But like I say she’s a carb monster, eats high cal foods just not much of it and it quite picky. There’s a really good FB group where you can post for advice from other mums; they initially come across as quite brutal and unforgiving in their approaches but it’s ‘needs must’. Their kids have/are seriously ill so want to prevent yours going that way. It’s a nasty life threatening illness. Also they need to be a good weight before any MH needs can be addressed. It’s ALL about getting weight on; so high cal foods and zero exercise! Definitely look at BEAT and reach out. What is she eating each day? Keep a food diary too. What school year is she? Is she attending? She may need supervised lunches either by a member of staff at school or you going in and sitting with her somewhere. It’ll depend what her wfh is. Please remember I’m not a professional!

If you know her height and weight you can use this to calculate her wfh percentage. BUT even if it’s 100%, which I doubt, don’t think it’s ok as refusing to eat and/or only eating salads or veg stir fries, no carbs or fats etc is behaviour associated with an ED. Some ppl can have anorexia and a decent wfh. It’s the behaviour that matters most. And it’s a slippery slope.
https://www.calculator.net/anorexic-bmi-calculator.html

I really like that NI book. I don’t think the current NHS England “force feed every two hours at home” regime works particularly well for most families…

OP, could you give her the choice of a couple of strategies to try today? Either meals or snacks or shakes and smoothies? Say you don’t mind which and you can try something else tomorrow, she just needs to pick one to try today? Recovery will require some buy in from her and it keeps you as more equal partners in it. If possible, it may not be. Hugs to you.

When you see ED services, which really needs to be sooner rather than later, you'll be given a meal plan (3 meals, 3 snacks, very high calorie) that you'll have to supervise. Is the dairy thing new? ED services will treat any, not very long established, food exclusions as a sign of the ED and so insist on those foods being eaten. ED services should see her very regularly (likely weekly for now) to see if she's gaining/maintaining/losing weight. If she keeps losing weight then she may need to be admitted to hospital.
All of this sounds very brutal and tough but eating disorders, especially anorexia, are so dangerous and food is really the only medicine. Once she's eating a bit better then you can start to address other MH concerns through therapy but, for now, she really needs to be eating.

Yes the dairy and carbs thing is new. She was eating cheese and pasta 6 weeks ago. She's at school in y10 and achieving very well although has been struggling socially.

She's been so withdrawn and barely communicating with us.
The thing she seems least reluctant to eat is home made oat and date balls I make. I've been adding seeds, coconut, honey, peanut butter to get as much as I can in them. She eats them in 2 bites. She's also ok with snacking on cashew nuts.

She's also become quite hostile to her adoring younger sister which is a change of character as they've always been so close. It's heartbreaking

These oat and date balls sound ideal. And adding the nut butters or anything you can to make them as nutritionally dense as possible is perfect.
The other thing my friend did for his daughter was smoothies. She was ok with those as they were "healthy" and he'd just load those up with fruits, protein powder and nut butter and a dollop of cream. You can use oat milk and oat cream if she says no dairy but it's a great way to get vitamins from fruit in

What’s important to understand is that the aim of ED treatment is both to ensure that the person with an ED gets adequate nutrition, but also to establish normal eating patterns. While your nut balls or smoothies or even fortified drinks are a good way of initially getting calories into her, surviving on a diet of liquid and energy balls is not particularly normal. You need to be encouraging a normal diet as much as possible and ED services will help with that. This https://www.dorsethealthcare.nhs.uk/application/files/4316/4968/9155/Re-establishing_normal_eating_7_day_meal_example_plan.pdf is an example meal plan for someone in the initial stages of recovery from anorexia. That probably looks completely terrifying and unachievable right now but it’s a good idea to know what you’re aiming for. The fact that your daughter was eating pasta 6 weeks ago is a good thing as, hopefully, with the right support, you can help break the ED pattern before it becomes too entrenched.

My understanding of EDs is that a side effect once your body weight is low enough is actual total loss of appetite, so a vicious circle. Even when you want to eat you can't. I think that's when the hospitals step in so that's one to avoid.
But also massively low moods and behaviours which are really out of character. All you can do is to tell your DD2 that her sister is really quite unwell and to try not to take personally. When she's back to herself/a more normal weight she'll be in a different place.

Do you think this is driven by GcSE anxiety? 8 weeks takes you back to Christmas. Have the school ramped up all the rhetoric about it? My DD is in year 9 and is already anxious so we're trying to nip it in the bud now and be clear in our expectations of her. She is bright but has some very high achieving friends (who slog) and has admitted to feeling stupid by comparison.

Last thing and unrelated. There's a thread in MN Classics about fat balls if you need something to cheer you (and DD1) up. It's the sort of thing that makes you weep with laughter.
Look after yourself too. This is not your fault.

@TreadSoftlyOnMyDreams some really good points. I’d like a laugh too but can’t find ‘fat balls’ in Classics - have tried searching.

https://www.mumsnet.com/talk/mumsnet_classics/2017083-He-has-eaten-a-fat-ball

I found it and very funny!!

There is definitely exam anxiety. She's always put herself under enough pressure and she's been complaining of school putting pressure on too.

At lunch she knew I would ask her to eat. I gave her an oat cake with a thick spread of cream cheese and a handful of bean sprouts. She asked for a protein ball instead and I asked why. She said she 'knows what's in it.. but don't know what's in the cracker and cheese' ... she used to stuff her face with the same cracker and cheese.

She ate the bean sprouts and cried over the cracker for about 15 minutes before eating it. She said she liked the taste but didn't enjoy eating it.

Should I start something like this meal plan now? It looks like a vast amount of food. But I need some kind of strategy as I have no idea when we will be contacted by the clinic

She doesn’t need A&E!

I think you need to STOP!

Ive had an eating disorder, the more you try to control this the more she will rebel. Please don’t do this. Get professional advice and help.

Please, please don’t try and force DD to do what you think is best, you’re going to make this worse.

if you can’t wait for the NHS to do the referrals try here first https://www.beateatingdisorders.org.uk/

My 16 year old is currently in recovery from anorexia. She was under the ED team for 2 years. The ED team told me if she ever went 24 hours without food to take her to a&e, she was very nearly hospitalised.
We didn't have to do 3 meals and 3 snacks straight away but had to build up to it. It's a long and scary road and hands down the hardest thing I've dealt with as a parent.
I got extra calories into her whenever I could but ED's push back hard and fast.
My dd is now weight restored thankfully. It's good that your dd wants the help, mine didn't at first

Also ED teams tend to see them very quickly, we only waited a few days

Ok thanks I'll be patient and just try to keep her eating little and often even if it just a couple of fat balls.