Stomach bug in 13 year old recovering from AN

[JoeySchoolOfActing]

Wondering if anyone can advise.

DD more or less weight restored since diagnosis of AN in 2023.

Mentally it is still a struggle for her to eat the required amount but she is gaining weight and height and feeling more comfortable eating out, going on holiday etc which is great.

She had a vomiting bug last week. Vomiting stopped about 6 hours but several episodes in that time and she was quite distressed. For the first 2 days, she mainly drank water and ate little and what she did eat was dry and plain, the usual stuff after such an illness.

However, she is now resistant to go back to a diet that was working for her whilst still in recovery.

She does a demanding sport so we won't let her train until she is eating normally again, but she is raging. It feels like the bad old days of refeeding.

Has anyone else been through this? I totally get that it will take a while for her appetite to return, but it is more complex for someone with AN as those appetite cues were more or less destroyed when she was in the grip of the ED.

Has anyone been through anything similar?

Would it help for her to think of food as the fuel she needs to do what she wants to?
I have an adult friend who manages an ED by thinking this way.

I'm sure you mean well, but we are a couple of years on this road, having been through an awful lot.

Your comment is not very helpful as that is one of the first things we said to her when she began restricting her food intake.

I am after comment from someone who has actual experience of AN and who has suffered setbacks in recovery due to physical illness which affect the ability to eat.

How old is your dd? My 16 yo dd has a lot of stomach pain issues and upset stomachs mainly triggered by over eating in the evenings basically because she’s really hungry and has refused to eat more in the day. This really escalated after Christmas and she has had so many issues and eaten a lot less than she should. Due a medical condition any stomach upset makes her very tired and she has to rebuild up to her eating levels over a few days. Unfortunately as this has been happening weekly, sometimes twice in a week, which is more severe the second time, she basically tipped into relapse.

My dd is likely autistic with PDA so it’s not as simple as eat this food (Eva Musby didn’t work, we are doing New Maudsley / Jenny Langley) as she’d rather starve than be told. But as long as she’s in recovery mode, I can now encourage and she will listen more. The issue comes when her brain stops recovering as was happening over the almost 2 months since Christmas until last week when dh and I had to stage an intervention.

The intervention: We are working with an ED coach. Dh spoke to her and did it all wrong. But the crux of it is we wanted her to have a good half term last week and we were giving her 3 days to systematically eat 3 meals and 3 snacks, eat more variety and distribute food more evenly over the day otherwise she wasn’t going to be able to do much in half term. And we didn’t want that to happen. But it wouldn’t be safe to just let her keep going as she’s going. I’m sure you’ve heard all that before.

We did the intervention the day before she was due to go to a friend’s house Friday so she wasn’t going to be able to go. It wasn’t planned that way btw. The ED coach told dh to sort it that evening. It got really messy and dd became violent. She did eventually negotiate as she really wanted to see her friend and she agreed to eat 3 meals 3 snacks, agreed to increase variety (as she eats the same almost every day) and add a large slice of cheese to her morning snack. Hopefully this won’t be necessary for your dd.

As for ongoing, I talk to my dd about how to manage increasing her eating back to normal levels slowly so that her stomach feels ok, doesn’t hurt and it doesn’t trigger another episode etc. If I tell her I’m going to manage it, she refuses to eat. I did give her a little meal plan over a period of 5 days once when things were really bad to build things back up. But she didn’t want that again. So if I ask for ideas as to amounts she can eat and what then she usually asks me what I think. With dd it’s about being a bit inquisitive and showing her I value her autonomy. The first day she’s eating very little (often just once or twice) and eats things like belvita for her meals and snacks as they seem to agree with her.

Since the intervention, dd has been a lot better. The slice of cheese in the morning has made a world of difference. We just had an issue on Tuesday as she went to the gym - I’m allowing it twice a week if she’s eating. Instead of saying to dd ok eat the belvita this time she suggested she just ate the cheese for morning snack and I said to add a few grapes to that, which she did. And it agreed with her stomach thank goodness. She seems to have gotten over the episode faster than in the past. I think two things have helped her to get over the stomach issues much faster this time are her mindset and the supplements I’ve added in. She is taking Lion’s Mane and Multispore, which is a pre / probiotic.

She’s now back in recovery mode. But was really irritable during the process for about 9 days, including with her friends. This is going to be an ongoing issue for my dd unfortunately.

My first thought too.

o/p it’s hard to say- as you point out in your reply to @vipersnest1 - and a bit rudely, tbh, she was only trying to help- eating disorders are a minefield, everyone is different and what works for one may not work for another.

so even someone sharing “actual experience” may not give you an answer that works for your dd.

i suggest you go back to her health care team and ask for their guidance. They will have a better idea of your child’s history and what works for her - far more so than random mumsnetters.

Thanks @Mummyoflittledragon for sharing, that sounds really tough for all of you.

My DD is 13, also ASD, not uncommon in girls diagnosed with AN.

I have experience of PDA. That must be incredibly difficult to manage with your daughter, but I agree that the key with those traits is the child having a certain degree of autonomy. Of course this goes against the Eva Musby/FBT method so I'm glad you've found a method that works for you.

My DD is slowly building back up to her recovery diet and hoping to get back to training next week, but that is absolutely dependent upon her intake of food.

She is also a bit calmer about it today so we will keep plugging away with the food options and only allow her back to sport once she is eating the full meals and snacks that she was eating before the stomach virus.

I do feel really sorry for her as after such a stomach virus, you do feel nauseous eating certain foods. She really can't afford to drop any weight though, so we will keep on keeping on and stand firm on the training.

Any drop in intake is a physiological trigger, so essentially it does put you back a significant amount. It's shitty and unfair, but you may need to approach it as if you were much earlier in the process and make food completely non negotiable with her again. Whatever strategy you used in the past, maybe very slightly updated for her current age. You still have a lot of control at her age.

You are absolutely right not to allow training yet. Make sure she has restored to pre vomiting weight. (Not meant as medical advice, but I am recovered from AN and know many, many other women with EDs, some recovered and some sadly not.)

@Whycanineverthinkofone I don't think of the ED board as random MNetters.

Ime, it's a group of women with a lot of experience in navigating the minefield of eating disorders.

You are entitled to your opinion about my response to @vipersnest1 , but I stand by it. We've been coping with this for a long time and of course we have thought of saying that to our child.

As for the gymnastics comment, it's not, but the judgemental tone from you and @Notgivenuphope is not appreciated.

Yes, that is a fair point about her healthcare team and if the restricting continues, we shall be doing that.

@verysmellyjellythanks, that is the main concern, the psychological trigger of the drop in intake while she was ill.

Appreciate your input, you're so right about it being shit and unfair. She has come such a long way since diagnosis. It was awful earlier this week to see her crying and furious about the food she was presented with.

Please stop derailing the thread.

I stand by my comments to you, your input has not been helpful.

I could not care less that you think I am defensive or rude.

Thanks @JoeySchoolOfActingYour poor dd. She’s so little still. I’m glad to see you’re getting back there slowly and you know you’re doing the right thing motivating her to get back to a place, where she can safely train and continue to look after herself.

As for going against standard advice, the ED coach calls it modified FBT and essential for dd’s recovery. I reread bits of Eva Musby the other day and realised I am actually weaving in some of the techniques. They can work when her brain is in recovery. The good thing about the intervention is that I think she’s dipping her toe in action, not just in terms of eating but in terms of wanting to recover… and I’ve just realised this.

I also agree your response was very rude. (Suitably qualified mother of anorexic teen before you tell me I am not nallowed here either)

@Mummyoflittledragon oh, that's amazing, the wanting to recover. Oh, I really hope she can continue to build upon that, it's what every parent of a child with an ED is so desperate to see.

Yes, FBT is brutal ime and I can definitely see how a modified approach would be necessary for someone with PDA. And you're spot on in terms of what the brain can do once in recovery vs. in the grip of the ED.

Thanks for sharing, we will keep on with the prescribed meals and snacks. I think the early days of refeeding were so traumatic for my DD that to feel like she was even remotely close to being back there was really upsetting this week after the virus.

@Bayonetlightbulb I didn't tell anyone they weren't allowed here.

I really don't see how your input is of any constructive use either and could not care less that you think my response was rude.

Please stop derailing the thread.

I've been thinking about your DD and I feel so sorry for her, it is just rotten luck to have this happen when she has been making progress in recovery. I will say that, as much it truly feels awful right now, it's valuable data for you as a parent that this kind of thing knocks her off balance. It would be a risk factor for anyone with a restrictive ED, but the exact impact varies from patient to patient.

I definitely don't mean to sound like I'm saying it's actually a good thing this has happened; obviously I'd much rather your DD had been able to continue building up progress in recovery without the interruption of her progress. But since it has, as well as supporting her to start eating properly again and getting back on track now (and she may not be back to the same mental place until she is actually at a slightly higher weight than before the bug), you are also armed with the info that any protracted vomiting is to be watched in her. When she's older and starts partying etc, as distant as it seems now, even bad hangovers might need an eye kept on them to start with. A "normal" eighteen year old who just finished A levels can spend the whole morning throwing up and not eat the rest of the day and be fine... but maybe even then, your DD may need support to restart eating again if she over indulges.

I don't mean this to sound hopeless or negative or like she will never get better. Early intervention and family support means she is in the best possible position to, and I know so many adult women who have made brilliant recoveries. I'm just aware of how challenging the biological trigger of unintended nutritional interruptions can be, and if the anorexia sufferer one loves is quite susceptible to this, then keeping that knowledge at the back of one's mind is empowering. Forewarned is forearmed.

It must be really tough

I had severe food poisoning from chicken and it knocked me totally (I have disordered eating)
The only things I wanted was full sugar coke and salted hula hoops for days and I haven't touched chicken since (6 months now)

Also the first thing that went through my head was about eating and how little food I survived off and I could feel it triggering me to start again - and mine isn't full blown, just disordered eating

@faithspikebuffy Yes, it really screws with your mindset as well as the biological / physiological aspect, doesn't it? There's a weird sense (for a lot of people, I think) that the body has "rid itself" of food and you're newly "pure" and can "start from scratch". Like obviously that's insane but it's so darkly tempting. One doesn't want the unpleasant suffering of the bug or food poisoning to be "wasted" by eating again.

EDs / any disordered eating are so messed up. Don't feel you have to put down what you go through as lesser.

@verysmellyjelly what you say makes so much sense - not hopeless or negative at all.

The setback of the vomiting bug has definitely made clear how susceptible she is to biological triggers. It has also brought back some terrible memories of the early days of her treatment, for her and whole family.

I knew her recovery was fragile, but it is difficult seeing it play out in reality.

Thanks for your responses, they have helped a lot and I am grateful to you for sharing. I also feel reassured that we are on the right track with what we are doing.

@faithspikebuffy I think it's very likely my DD has thought like that this week - thank you for sharing. Sounds so difficult for you too, I really wish you well in your recovery, it is such hard work.

I've had the sickness bug twice. Triggered me a lot and I'm still restricting now and excessively weighing myself. Can't help you but unfortunately I think it's a normal set back.

@hulahoopbbq that's really difficult, I'm really sorry to hear you are also suffering. I hope you have some support irl, it is v difficult to cope with alone.

Thanks for your input, It does help to know that this kind of setback needs to be taken seriously. I really hope you make a full recovery, physically and mentally, sending you my best wishes.

My daughter had a vomiting bug very early into her "recovery" (in inverted commas so as not to give the impression that she is recovered because she isn't). It was a massive trigger for her and was very hard to manage. It's hard enough trying to get her to eat when she is well and complaining she isn't hungry let alone when I knew that it was actually a rea physical feeling rather than psychological.

Once I knew that the actual vomiting was over, I just cracked on with making her eat no matter how hard it was and how much she insisted ahe wasn't hungry. I allowed her to avoid foods she'd eaten around the time of the vomiting but that was it. It was very hard and I felt like all the trauma of the previous months were wasted but actually she didn't relapse all the way back. It took at least two weeks for her to recover fully from the bug.

It's really not what you need though.

@idril thanks for the solidarity, we are in a similar place, including the use of the inverted commas.

This virus has revealed how full recovery still seems a long way away.

However, she is getting back on track with portion sizes, it's really hard for her and us, but we will keep going.

Wishing your daughter well and sending strength to you to support her.

Just want to say thanks so much for these words. I appreciated them very much at the time and you are being proved right.

It was a very real setback, but she got back on track and is doing a lot better now.

I feel like it has boosted her confidence in her ability to cope with setbacks as they will inevitably happen at various points along the road.

It was bloody awful, traumatic for everyone feeling like we were back in those awful early stages of recovery, but if it gives hope to those are there right now, things can get better.