DD13 eating <400kcals/ day

[mumoflittlemice]

Apologies for long post - trying not to drip feed although there’s bound to be things I’ve missed:
Our lovely ASD/ADHD DD13 who has had struggles with food for many years in ways that I (probably wrongly) wouldn’t have characterised as ED, now suddenly seems to be in the absolute grip of it. She has been eating a very regimented diet for some months of scrambled eggs (1-1.5 eggs) for breakfast, a tiny Greek style salad packed lunch for school, a mini cheese portion as a snack, fried egg and avocado bagel after school and then she would mostly eat whatever the rest of the family were having for dinner later in the evening. Then she stopped having dinner with the rest of us saying she was full from her bagel at 4pm. I could understand this and didn’t want to be pushy, reasoning to myself that overall her diet had a good balance of protein, veg, carbs etc and she was still enjoying treats here and there seemingly quite normally - an ice cream in the evening if we had some in, a brownie / cookie at cafe if we were out and about etc. I had noticed her being slightly more vigilant about food in general and she had lost some weight but looked and seemed healthy and energy generally ok etc…

Over the past two weeks she has drastically reduced her intake of food/ calories and is consuming barely 300-400 kcal per day, struggling when she eats anything - openly saying she does not want to eat - and we seem to be fully in a crisis. Her DSis16 nearly 17, DH and I are all desperately trying to support her and I am floundering, we all are. DD13 has lost about 3kg in the two weeks I would say. The only positive at this moment is it is all out in the open and she is talking to all of us (not loads or all the time and sometimes reluctantly) about this. I got in touch with her former therapist who was seeing her during eating difficulties and episodes of SH and she advised GP route first this time as she is actively losing weight. We have the GP booked for Tuesday.

I am really looking for advice on first steps here from parents who have walked this path. I am trying to educate myself on ED / AN etc. DD13 has also admitted recently that she previously had ‘around 3 weeks’ of making herself sick and says that she stopped that. She also says that she has a voice in her head that tells her not to eat etc. she believes she is fat even though rationally she knows she is not. She has become obsessed with coming with me on every dog walk (they are longish ones, about 3 miles twice a day) and I feel foolish for not putting all of these pieces together more quickly and realising how much difficulty our beloved DD is actually in.

She is 5’6” and says she is 58.8 kg. She was over 61kg about 3 weeks ago which I only know because we have to send her observations off when we want a repeat prescription of her ADHD meds. She weighs herself in private though so as much as I want to trust her, I can’t be sure she is telling me the real amount. Her appearance is very slim but not painfully thin, but she’s certainly heading in that direction if she loses more weight which of course she will unless she starts eating more. She seems absolutely trapped and I am desperate to help her. What is the seriousness of her situation right now (it seems very serious to me)? What first steps do we need to ensure we take immediately? What are the pitfalls to avoid and essentials? ED parents of teens who have been there, please can you advise us?

Sorry to hear this
It does sound as if your DD has an ED. You have done the right thing in making a GP appointment. The BEAT website has helpful resources, including what to expect and ask for at that first GP appointment
The recommended treatment is to eat 3 meals and 3 snacks a day, avoiding blood sugar spikes and getting the calories she needs. What she eats is less important, just eating is the key.
There's an Eva Musby video (bungee jumping) that i found helpful at this stage to understand how to support meals
Feel free to join the main support thread, there's lots of very wise parents on there xx

I’m sorry you’re all experiencing this. Does she actually want to lose weight or have body image issues or is she saying she doesn’t feel hungry?

autism can affect interoception and she might not be getting typical ‘hunger’ signals. Her ADHD medication can also suppress appetite significantly so you might want to speak to the AdHD service as this weight loss should have flagged with them.

My dd is in recovery from ED. From what you’re describing, it is very possible your dd isn’t mentally well at all. And this is very serious. Much as your dd is still within normal weight range, she needs urgent intervention due to the rate at which she is losing weight and her calorie intake.

There is a checklist called MEED (medical emergencies in eating disorders) which healthcare providers use. Your dd is red on MEEDS in 2 ways. Firstly, she is losing more than 1kg a week and secondly her intake is less than 500 calories. The vomiting is also not a good sign. It signifies she’s having some big feelings, probably guilt, after eating.

Idk if the vomiting has genuinely stopped and if she has now chosen to not eat in the first place, ie to restrict, rather than to eat, perhaps what we would consider to be a normal amount of food, then vomit. It also sounds as though she has some level of body dysmorphia as she believes herself to be overweight when she isn’t. And you don’t need body dysmorphia to have an ED, but it is another indicator.

With the rate of weight loss and low intake, you should be getting medical observations for your dd. Heart rate, bp, pulse, blood tests. And it sounds as if she has been restricting for some time, so she definitely needs to be seen sooner rather than later. Because she’s eating so little, the advice should be to take her to A&E today for these. I do appreciate the environment could be very difficult for your dd as she has SEN. And if you choose not to, she needs to be seen by the GP tomorrow for basic obs and an urgent referral to CAMHS ED services.

In the meantime, try and get her to eat at least 500 calories today. Don’t beg. Don’t talk to your dd about calories, the correct words are intake / energy intake. And stay with her / monitor her for half an hour after she’s eaten to ensure she isn’t purging.

All exercise needs to stop at this level of intake, she is going to have bounds of energy right now, until she suddenly won’t. This is all evolutionary and the desire to exercise becomes a compulsion into people, who are genetically predisposed once their intake is reduced. People lose that as they start to restore weight.

As your dd has AuDHD, it is very common to eat the same foods repeatedly. That brings comfort and predictability, so I wouldn’t be concerned with that. Right now, it’s important for her to eat. Did she become vegetarian recently btw? And what do you mean about her always having difficulty around eating / food?

And I see that there’s a post just appeared above mine from Savvysix. ADHD meds absolutely can interfere with appetite and these will not be good for your dd.

Gah! I wrote a whole massive reply and I lost it! Why?!
I wanted to start by saying a massive thank you to @LurkyLurkyLou@Mummyoflittledragon@Savvysix1984for your replies and advice. I am so grateful.

DD13 has always struggled with textures, tastes and many different types of food. I can remember collecting her from nursery at around 18mths and she would still be chewing a piece of fruit from lunch/ snack time and not swallowed. Years later we had a time that I can remember thinking would never end, where she would have to get up from the dinner table and spit her food out into the bin where she couldn’t swallow it. She would continue filling her mouth when eating, chewing but not swallowing and then have to let it all go as her mouth got over full. It was like she was programmed for putting the food into her mouth, chewing it, but the swallow button was out of order. It went on for probably 2 years and she did lose a lot of weight.

@Savvysix1984you are spot on with the interoception difficulties; she has struggled to know when she is hungry, thirsty and even in pain, until it was bordering on extreme. This did seem to have improved over the years but we’ve still had to keep an eye out for it.

I would say that she does want to lose weight for sure, but with all of the difficult relationships with food and eating, it’s not the whole picture. Body image wise, there is definitely a disconnect there. She ‘believes’ she is fat while ‘knowing’ that she isn’t. Like a dysmorphia maybe? I’m not sure I am using that term correctly. She is very intelligent and has a degree of insight when she is in her right mind, but I am finding it is almost like a Jekyl (sp!) / Hyde situation when the ED is doing the talking. She does feel hungry, really hungry but like she can’t / mustn’t eat. It’s heartbreaking seeing her fighting this internal war. I guess I don’t need to tell you guys this, as you have the T shirts.

On the note about the ADHD meds: I’ve stopped them as of a few days ago once I began to really twig how far this has developed. It’s odd because the adhd service did pick up when she had lost 0.5kg a few weeks ago and said to keep an eye on weight loss, but when I requested the next prescription and her weight had gone down more, they sent it through without comment. However, as I know her meds are stimulants and appetite suppressants I’ve told DD that until things are in a very different situation she can’t have them. They were helping her so much too.

I had a very frank but compassionate talk with her this morning and explained clearly the seriousness of the situation. I’ve said that our goal is going to be three meals and three snacks per day. I’ve said that it will never be a punishment/ reward situation, but it is a fact that we won’t be able to go on our holiday (that she is really looking forward to) if we’re still in the same place as we’ve been the past two week.

So far today she’d tried really hard and has managed about 1.5-2 eggs worth of scrambled eggs made with butter with half a toasted buttered bagel for breakfast, then things went downhill when I tried to get her to eat half a banana and a small piece of homemade cookie before we went to the movies. She refused and I said she could chose an alternative (she’s not crazy for bananas) and offered a rice cake with soft cheese spread, which I know she likes. She ate it and the cookie piece slowly through tears. At the movies she ate a small handful of chocolate M&Ms. I can tell she is absolutely panicked about what she’s eaten so far today and said it must be about 5000kcals, which it is obviously nowhere near. Still she’s managed a cheddar cheese portion and is desperate to come on another dog walk (DH had already invited her on the morning one so I said nothing and let her come). All of this is way more than she’s eaten recently but I can feel her stress rising with each eating occasion.

The GP appointment is booked for Tuesday morning and I am in two minds about letting her go to school tomorrow. DH says if she eats an ok dinner and breakfast then she should be allowed to go and I’m leaning in that direction. I’m just nervous about the pressure building on her to ‘perform’ to get what she wants (to go to school) but I guess if it means she eats…?!

Before I lose all my reply again (!) I will post, but thank you all again so much. I did read most of the most recent parents thread and some of the older ones too, in trying to educate myself on this somewhat. I must admit I found it so overwhelming so somewhat selfishly have posted my own. I have a clinical background so can take her obs myself and recognise if they are of immediate concern.

I would be so glad and grateful of a hand hold and any advice any of you or others in the know can offer while we navigate these early steps and I’ll keep posting as we go along if anyone is ok to stick with us.

@Mummyoflittledragon Yes! Vegetarian since January! Initially this seemed such a good thing; she was suddenly eating such a wide variety of foods and vegetables from being very restricted and eating hardly any veg. Even pulses! Things she never would have eaten before then. I was so happy and joined her in the vegetarianism. Now she does eat meat sometimes, although still much less than previously (when she ate really too much of it) but obviously everything else eating wise has gone sideways.

@mumoflittlemice just keep her home tomorrow and feed her 3 meals/3snacks. She will not eat properly otherwise. Keep giving her things you know she will eat. Keep her out of the kitchen while cooking.

Home - F.E.A.S.T.

I found BEAT not that helpful - but the above charity is brilliant.
They have country specific 24 hr phonelines manned by parents
and a great 'first 30 days' guide on what to do.

STOP the dog walks , no extra activity, no school, at least 1 hr supervision after every meal and snack, and 3 meals, 3 snacks every day.

I wish you the best my DD and I have been in the trenches for 6+ yrs and finally coming out of it. I wouldn't wish it on anyone or any family
You need to be tougher than the ED/AN and you need to get educated and smart very very quickly.
Do not believe a word she says - the illness makes them more devious than you could ever imagine you darling child could be

https://charliewaller.org/mental-health-training-support/parents-and-carers/eating-disorder-workshops

Get on one of these - they use the Eva Musby framework but it helps bring it to life.
Buy the Eva Musby book - its about the language to use.

Food wise, she's still an ok weight but obviously losing 1kg a week is a lot and she'll become underweight very quickly. The body is incredibly resilient and will adapt on very few calories until it can't - so its possible any blood tests, ECGs etc will show as "normal". If they do, instruct medical people NOT to say her results are normal in front of her - she will likely restrict more.

She needs 3 meals and 2-3 snacks a day. Ideally around 2000 calories. She will push back on this, hence the Eva book is helpful in giving you guidance.

My daughter has a PDA profile so doing "magic plate" where food is just served up did not work. Instead, I worked on a more collaborative approach and we agreed on a handful of breakfasts, lunches and dinners that met the brief and were acceptable to her food rules. Then gradually worked to push those food rules.

Its horrid and im sorry youre going through this. Its not a quick fix, and help is very area dependant.

It sounds as if your dd may have ARFID (avoidant restrictive food intake disorder) or at least tendencies towards this. My dd is the same, but she wouldn’t put any food she wouldn’t eat in her mouth in the first place. That’s actually then potentially 2 eating disorders working together, which makes things more complicated and serious.

Becoming vegetarian in response to restriction is common. This then often accelerates the restriction. This is because some people really should not be veggie, like your dd and mine. My dd is eating chicken again btw, which is great as the brain needs animal protein to recover, along with fats and oils, predominantly animal fats like butter and cream.

So your dd has eaten 500 calories. That really isn’t enough to be walking today then going to school on. The brain alone needs 500 calories a day to function, which is why we see personality changes. It cannot function properly with such low intake. Your dd is actively losing weight. And losing fast. I get your dd doesn’t get the severity of this yet. However, the only way it goes if you don’t reverse this will be to stop all activity and go on bed rest.

Knowing what I know now, I wouldn’t allow her to go to school until she’s seen the GP at the very least. If your dd wants to go to school enough, you work out what she needs to eat to be able to go. The incentive.

@FruityFrogthank you for your comment and advice. Please can you help me to understand the reason for keeping DD out of the kitchen while I am cooking? Thank you

@Theredjellybeanthank you for your advice. I am so sorry for what you and your DD have been through. I’m so glad to hear you are coming out of the other side 🙏 I must confess my heart sinks every time I read someone’s years long journey in this nightmare 😞

I will have a really good read of the site you recommend, thank you so much. That 30 day guide sounds just what I need. I appreciate you all sharing the benefit of your very hard and painfully ‘won’ experiences to help us.

@WhatsitWiggle thank you so much for your reply and advice. I am taking everything on board that everyone is saying.

I ordered the Eva Musby book yesterday after seeing it recommended several times on the parents thread. I don’t even fully know what the magic plate idea is yet but I saw that parents of other SEN/ND youngsters with ED said that they had to at least adapt it or not use it for their child so I’ll keep that in mind. I need to educate myself and fast as @Theredjellybeanquite rightly points out. I’ll be diving into that book as soon as it arrives.

DD has made it to over 500kcals today I would say and although not by much, it’s still a massive improvement on the past couple of weeks. I have felt quite paranoid that she will eat to please us and then purge, so I am trying to monitor her after eating as much as I can.

@Mummyoflittledragon yes I would I say that she fits an ARFID profile and that she / we have been dancing around that for a really long time.

The vegetarianism seemed so left field at first as meat was one of the only foods that she did not struggle with for the longest time. As she wasn’t eating much of anything else, she consumed quite a high proportion of meat in her diet prior to cutting it out completely. As I’ve mentioned, she will now eat meat maybe once or twice per week; some chicken or a little bacon - or she was, before she began seriously restricting and just cutting back on everything.

So, can I ask, again just to understand, it is ok to offer an incentive to get her to eat? Today I know she has tried extra hard for a few reasons; 1) she really wants to go to school tomorrow and DH said if she ate xyz plus breakfast tomorrow, then she could and 2) she is desperate that we don’t cancel our holiday.

We are also moving house later this month so it feels absolutely beyond stressful the way everything is colliding, which I am sure is really not helping DD either 😩

Offering an incentive is absolutely fine. And finding something our loved ones want to do more than they want to restrict is absolutely the way to nudge them forward to recovery. However, allowing your dd to, go for a walk and then to school whilst eating 500 calories is nowhere near enough. That’s giving the ED too much power. And it’s dangerous, because at that level of intake, she absolutely shouldn’t be doing all of that.

I have been where you are and done exactly the same as you are both doing. So it isn’t a criticism. It’s a reality check. Now that your dh has said it, you’ll need to follow it through, because otherwise your dd won’t trust you, especially as she has SEN, she will see things as very black and white, I imagine. And you need a lot of trust to get through this. But today needs to be the last day that your dd is allowed to get away with doing what she wants to and eating so little.

I hope you are telling the school with immediate effect she cannot participate in PE. It is dangerous on her level of intake. Tomorrow she’s at the GP. So she won’t be going to school first thing. I presume she’s at state school. Does she carry her bag switched on all day? If so, look at her daily step count. That’s probably going to be in several thousands as she walks to lessons alone. Energy out needs energy in. Every step is a step.

If your dd really wants to go on holiday and to be allowed to go to school, you should be getting her to eat a lot more. And you want to increase her intake gradually in a stepped way. If you’re reading the current main thread, the parents with dds in hospital talk about that. And it will be difficult to do that without some form of guidance from CAMHS. Her lunch is really tiny. And a very typical lunch for an anorexic. The good news is that she is eating at least 3 times a day, so you have opportunities to increase her intake during those times and to add in more little meals.

The gold standard for treating any ED is 3 meals and 3 snacks. This is to stabilise blood sugars and regular meals slowly gives the body signals that it is ok to eat. Today she eats as agreed, making sure she has dinner as well as the bagel as soon as she’s home (leaving 2-3 hours between these two). And tomorrow, she eats her breakfast and presuming the GP is before 11 am, get her to eat a snack when you get to the car. ‘Sweetie, I know you really want to go to school today. Just have this and then I’ll drop you off.’

Then she will have the tiny lunch, which obviously isn’t enough, she has the bagel as a snack, then she needs dinner. If that’s the same thing every day to make it easier to eat, that’s fine and as long as there’s protein and carbs, preferably some fats / oils as well, it’s a very ARFID way of eating. She does need fruit and vegetables, but because her intake is so low and she’s having the salad at lunch right now, I wouldn’t prioritise these. That then means she’s eaten 5 times rather than 6 but it’s a work in progress.

Make sure the snack is a decent amount. ED sufferers often get on well with the little packs of 4 Belvita breakfast biscuits, but idk if that is something your dd will eat. This snack then becomes something she takes to school and eats at morning break.

As for the workshops, they are brilliant. However, they’re based in the new Maudsley book, Skills based for carers of loved ones with an eating disorder. Jenny Langley wrote the Charlie Waller courses and co authored the parental training materials. The book: https://www.amazon.co.uk/dp/1138826634?ref_=ppx_hzsearch_conn_dt_b_fed_asin_title_2

This is Jenny and her email address is at the top. If you want to be added to the monthly carers zoom meet up, contact her. Have a root through the website. There’s plenty of ressources on there. And big chunks of the training manual, which is basically an expanded version of the book is published on here newmaudsleycarers-kent.co.uk

I would tread really carefully with the Eva Musby book. Just light touch it. It can overwhelm someone with SEN, especially if they have demand avoidance. It wasn’t for my dd.

@mumoflittlemice one of the most distressing things about having an ED challenged is that it fights back much stronger. Even if she says she wants to get better, part of her will be feeling guilty, distressed by all the food and actively trying to reduce calorie intake. By taking any food decisions away from her and just feeding her without her input means she can't negotiate with you to have less butter or fewer pieces of toast or whatever. It's agonising to be in the position of being starving hungry, knowing you should eat but feeling compelled to reduce your intake.
This is another reason why school is unwise. She has been eating at home this weekend because you're standing over her. Guaranteed that won't last without your outside influence. She will not have the willpower to make herself eat. Why would she, logically? She's had the willpower to only eat 400 cal for several weeks!

You mention you’re moving house later this month. It is worth speaking to your DD about how she feels about this as I don’t think it’s a coincidence that her restriction has ramped up when she’s facing a massive change, especially for someone with SEN/possible PDA profile. This restriction may be a reaction to feeling out of control and by controlling her food, she has control over something in her life.
I myself have a (long) history of severe eating disorders, that stemmed from my teenage years and lots of things in my life changing quickly/out of my control.

Thank you all again for taking the time to give me your replies, advice and experience. This morning was horrible, she was so upset and angry, but I stayed very calm and repeated that we had agreed that eating a boiled egg (her choice of food item) plus half a toasted bagel with butter, would mean she could go to school. She did do it but wow, it was rough. I'm not at all convinced that she will eat her lunch obviously and she asked me yesterday if I would be annoyed if she brought it home uneaten...
She is definitely feeling very panicked about how much she is eating / being asked to eat, even though as everyone has said, it is way under what she needs. I do feel like I have sleep walked a bit into this situation with her; not picking up enough on the more gradual weight loss that happened as she started to cut out dinner after her bagel and eating other 'additional' foods like snacks gradually became vanishingly rare. If I am painfully honest and really reflect, I think I was almost proud or impressed by her self discipline (as I subconsciously viewed it then). The thought of that makes me feel so sick and ashamed now and probably speaks to my own issues with food/ weight/ eating etc. I am determined to focus on how to help DD over all else, but there is a big part of me that is very ready to blame my own example and facilitation for why this is happening. That feels like an indulgence that we don't have time for right now.

@alwayshungryhippo regarding the house move, I can totally understand your thinking here, but dd is very keen to move and wants it to happen desperately. She has wanted it for a long time and is very invested in it happening asap. She is going to be allowed to keep chickens at our new house, there will be lots going on such a redecorating her new room (and a whole renovation of the house) which are all things which will give her big dopamine hits. She loves that kind of thing. We will be in a better area which she is excited about and right next to a beautiful park and beach which again, she loves. We're not blind to that fact that even with all those positives, it is an absolutely massive upheaval and there has been and will be associated stresses around it, of course. We think that possibly more significant is that she had a bit of an upset/ awkward situation with her friendship group over the half term and her eating definitely dropped off a cliff immediately after that first blew up. She tried to seem like she could shrug it off at the time, but it was obvious she was very stressed about it.

DD attends a specialist school primarily for ASD/C children. It is a very small setting and she is settled there and does very well with her studies. They are not allowed their phones at school at all, they hand them in to the office on arrival, no smart watches, tablets, nothing like that, which is something I love tbh. I have however removed her access to TikTok and Instagram as of yesterday which went down a treat as you can imagine. I have also removed the bathroom scales but found a tape measure in her room this morning following this, which I have also now taken. Are these the right things to do?

@FruityFrog thank you for explaining that, it makes sense. Yes, the negotiating is definitely happening. This morning she was trying the 'I've eaten enough/ most of it/ more than usual' etc etc but I calmly held fast, 'there is no negotiation to have here, you will need to eat it all to be allowed to go to school'. I was accused of treating her like a five year old, taking away her autonomy, being unreasonable etc but I replied that I was taking away the illness's autonomy and I am treating her like a 13yo who is very ill and needs support. The illness / ED is unreasonable etc. Obviously she did not take that on board at all in the moment, but I hope it will go in somewhere, even if it is in the future when she looks back. I did have to apologise for saying this was worse for me than it is for her, which I stupidly said when I was upset at the weekend. Of course it is not harder for me and I said sorry for this and that I did not mean it.

I am going to spend some time looking at the various resources now. I will come back with an update after the GP appointment tomorrow. I keep flip-flopping on keeping her off of school. I know that I should and honestly I am scared to as it feels like escalating things. I know that is wrong and I am basically being cowardly.

Major mh crisis get her to GP.

We kept DD off the first day that we discovered it with her as she was so tired emotionally after the conversation the night before that it seemed like a reset day for her. It worked really well for her. We then implemented 3 meals 3 snacks before we had the GP appointment and she has responded really well. However, what I will say is that she is very (as far as we're aware) NT, but also quite a rule follower, and has been able to eat whatever we give her - she still cannot eat intuitively, but she has put on a lot of the weight she lost, and more besides. Well - she had last time she was weighed, I still am on tenterhooks but we go again in 2 days.

Wishing you all the best - it is almost easier when someone says "no, you're not imagining this, there is an issue, here's what you need to do". Our GP was great, and we had a referral and a call from CAMHS within 6 days of our initial consultation.

Oh gosh, sorry, yes it was the Janet Treasure book not Eva Musby. I had so many resources on the go.

One of the things they tell you is to separate the ED from your child. A lot of resources liken it to a voice in their head, telling them that ED is good, and parents are bad. One of the courses I attended suggested to think of it as my daughter being in an abusive relationship. I wouldn't just stand by and let her get hurt, I'd try to extract her from it by helping her to see it wasn't love.

When she is asking you "do I have to eat this?" it's because she wants to, but the ED is telling her she is weak if she does, it's better not to eat. So she needs you to stand up to the ED, to say 'yes, I know best and this is what you need'. It's horrible when your child screams at you, tells you how awful you are - but it's not her, it's the ED.

It's a horrible, horrible illness. I really do hope that CAMHS in your area is better than the one in mine and gives you timely support. IME there's a huge expectation on the parents/family to do most of the heavy lifting, so make sure your husband is acting the same way as you.

@Libre2 thank you for this nugget of hope, I badly need that. I think I do also need that sanity check almost that you describe and hope that will come tomorrow at the GP's. We are on the Kent coast and previous experience of being referred to CAHMS for different issues with her sibling (severe anxiety/ OCD behaviours) were either rejection ('not serious enough for us, see early help, community paeds' etc) or resulted in some half hearted 'CBT-style' limited program (not a proper CBT trained person) which unsurprisingly had limited results. I am praying perhaps naively, that ED services in our area will be more responsive & effective?! Otherwise we will look at private services if that is recommended/ as good/ better? We will use money we have set aside for the house project if needed which will have a big impact, I'll sell my car and get a tin can to roll around in if I need to, nothing is more important, but I would like to choose wisely for DD's sake.

@WhatsitWiggle thank you, I have ordered both books now, one arriving this pm, the other tomorrow. I've got a lot to learn. DH is fully on board and we will be in lockstep regarding how we proceed. We were still playing catch up yesterday as I was getting advice and he was talking to her at the same time so we hadn't compared notes so speak. I'll be sharing what I learn with him (he works long hours) and have sent him the link to this thread. He is a wonderful dad and DH.

If she’s on ADHD meds that can cause lack of appetite and weight loss

I’ve just checked back on DD’s weight from when we had to send off her obs for her ADHD meds prescription. She has lost 12.6lb (5.7kg) in just over 8 weeks. This has really shocked me and she had already lost weight before the April weight was taken 😣