16yo refusing to eat or accept there is a problem

[Emmski44]

Hi all, really need some help. My 16 year old dd has been restricting food for a couple of months - she denied it, but has had a crappy summer so we hoped starting college and making new friends would help. She loves college and has made friends but on Thursday night we discovered rotting food in her bedroom that she has been hiding. She admitted sage hasn’t eaten tea for 2 months and then told us she hadn’t eaten since Tuesday. I rang 111, paramedics attended and she very reluctantly agreed to go to hospital after abnormal ecg. 14 hours later, blood tests normal, blood sugar low but not dangerous, ecg ok. She refused all attempts to see mental health team - dr told her even though she was ok now, she wouldn’t be soon - she said she didn’t care. He sent her home with no plan in place. She has still not eaten, I made her soup last night and she threw it down the sink. She has said she might eat an apple today, but she hasn’t eaten since Tuesday and even then only ate a sachet of porridge. She refuses to engage or accept she has an issue, and becomes angry and aggressive when I tell her she needs to eat. What can I do - I do not believe she has capacity to make decisions about her health now but hospital disagreed. I self referred to local ED unit but they said they can’t do anything without her consent!

This is a living hell for you. How much weight do you think she's lost? My experience is that it takes severe malnourishment before much is done. Big hugs.

I am so sorry OP, sounds like a nightmare.

V. surprised docs didn't do more. You obviously don't have to say,but is she at a dangerously thin point?

Would it be possible to lay off the breakfast/lunch/dinner concept idea for now,and get in small nibbly bits like mini cheddars,rice cakes,mini kit kats etc.that she could help herself too without the pressure of a sit down meal and all eyes on her? Maybe as nonchalant as possible?

I think she’s lost at least 10kg in the last couple of months. I am terrified that we will have to get to a point where she is dangerously ill before anyone does anything. When I spoke to the dr at the hospital, I said you must know how much better her recovery will be if we can start treating this now, but he just shrugged and said without her consent, he had to act within the law!!

She isn’t dangerously thin but has lost a lot of weight quickly. That’s a good idea about the snacking, thanks

Keep an eye on her physical health of course -
any signs of faintness. Palpitations, chest pain, weakness on standing - a+e or 999
regular blood tests at GP in meantime -
Any signs of vomiting / using laxatives etc -
GP medical check up asap
will she allow u to weigh her regularly- weekly - even if she closes her eyes so she doesn’t see the number so you can keep GP informed and they can risk assess against speed of weight loss -

she may have mental capacity now, but that may change - weight loss = cognitive impairment
and an anorectic mindset will over ride logical thoughts anyway.
try to keep rapport / dialogue going as much as possible -
what is upsetting her, what is she struggling with (not food related - so what is the context that this has developed)
see if u can establish shared goals -
e.g can we work together on eating enough to prevent further weight loss and lessen the chances of needing hospital admission ?
What foods are your safer foods that I can get for you ?
what will help you hold your weight and not lose any at the moment ? Me eating with you ?
not commenting on your eating ? Not saying well done if u do eat ??

educate that as hard as that may seem, how would she feel if she in a hospital where the food is ‘prescribed’ and the choice far less,
or needing a nasogastric feeding tube to ensure she does not die of anorexic complications? Said in a non threat way, but conveyed with genuine concern of what the future may look like, if she doesn’t allow herself sufficient fuel in the tank to prevent further weight loss -
talk about stopping weight loss as opposed to working on weight gain for now x

So sorry to hear this, this definitely sounds like ED behaviour
The hospital should have followed the MEEDS checklist, and the things you mention should have flagged the need for help.
Were you referred to camhs? Not sure if they can if your DD will not give consent but they should have
If you can persuade DD to see the GP, even if it's to check her bloods and ecg a (which of course she'll expect to be fine, so may agreee to go to prove you wrong) that should trigger some follow up help.
In the mean time the suggested approach is to calmly offer food, regularly. Food will be terrifying her right now, you need to gently reassure her its ok to have it, and avoid getting into lengthy negotiations
I found the Eva musby bungy jumping video and the BEAT website helpful at this stage
And feel free to join the parent support thread, there are some very wise parents on there!
Take care, its so tough on all the family when this happens

Also to add, she'll be scared of anything she deems high calorie. I'd get her some of the low fat huel drinks or similar protein drinks. Then she's at least got a way of getting some protein and vitamins, even if it's not a balanced diet.

Hi @Emmski44 how is your daughter today. Has she eaten anything?

You have received good advice on here about Meed guidelines. She would be in the red and should be receiving regular medical attention. After an abnormal ECG I would expect them to at least follow up.

The ED team will be concerned about her weight to height percentage, but they will also be concerned about her weight loss. It would be good to get her weight now so you know how much she is losing.

It is very common for people with dirsordered eating to say that they don’t care what happens to them etc etc.

Unfortunately, those of us who have experience with this, know that the NHS is seriously underfunded and often you have to be really at crisis point to receive help.

Do not be afraid to keep taking her to A&E. Children can deteriorate very quickly and on the main thread we have seen this before. I would question of the previous visit was an unsafe discharge. Your GP can urgently refer you to the Eating Disorder team. They should see you within two weeks.

We know how hard and lonely this can feel.

Thank you all for your replies - she ate some porridge late last night and said she had eaten cucumber, although we didn’t see her eat that. She is now saying she will eat snacks when she is hungry - rice cakes, porridge, cucumber and tomatoes, but she is adamant she will not eat meals. I made her tea last night and she just put it in the food bin.

I don’t want to drip feed but she does have a diagnosis of ocd which she has refused treatment for - it looks to me that she has replaced some of the ocd rituals with food rules.

she has also said she will abscond from A and E if she is made to go - I am just keeping a very close an eye on her and will probably need to call 999 again today.

thanks again for your replies and suggestions.

Hi @Emmski44 you are doing all the right things. You have to keep offering the meals even if she doesn’t eat them.

Having OCD and an ED is very common. Lots of our children have anorexia and autism etc

We will be thinking of you today.

I’d call the ambulance again.

She needs to be in hospital on a feeding plan 🤷‍♀️ she sounds very very unwell and they can die when they’ve been restricting food to less than 500 calories a day.

If she absconds from hospital you need to ask about her being sectioned, she sounds like a danger to herself which could be life threatening.

@Emmski44 @Girliefriendlikespuppies is right. We say what we say as we have more knowledge than we wish we had.

It is a frightening time for you all, but the sooner you get help the better. I don’t think she will improve without any medical attention.

This is so difficult for you OP. I have an eating disorder so this is just a personal perspective. Not many people are aware of it but if any pressure is put on me to it I can’t cope and won’t eat anything. I have a few safe foods like salad I can manage when I’m feeling ok but it’s extremely limited. I can only suggest taking the pressure off, asking her what her safe foods are and having plenty available. See if she can be referred to the eating disorder team, there’s currently a waiting list where I am but at least there’s help available in the pipe line.

Hi all, I called 999, a paramedic called and asked if she would go to a walk in centre. She refused, so they sent an ooh GP round. He has just been and basically said there is nothing he can do, she is physically ok at the minute, he doesn’t think A&E will help and will refer to CAMHS despite her sitting there and telling him she will not engage with them.

I feel helpless tbh, I will talk to the ED unit tomorrow and pray they will be more helpful.

Unfortunately we know this happens all the time. The NHS is fundamentally broken when it comes to eating disorders. I would book an appointment with your GP tomorrow and advise that you are seriously concerned for her well being. An urgent referral needs to go into the ED team. Your GP can and should do this.

I am so sorry you aren’t being supported as you should. This is wrong is so many ways and it really is so infuriating as it gives the ED voice power as your daughter now thinks she’s fine, despite not eating.

I know were told to trust the experts, but this GP is wrong, your daughter needs help now, she won’t get better left at home. I am so sorry you aren’t being helped. Please don’t stop fighting them, you shouldn’t have to but you will need to.

I’ve seen advice on similar threads with DC who are under ED services where physical activity - including going to school etc - is off the cards whilst intake is so low.

How do you think she’d react if you explained that she has to stop everything unless she can increase her energy intake?

I would ask if she is willing to talk to a private psychologist of her choosing. Take her out for her favourite type of outing. If she is willing to eat snacks it’s better than nothing. Also try and work out how things are going at school. I think this is a very difficult age with girls. I hope you get some support soon.

@FusionChefGeoff is correct. Most ED services would advise bed rest, although I would say she should be in hospital.

Definitely bed rest should be advised on that intake
Sending support

I know it may sound silly but have you asked he why she isn't eating?

Is she scared of weight gain?
Scared of choking?
Is she finding it difficult to face food?
Does she want to eat but can't?
Is she feeling hungry?

Yes, she said she hates her body. She struggles to talk about her emotions so at the moment, she is saying she does eat - even though it’s less than 200 calories over 5 days - and she will eat if she’s hungry - she says she’s just not hungry and has no appetite.

@Emmski44 it’s good she’s opening up to you.

It’s hit and miss tbh, but we are all just trying to show her how much we love her. Thanks so much for your insights

Can you put her in the car and take her to A&E? Explain she is not safe at home, she needs all of the observations including bloods, ecg, bp and pulse (standing and lying down.)

Once anorexia takes hold it is v difficult to turn around at home and with her very low intake she would be at risk of refeeding syndrome.

Hace you got any leverage? Phone, money, lifts, clubs, college? Anything that would motivate her? Start reading up on FBT, at this point I think your dd is too unwell for it but you will have to take control of her meals and snacks at some point.

The pp is correct in that she needs to be on strict bedrest, if you notice any breathlessness, feeling faint or cold call 999.