Our second appointment at the specialist eating disorder clinic took place four days ago. We saw a psychologist and a therapist, with the latter leading. They were both very good.
Unfortunately, though, our daughter had lost more weight. The rate of loss has decreased, from a kilo a week to, roughly, 600 grammes, but that is scant consolation. Now the poor child is beginning to suffer a few health consequences: she has difficulty with bladder control and her feet are a mess, a combination of poor circulation (which is part of the long-haul battle) and poor shoes (which we put right immediately).
The therapist made a note of the typical amounts of food we have been giving our daughter and then, in a new column, wrote down all the additional things she should be consuming. At the end of that, she asked me which of these additions I believed we could add to our child’s diet immediately.
Additional things that she will have to consume at school—a mid-morning snack of a banana, a cereal bar or a smoothie, plus an additional, high-calorie element at lunchtime, such as a packet of crisps or a chocolate biscuit—will have to weight as the care team knows it would be hard to implement that when we, the parents, cannot be there.
We are left with a slice of toast with spread and jam and a glass of juice in addition to the cereal she had been having for breakfast. On returning home from school at about 4.00 pm, she has a hot chocolate drink made with milk. She has a bigger portion at dinner, plus whatever pudding we are having (apple crumble, ice-cream et cetera).
The team wants to add a snack before bedtime too, but we find ourselves eating a little later than a lot of people here and the end of dinner is often quite close to bedtime. So we have not been doing that either.
On timing, the therapist said we have to put time-limits on the meals: 30 minutes to get breakfast eaten, 20 minutes for the hot chocolate, 45 minutes for dinner. If she manages to keep to these times, she gets to go on a short walk.
That first day, when our daughter came home from school, she went to her room immediately. I heard some crying and went to see if she was all right. I asked her to come downstairs. It was clear she was just avoiding the hot chocolate. So I made it anyway and took it up. She wailed.
Eventually I got her to bring it downstairs. The 20 minutes were nearly up and she hadn’t touched it. I thought I was going to fall at the first extra hurdle. But on 19 minutes, she picked up the mug and gulped it down. Dinner went not too badly, although she seems always to want to cut everything up into tiny pieces before starting to eat.
The other good thing we learned at the appointment was not to get into ‘anorexia conversations’. When the child is complaining about portion sizes and the injustice of today’s portion compared to yesterday’s, you can just say: “This is an anorexia conversation, and I’m not having it with you.”
If this sounds too simple, I have to tell you that for the most part in the four days since the clinic it has worked for us. It is an advantage here that our daughter is still so young. I don’t know if that tactic would work too well with a 16-year-old.
The bottom line is that in the last four days, our child’s food intake has increased substantially. She is still very tearful and down, but we strongly believe every mouthful is doing her good and that a physical improvement will lead to an overall improvement.
I will admit I was afraid the care team might say we had had enough of a chance to halt the weight loss and that it was now at too dangerous a level to allow us to keep our child at home. I am still afraid that might happen. I don’t know how much food someone in her condition needs to eat every day to build their weight up, but I suspect it’s a lot. The people at the clinic put her at 34.2 kilos. She is “very significantly underweight”, they said. Please God the food increase of the last few days will be sustainable and will be enough to make a difference.
Peace to all, especially those caught up in a fight against anorexia.