weight; height thingie stats

I have been surfing and reckon this is the age: weight: height thingie on which scale Waif is 77%.

In other words, she is 77% of the weight she should be for her age and height.

I have not yet found an actual chart on which I can check the measurements myself so working backwards, her ideal weight is 100/77 x current weight = 47kg.

Hmmm... Waif and I are aiming at 42-44kg. That represents about 90% of a "normal" weight for her age and height, and is well above the 85% danger cut-off.

40kg is her 85% level. This is the level above which she would not be automatically diagnosed as having an ED. Funnily enough, my initial instinct to tell her that if she fell below 38kg then I would be taking her to the doctor, was about right, especially as she may have been 1 cm shorter in the late Spring.

fall out

Waif is still in bed, 36 hours after her Maudsley visit.

Yesterday she had a sore throat and headache, no doubt due to her continuous crying :-( Today, she has a tummy ache.

She is reluctant to go in to school because she says that she won't learn anything and will just be miserable as she is in pain. That seems like a reasonable argument. I will, however, put her under gentle but firm pressure to head back to school tomorrow as I don't want her to miss so much school that catching up will put her under stress. I am not sure whether her pains today are viral, but at least her mood is improved.

I took her to her GP yesterday, as suggested by the Maudsley doctor. The GP agreed that Waif has a lump on her neck, but is certain that it is a harmless goitre - a swollen thyroid gland that is not uncommon in puberty. Her gland is not one that is overactive as her blood tests were normal so he said not to worry about the lump as long as it remains soft and mobile.

I wonder if it is affecting her swallowing.

The Maudsley psychiatrist kindly phoned me back. Waif is begging me not to take her back there: she says that she is now eating sensibly (she is, and already looks healthier after 10 days) and wants me to promise that if she puts on weight then I will cancel future appointments.

I asked the psychiatrist whether perhaps I was inadvertantly medicalising a normal part of Waif's growing up. He agreed that her questionnaires showed none of the markers of Anorexia Nervosa apart from the weight loss: she is not depressed, not anxious, not concerned about body image etc. This convinces them that she must be hiding things, or else suffers from EDNOS (Eating disorder, not otherwise specified)....hmmm...she doesn't seem to fit into the Wikipedia categories.

I am worried that she may have some sort of underlying wasting physical condition that is not being explored because a psychiatrist is instead looking for some kind of deep psychological trauma. Waif is in a Catch 22 situation because they won't believe her when she tells them there isn't one. Waif reckons they are 'giving' her emotional trauma by trying to put words into her mouth eg the psychiatrist asked her which chocolate bars she liked, and she said that she didn't really eat chocolate bars. He then pressed her to name a favourite so she said Mars bars (I have never known her eat one). Then later in the interview, the family therapist (nicely, and with a smile) suggested Waif was fibbing by saying that she (the FT) doubted Waif really ate Mars bars as she claimed.

Hmmm... although I quite liked the family therapist who seemed firm, experienced and direct, I was not sure about her intellect. She told Waif that the criterion for anorexia was a weight:height ratio (or some such term) of 84% or less, and Waif's was 77%. She then sought to explain this by saying:

"So, Waif, do you understand? That means that if we took one hundred girls your height and age and lined them up, then..then....." She petered out, confused.

"then you would be the first in line because you are in the first centile" I helped out after an embarrassing silence, realising that the FT was confusing centiles with her weight:height ratio thingie (which scale I must track down...I shall ask my friend who is the borough child psychiatrist and also treats anorexics).

Even non-numeric husband said afterwards he thought the FT was daft at this point as he couldn't imagine why you would line up 100 children where the fattest would be "normal", and the thinnest would be weightless, and Waif 23rd in the line, as FT appeared to be doing. I was surprised as I would expect an ED specialist to be familiar with the various types of scale and measurement. Fortnunately, the psychiatrist said that it would be he alone who conducted the future consultations. Perhaps they have decided we are too functional to need a Family Therapist.

Sigh, I hope I don't sound ungrateful. It is a marvellous thing to have access to the best service in the world for Eating Disorders, I just hope it is the right place for Waif. Half of me feels that we should be able to sort this out intra-family but the logical part of me knows that I was failing on that front as Waif has lost 10% of her body weight SINCE I have been trying to encourage her to eat more.

Ho hum, I have agreed that Waif should attend her next appointment at the Maudsley on Friday next week. This is the last day that I have on sabbatical, and I will be back at work the week after, so future visits will be very awkward unless they are on Mondays (my day off).

Meantime, I am advertising locally for someone to be home after school to cook and supervise the girls' supper.

How The Maudsley went

Waif had her first visit yesterday to the Eating Disorders Clinic at The Maudsley.

It is a beautiful centre - very clean, state-of-the art and professional. Waif had a whole team devoted to her for 3 hours: a psychiatrist, a family therapist, a psychologist and an assistant psychologist.

Waif, hubby and I were interviewed by the psychiatrist and handed in our questionnaires. There were cameras and sound equipment in the room and the rest of the team watched us on screens. That was unnerving but we quite soon grew used to it .

Waif coped seemingly well with all sorts of questions: she was consistent in saying that she was happy, thought she was too thin and liked food and eating. Her questionnaire scored ZERO for eating and any other mental disorder. And yet, and yet, her weight for height (or some such term) is 77%, and anything below 84% is considered anorexic. Waif was upset by the therapist suggesting that perhaps Waif was keeping things back.

On her self appraisal quality of life study, Waif said that she had not felt miserable on a single day in the last 28 days, had lots of friends and loved her family :-)

We were each asked at the start to say one thing that we liked in each other. Waif said that Hubby was fun, and then said she couldn't answer for me because she liked everything and I was perfect. Sigh, being a love fest sort, and unoriginal, and because it is true, I said I felt the same about her: she is adorable, hard-working, empathetic, kind, funny, interesting.... She also put that she is closest of all to older daughter. I told OD who was flattered and pleased :-) We are so lucky to have children that get on so well with one another, and always have.

The psychiatrist thought that Waif should have a scan for the lump on her neck. I have booked an appointment with the GP for this afternoon. Although unlikely, perhaps there is a purely physical reason for Waif's weight loss. She has certainly been eating well in my presence recently but only slowly gaining a kilo or two.

They sent us away with a meal plan and an appointment for next Friday.

So, all went seemingly well.

But the Waif has been in tears of despair and agony since we have returned - 17 hours of tears and misery. She was so happy before :-( Perhaps the Maudsley is a blind alley. Perhaps I am making a naturally thin child deeply self conscious and unhappy :-( I have called the psychiatrist just now to talk to him but they have two more new patients today and are very busy so there is no guarantee of a call back. I am not sure what I will say - I am tempted to float the idea of Waif not returning if she continues to eat well and put on weight, but first I want to know if her kind of reaction is normal or not.

Waif has also picked at her skin in the night so that she has raw patches along her arms and legs :-(

I am about to sit with her and watch a gentle Disney film with her wrapped in my arms and see if she feels better.

Forms, forms and more forms

:-) The forms arrived from the Maudsley although not in time for me to post them back to arrive there before we do on Monday morning as Waif needs to add her tuppence worth tonight. They said I could just bring them on the day. I hope that doesn't matter.

I realise how lovely is the Waif. The questionnaires are several: one to see if she has OCD (nope), one to see if she is lacking social skills (nope), one to see if she worries unduly (nope) and one general one in which I note that she is great with people, does all her work beautifully, keeps her bedroom tidy, looks lovely, is caring, gets on with everyone in the family, is easy company, has never struggled at school and is never argumentative, doesn't have bad nightmares and has never seemed depressed, and never been bullied.

The only questions where I have anything to say is that she is scared of spiders, quite wants to change schools and often sleeps in my bed. Hmm....that last one being unusual at 13.

I am glad yet trepidatious that we are going on Monday. I have not yet consented to the hospital being in touch with the school because I first want to discuss that with Waif's care team. I don't want to create problems for Waif at school.

Disappointment

Waif was apparently having such a good week. Whilst she never ate much in front of me, she was taking in substantial snack for morning recreation (usually chicken soup), telling me that she was eating lunch and then eating a reasonable supper with pudding (even if only a single biscuit) in my presence. Yesterday, her older sister told me that she had seen Waif at lunchtime eating a fruit salad that had supposedly been her Tuesday snack, and not eating lunch. I realised that, like it or not, I needed to weigh Waif again and not purely wait for our first appointment at the Maudsley Hospital on Monday.

I was optimistic at the weigh-in this morning even though I was aware that this was all relying on her honesty, but immensely disappointed to discover that she has lost weight. Older Daughter thinks that Waif may have been dismayed last week at having put some weight on and was determined to take it off.

I am now going to insist that Waif eats more than a bowl of bran flakes for breakfast. Today I cooked scrambled eggs on toast with tomatoes, and Waif also ate a jelly. I was prepared to sit her ther until she finished even if it meant missing our 7.10am deadline for the school bus. Luckily, however, she ate it without complaint. I realise from reading message boards how fortunate we are that she isostensibly a very compliant child.

Hmmm...Waif suddenly announced to me in the car yesterday on the home from school run that she is a very good liar and that's why she never gets into trouble. Hmmm.......I wonder if she was telling me something and indirectly asking for some help.

Meanwhile our questionnaire from the Maudsley has not arrived. I telephoned on Tuesda morning and discovered that they had not sent it. They muttered something about the postal strike but I don't see why that had prevented them from posting it. THe lady said she would send it right away, first class. It didn't arrive yesterday. I shall wait for the morning post and then chase them again.

I asked my husband this morning whether he has yet read any of the links I have sent him on the Maudsley approach. He hasn't. I am not sure that he realises that this should be a priority for him. I anticipate Monday at the Maudsley will be a shock for him. And for me. I still hold onto the tenuous hope that they will tell us that it is all a big mistake and we should go home - Husband is right and she is simply naturally very thin and not abnormal at a BMI of 14.8.

Heartbreaking

I followed Laura Collins' kind steer and went to read the messageboard at www.aroundthedinnertable.org.

This thread, about a ten year old girl and her desperate mother, is movingly heartbreaking :-(

http://www.aroundthedinnertable.org/post?id=3545650&trail=100#88

My impression so far is that the UK system of health is better than that clearly prevailing in Australia- I may be lucky living nearby, but Waif had a referral straight through to the Maudsley and she is way off being as ill as poor Elleelephant's daughter.

I only wish I had any advice but am not yet at that stage as I know too little about approaches to ED. I am hoping to learn much more at the Maudsley, and am glad that I seem to have a headstart on the ED and hope to nip it in the bud. It must be terrifying to have a too too thin child simply refusing to eat.

Eating better

Waif seems to be eating very well at the moment, although often not in front of me so I am reserving judgment a little until I have some metrics.

She made herself a large hot chocolate topped with whipped cream and mini marshmallows at breakfast time and took it off to her room. She said yesterday that she had eaten chocolate muffins that she had made at a friends' house, and yet still ate supper and then she took bowls of ice cream down to the tv room for her and her friends.

Waif still looks stick thin but I am seriously hopeful that she must be gaining weight. Perhaps the incentive of an appointment with an eating disorders specialist in 10 days time has proved to be a spur.

I also surreptitiously checked her pulse as I have read that children suffering serious physical effects from anorexia have very low heart rates. Hers seemed fine (maybe 72 bpm).

My husband took her out to lunch today at Selfridges, prior to having her ears pierced. After a slight mishap (the waiter dropped her plate and there was a long wait for a second meal to arrive), she ate well apparently :-) - a whole chicken breast and all her mash. Older daughter chose her usual steak and chips.

When the Selfridges ear piercing plan was hatched a couple of days ago I was considering imposing some weight limit on the treat of ear piercing but didn't have the heart as she was so excited and, as noted above, eating so well.

Despite having been called on Monday afternoon by the Maudsley, I have not yet received written confirmation and the promised questionnaires. Perhaps the recent postal strike action is to blame. If nothing arrives by Tuesday, I shall phone the Maudsley and query the position.

Waif's blood results were fine.

I weighed her again yesterday and she came in at 36.5kg (clothed) so she has not lost weight in the last week or so which is good, and may even have put on some. I have put on 1.5kg what with all the biscuits in the house, to which only I succumb. That is not such a bad thing - some say I am thin (although within a normal range at 52kg and about the same height as Waif).

I had a call from the Eating Disorders Unit at the Maudsley Hospital yesterday. Waif is to come for a 2 hour initial assessment on Monday 21 September. This is brilliant news.

Ideally both I and my husband should attend too. My husband has put it in his diary and is hoping to come. As my sabbatical lasts until 1 October, and in any case I don't work Mondays, I am clear to go too.....I would have gone anyway even if it lost me my job....

Bless the National Health Service. Waif is to be seen by world specialists at no cost whatsoever to us. Whilst we are fortunate in that we would otherwise have paid, this gives me heart that no child need miss out merely because of lack of parental funds.

The lady on the phone said that there were a lot of forms to fill in, and questionnaires, both hard copy and on-line. She stressed that it was important to do this sooner rather than later so I plucked up all my courage and told Waif about the appointment. She was not happy but nor did she outright refuse to contemplate going. I told her that if she put on lots of weight between now and then, then they might simply send her away again. I am not sure I should have said that.

I am doubly fortunate in that the Maudsley Hospital is about 6 minutes drive from Waif's school so she should only miss three periods of school even for a 2 hour appointment.

Meanwhile, I have withdrawn consent for the school nurse to talk to Waif until I have taken specialist advice. From her messages, the nurse is acting more like the school's lawyer than their health care provider: her only goal is seemingly to assess what liability and risk there might be for the school in Waif's continued attendance. I mailed her thanking her for her concern and saying that if at any point she thought Wiaf too fragile to safely be at school then she should immediately let me know and I would get a formal medical opinion from her doctor. Meanwhile I asked if the school provided any kind of support as I had heard that other London day schools might, for instance, require certain children to eat lunch with the nurse so that their intake could be monitored. I have not heard back. I am not expecting a yes, unfortunately.

I still live in hope that the problem will simply disappear and prove to be a storm in a teacup.

Waif had a small piece of toast with a scraping of jam for breakfast today, crusts cut off. I made her a fresh orange juice into which I sneaked a teaspoon of sugar and I insisted she also drank that. She has taken in tomato soup in a thermos for her morning snack. I hope she doesn't decide instead that it is lunch. She is in the dance club after school today so needs some energy.

I am trying not to think about the impact on her teeth of all these unhealthy sugary foods that I am pushing her way.

blood results

Waif's blood results are normal. This is good, I guess, although a physical explanation for her weight loss would have been easier to tackle.

I now await the grinding of administrative wheels for her appointment at the Maudsley. It could be a couple of weeks away......

second day of term, slipping already :-(

I put a croissant and a hot chocolate on the table for Waif at 6.30 this morning. She announced that she no longer likes hot chocolate and wanted a bowl of bran flakes not a croissant. I told her that she had to eat TWO things for breakfast, not one, so she said she would have the bran flakes and an apple juice. I saw her pouring a medium small bowl of flakes and then carefully replace half of them back in the box. When I turned around she put her apple juice carton into the recycling. There was something about it that made me go and check. The carton was still full. I called her back to the table and insisted that she drank it and told her that she relaly must eat TWICE as much as she is currently doing.

I asked Waif what snack she would like to take in for morning recreation. She said that she had already packed biscuits in her bag. Only yesterday she told me that I had to trust her so I did. But older daughter called me into the other room and told me that Waif had packed only ONE small biscuit. I checked. It was true. I put two more in and told Waif that she must eat them AND eat lunch. SIgh, I am not sure if the biscuits are a good idea. I believe that sometimes when Waif eats smething she perceives as a "bad" food (biscuits, chocolate, sweets, pudding) then she tries to make up for it later by skipping a meal. She would be better off with the meals. Next week I shall send her off with healthier snacks eg tuna sandwich or cheese.

Waif has a rollerblading party after school today. I have not yet got to the stage where I am banning her from going out but am seriously worried that she will not eat any food today beyond the bowl of bran flakes. I am going to weigh her on her return (yes, I know it has only been 2 days since I last weighed her) and if she has lost a kg or more since Wednesday then I plan to ground her from after school activities next week so that at least I can supervise a snack at 5pm and supper at 7.30pm.

update on first dy of term

Waif told me that she ate "so many biscuits" at morning rec that she decided to skip lunch. Hmmmm...

So today's tally:

1 bowl of bran flakes

"so many" biscuits......? 3 maybe

Chocolate fridge cake on return from school

Chicken pie and a quarter avacado

Sticky toffee pudding

Not enough real food :-( Not many vitamins and not enough protein or calories.

Calorie estimate: 1400

I will enforce a hot chocolate at 9pm after picking my other daughter up from choir.

first day of term

Waif set off merrily this morning, claiming to be really looking forward to her first day back at school for the new year. She leaves on the 7.10am bus and I expected her home again at 4.45pm. It is a long day and I have to trust that she has eaten one or two of the biscuits in the box she took in to school to share, and that she has eaten lunch (unlike the case in the Spring Term when I discovered - on receiving the lunch bill at the end of term - that she skipped it most days).

The school system does not work well on lunches - if a girl forgets her swipe card (which is used at lunch time as payment) then she can only get something to eat by queuing at the Bursary, apparently getting into trouble - "they get really angry" - and taking a lunch chit. Furthermore it can only be done at 1.15pm, half way through the lunch break, leaving little time then to eat - and is not possible at all if some lunchtime activity is booked in eg a games practice. I did raise this as a problem with the school last term and was told (in a genuine fashion) that a girl forgetting her pass should just go and find the Head of Year or buy something in the cafe. Well, girls are not allowed in the cafe until Year 11, and say that they would not have time/ know where to find the Head of Year.

Older daughter returned home as expected at 4.45pm but no Waif arrived. Apparently Waif has decided to stay on for the hockey trial. As she did not take her phone, I cannot arrange to pick her up so she will not be home until 7pm (on the late coach) which is a long time after her 6.30am bowl of bran flakes. Cicken pie is in the oven (time 6.15pm).

Older daughter forgot her swipe card today, so did that queuing or a chit thing. By then the only lunch left was chicken tikka and rice. She took the chicken but does not like rice and asked if she could have a baked potato instead (from a different counter). She was not allowed. Lunch costs £3.95 - I would have thought a piece of chicken and a baked potato would not be too much to ask.

Progress

The GP yesterday agreed that the time had come for specialist support. He proposes to refer Waif to the Maudsley. He says that there is some administration involved: the surgery is in Lewisham whereas we live in Greenwich. He must refer Waif to Greenwich, knowing that they will on refer to the tertiary centre that is the Maudsley. I understand that the Greenwich psychiatrists routinely on refer to the Maudsley. He cannot however directly refer to the Maudsley even though he knows this is the right place for her, and is fully confident that Greenwich will send her there. Consequently, there may be some delay.

The GP said that I might want to explore the private health insurance route as it might be quicker. I phoned BUPA. I discover that they will happily pay large amounts for inpatient treatment at The Priory, but will pay only up to £1,000 for outpatient treatment at The Maudsley. The logic that The Maudsley approach would be cheaper for them does not seem to cut ice. I guess that's fair enough. I have been advised by my child psychiatist friend to stick with the NHS as she says the Priory admit far too readily as (she speculates, please don't sue me) that is how they make their money, and she advises that the Maudsley is the right place for Waif.

Waif also had her blood taken for testing yesterday. She is needle phobic but, bless her, still submitted to the phlebotomist with only a small amount of damage to her sister's hand whilst it was drawn - ridiculously, I could not go in with her as blood is no longer taken at our doctor's surgery nor at Lewisham Hospital but is instead taken at a few centres throughout the borough (to save money centrally at cost to all the patients instead in terms of transport, time and parking fines). Only 3 or 4 of those centres can cope with children. Only one of those has a walk-in service (otherwise the wait is over 2 weeks, seemingly, to get blood taken). That particular centre is in the residential centre of Catford with only 4 pay-and-display places for cars, all taken as the clinic has well over thirty patients queuing, so I had to sit in the car in a residential bay. I would not want to be the parent of a child needing frequent blood tests in Lewisham. I was lucky that Waif's older sister is so sensible, so nearly grown up and so present.

Neither the GP nor I are expecting the bloods to turn up anything but I can see that it must be done to rule out some physical explanation for the Waif's loss of appetite.

Perhaps due to the prompt of the doctor telling her she was too thin and might have to see a specialist, perhaps due in part to the long talk we had the night before about the dangers of under-eating, Waif ate so well yesterday :-) including shepherd's pie and cauliflower cheese for lunch, and a large steak and chips followed by honeycomb ice cream and toffee sauce for her supper. I slept well last night for the first time in days. So did Waif - she was not in my bed for the first time in weeks....she slept in the spare bed in her older sister's room........eschewing either of her own bedrooms.

Meanwhile, the school nurse phoned me yesterday wanting to know how Waif was doing - she had phoned me last term, concerned about Waif's loss of weight which had been pointed out to her by the sports teachers, and today is the first day of the new year. She wanted my permission to talk to Waif fortnightly to monitor if she was well enough to attend school. I am reluctant as Waif will hate it but felt that I was not being given more than a token choice, so I acquiesced. I shall have to forewarn Waif who will be mortified.

I am today hopeful that Waif is truly going to start eating and getting better. My cleaner is a fully qualified social and health care worker in Hungary, and she reassured me yesterday that most children with eating disorders recover rapidly.

Middle of the night

It is 1.30am and I cannot sleep. I am sick with worry. I am in a story I don't want to be in. I want to break out of it. I want the Waif to break out of it.

I weighed Waif last night and despite a week of her eating reasonably (ish), she came in at 35.5kg - that will translate to 35kg in the morning. This is further loss. I am losing her. She is fading. How did she get here? Why won't she see how she is damaging her body? I should say how the anorexia is damaging her body.

Pudding will no longer be optional.

Waif disappears sharply at the end of every meal (pre pudding). I have never insisted that my children formally request to leave the table and she slips away unseen whilst I am clearing the plates. I am now slightly worried that she may be making herself sick.

She tried to avoid eating today by claiming she felt sick. This may or may not be true - her sister had a tummy bug over the weekend, but I could not afford to allow her not to eat.

I am going to institute a rule that she does not leave the table without permission. She is to stay at the table until she has eaten enough and even digested it a little. She is going to hate me for a while. I can't stand back and watch her disappear before my eyes.

I am so glad that I am seeing the doctor later today. I have to be careful to be calm and rational when I feel out of control and demented. This whole situation feels unreal.

I can't believe that I have let this ride for so long. When I first became concerned that Waif was losing weight, she was 42kg. Tis was after a term of skipping lunch so I expect she was nearer 44 or 45kg back in January. I told her then that if she got to 38kg I would consult the GP with her.

She reached 38kg in about June. So by then she had lost at least 10% of her body weight (this a 12 year old), at a conservative estimate, and yet I allowed the doctor to fob me off with a "Let's get her back in 3 months and see how she is going."

I am not going to allow that complacency today. From the litereature, it seems that the earlier anorexia is treated, the better the outcome. My stomach churns when I read the morbidity and mortality statistics for anorexia. Waif HAS to be treatable. She HAS to get better. I fell physically sick when I think about her emaciated state. How is she feeling, I wonder? She doesn't want to talk about it. I love her so much and this a nightmare. Nothing else is important in my life right now.

My older daughter is supposed to have read 1984 over the holidays. She has not so far (one day to go) although she HAS spent 2 weeks on Spanish camp (not much fun) and fully revised chemistry ahead of next Summer's GCSE's, and done a week's work experience in a hospital for she wants to be a doctor. So she has not been completely idle. Nonetheless, my husband told her last night that she would have her pocket money stopped until she reads 1984. She was in tears wondering why Waif gets only rewards (eat this and I will buy you cinema tickets) and she gets only punishments :-( We need to be careful not to lose sight of her needs too. I told her that of course we wouldn't stop her pocket money but that it really was a good idea to read her set book as it wouldn't go away and she has to read it some time. My older daughter is so thoroughly lovely and kind and intelligent. I am not sure how much to share with her. Enlisting her help would be invaluable yet I have no wish to place heavy burdens on her 15 year old shoulders. It is no fun being the sibling of a sick child.

Pre doctor thoughts

Phew, the last four days have been quite tricky: having guests and yet concentrating on Waif eating properly is tough and I am not sure we fully succeeded. There have been many tears.

Last night we had drinks with some good friends, including Anna. Anna is the borough child psychiatrist. She thinks that the Waif looks far too thin and also ill. She advises that we get an immediate referral to the Maudsley. She said we "didn't necessarily have to go privately". I do not care greatly - if we have to pay, then we will pay. We are fortunate that we can. OTOH if the NHS and/or BUPA will stump up then I shall gratefully accept but really that is a secondary issue that I am happy to address after treatment commences.

This morning, Waif had a small bowl of bran flakes. At 10.30am I made her a snack of a chipolata toasted sandwich. Waif carefully picked out one chipolata and ate half of it. She then negotiated down to a swap for a quarter bowl of yoghurt and sugar.

She ate a medium lunch (some chicken pie and ratatouille - no potatoes, no bread and the pie crust cut off and left), and says that she ate a large mars bar in the cinema this afternoon.

Sigh, I hope this proves to be a storm in a teacup.

I am worried that if Waif gets a stomach upset (as her older sister has had for the last couple of days) or swine flu, then she will not have sufficient strength to fight it off without becoming seriously ill. This is one of the questions I want the GP to answer for me tomorrow.

I have made a prebooked appointment for the Waif tomorrow afternoon at the GP surgery. I will phone in the morning and get an on-the-day appointment for the morning to discuss issues in the morning with the doc. I shall tell him that as far as I can tell (and I am not wholly incompetent) Waif has a BMI of about 14.5, is in the bottom first weight centile for her age and height, and is reluctant to eat properly. I shall ask him for a referral. If he is still reluctant I shall point out that Waif has lost over 15% of her body weight since Christmas and at what weight exactly would he make a referral? I shall point out that again, as far as I can tell, early intervention is much more effective than late.

To my utter surprise, my husband has agreed to go to work late tomorrow so that he can attend the morning GP appointment. I am really pleased about this as he will need to be on board with any treatment approach, and I also can't help believing that a 6ft 4, besuited city lawyer will be taken more seriously than a middle aged neurotic housewife.

School is the next big hurdle: do I allow Waif to choose her own school lunch (and possibly skip it) or do I turn up every lunch hour to supervise the eating of sandwiches in the carpark, or do I send her in to school only for half days? I need some advice as to how seriously to treat this. Luckily as Waif is entering Year 9, this is not a big exam year giving us some leeway to miss lessons.

I have not weighed Waif for 7 days as it upsets her so, and weighing a pig does nothing to fatten it. I trust the doctor will do so tomorrow.