Friday, 28 August 2009
I didn't realise that I need to get Waif toeat a LOT of calories to make up for her weight loss - nobody quite knows why (it is to do with the body's response to starvation) but this extract from some Maudsley information has a link to studies showing it:
But your child needs lots of calories and a balance of protein, fats and carbohydrates. Most people are
surprised to learn just how many calories it takes to reverse the malnutrition of anorexia. (Some doctors
are surprised about this, too.) While no one can explain exactly why this is true, the answer probably has
to do with how the metabolism is altered by malnutrition. To read more about why so many calories are
needed see these studies.
I have posted the link to recipes in my side-bar.
I have been doing some research and an approach called the Maudsley approach seems to me to make the most sense and to have the highest success rate - 75-90% after five years if the previous course of the illness has been short. This it has been - Waif was over 42kg at the start of the year which, whilst slim, was well within te normal range for a 12 1/2 year old of her height.
The approach also manages not to treat parents like either the enemy or idiots, and instead encourages them to be part of the solution.
The Maudsley hospital is 10 mins on DLR then 1o mins on British Rail from our house so door-to-door would be feasible within 40 minutes tops, so I reckon my mission on Wednesday with the GP is now crystallising: a referral to the Specialist Adolescent Eating Disorders unit at the Maudsley. If we need to pay, we will, but hopefully the NHS or BUPA will cover us one way or the other.
My husband's parents are arriving tonight for the week-end. I am not sure whether to warn his father in advance not to make mention of Annabel's weight or comment on what she is eating. I hope he will figure it out for himself.
The older generation can be a bit odd. Yesterday at lunch (Waif ate the starter sized risotto; her big sister the rib-eye steak and chips; neither touched the bread or pudding), there was an older, very well spoken couple behind us in the restaurant celebrating their 40th wedding anniversary. They were lamenting how little time Richard (presumably their son) got to spend with his children (presumably he is divorced, although he might possibly have been on overseas postings in the army) and in such short chunks of time. "How lovely" I thought. "They have good solid family values and realise how important it is for children to spend time with their fathers as well as their mothers."
Then the man said "yes, Richard doesn't even have time to teach them proper table manners. They are appalling."
Out of all the life skills, anecdotes and wisdom that Richard doesn't have time to pass on to his children, I personally would have ranked table manners quite low down.
I thought I was doing well this morning: I have arranged with the GP that I can pick up a new blood test form. What is more, I have found a walk in blood test clinic that is only 15 minutes drive away. I have also booked the next availbale appointment for the Waif's GP, which is next Wednesday.
I told Waif about the blood test and she refused. I suggested that we measure her weight again and if she had put some on then we could postpone the test. I try to make weighings surprise and instant to be sure that she doesn't drink a pint of water immediately beforehand. Unfortunately the phone rang at that very moment and I had to go downstairs - it was the estate agent whom I had cancelled for this morning in order to be free for the blood test. This meant there was a gap before weigh-in. The good news however is that the Waif came in at 37kg...in clothes but without shoes. I agreed to postpone the blood test. Now I know there is a walk-in centre, I can wait until (let's hope it never happens) Waif is losing weight again, or not putting it on, and take her straight along.
I am considering keeping the GP appointment and going along alone to discuss issues with the GP. I have now read a few websites and they all seem to parrot the mantra that carers should avoid talking to the sufferer about weight or eating habits. She is thirteen! The Maudsley method rubbishes (I think) this approach and says that the parents should dictate what the child eats until she is back to a normal weight. That makes much more sense to me. I am lucky that Waif is generally a compliant child and if I tell her something (eg eating a particular item) is non-negotiable, then she will do it.
I am obsessively calculating the Waif's BMI on different online calculators in the hope of receiving a different answer. All I get is that she is under the first centile for her age and height and should see a health care provider.
I will book an appointment now. I am an incompetent mother as last time I saw the GP (a monthago) he agreed that a blood test would be a good idea and gave me the paperwork. I dutifully booked an appointment for the bloods (there is a two week wait). However in those 2 weeks we went on holiday and the Waif put on a kg or two so, on her return, I cancelled it as a reward. She has lost weight again since then and now I can't find the blood test form. My husband has filed it apparently and knows where it is, but he has not been home whilst I have been awake and I forget to ask him over breakfast to dig it out. He doesn't generally take calls from me during the day or answer emails so communication is difficult. I am this morning going to phone the GP again and get a new form. I will also make an appointment for next week so that I can take the Waif if I need to. I am embarrassed about losing the forms. My embarrassment is immaterial.
Waif was walking down the street yesterday and someone shouted "Eat more meat" to her. Waif couldn't understand as she said she is not vegetarian. Her older sister suggested that they meant she looked too thin.
The head of year at school phoned me back and has agreed that Waif can drop a subject (Spanish) a year early - the idea is to give Waif a little room in her life and less stress. She will have one less homework to complete and 2 or 3 free periods a week. Those could come in handy if she ends up missing lessons due to medical appointments (fingers crossed not) and will allow her some catch-up time.
She also mentioned the website Beat which I had come across before but will now look at more closely. She said that the school nurse (back on Monday) could recommend counsellors. Is that what Waif needs?
Waif and I had planned to go swimming together this morning but Waif has just announced she doesn't want to come in the pool and will just watch. Well, I don't want to push her at the moment - I am not sure why she doesn't want to swim (?perhaps she doesn't want me to see her change). I will go with the flow. We are staying in.
Waif ate two scotch pancakes for breakfast - she only really wanted one but I insisted. She traded me the pear she was going to eat. I am hoping a scotch pancake has more calories than a pear.
She wanted to know what I had eaten for breakfast which is actually nothing as I hate to eat before swimming. She accused me of hypocrisy but I pointed out that once she was in the "normal" range for her weight she could eat what she liked but at the moment she had to eat what I said. I think this is the Maudsley approach. I need to double check.
Tuesday, 25 August 2009
Waif had a hot chocolate mid-morning and then ate three fishfingers, one new potato and a spoonful of baked beans for lunch. She has postponed her piece of fruit for later in the afternoon.
I have left a phone message at her school for the Head of Year to phone back to discuss what help they might be able to give. I am arranging for Waif to drop a subject early (she is just going into year 9) to buy her some extra time during the school day to try to relieve any pressure she may be under. In return, Waif has agreed to practise the piano more, which I should provide a good counterbalance to her academic work, and so provide a stress release. Waif needs to relax a little for she is a complete perfectionist: at the start of every day she draws up a timetable detailing every 15 minutes of the day. What other 13 year old does that? At the moment she is researching an idea I had for inventing a GCSE revision game. Waif says she is approaching it like "Beat the Parents", a children's reality game where the children have to market some kind of product better than the adults do.
Waif baked a cake this morning, which I took as a hopeful sign, but she is refusing to eat any of it as she filled it with strawberries and cream and she does not like cream.
I have today weighed the Waif again - twice a week seems to be reasonable. She comes in at 36.5kg which is reassuring to me but somewhat devastating to her. She immediately stalks off and slams her bedroom door.
I plough on. I insist she eat a sausage toastie for breakfast, but slip in resolve when it came to the apple juice - the Waif wanting calorie free water, and promising to drink the juice later in the day....this is a common ploy on her part:
"Mummy, I am saving my piece of cake to eat later in front of the tv" then, later "oh, mummy, supper was so filling, I don't have space for the cake. I will eat it tomorrow." etc etc. She is so plausibly charming.
I have googled Anorexia and Mummy and found this article in the Times:
Unfortunately, it addresses only the problem of some woman worrying that her daughter might be too fat!! The Waif is def not too fat. Bi-afran is how she looks :-(
I have taken note, though, of the ideal day's food menu provided at the end of the article. Sigh, hitherto I have rarely served snacks or puddings so my children would not eat as much as in the ideal day's food diary. By some way :-( I guess that is why we are all on the slim side . I don't mind that but Waif has taken it too far.
Left to her own devices, Waif is willing to eat only ONE thing for breakfast (either a small bowl of milkless cereal OR a croissant without butter OR a bowl of fruit), three quarters of a tuna sandwich for lunch and then some fish and vegetables for supper. I estimate this to total about 1,000 calories - well short of the 1,800 she needs.
My older daughter buys Hello magazine and Shout and Look. On a flick through, I see they are devoted to slagging off celebrity women for being a) overweight and b) underweight. I am going to ban those mags from the house. Why does anyone buy them anyway? What a load of drivel.
I cannot decide whether or not to book another doctor's appointment. Waif will point out that she has put on weight in the last few days. I am going to change tack and contact Waif's school for advice. It being a high pressured London girls' private school, they have a vast bank of knowledge and resources (I hope).
Sunday, 23 August 2009
I start this journal in order to marshall my thoughts and to provide a record of a journey that I hope will prove short and easy but suspect might be rather rocky and long.
My gorgeous younger daughter, the Waif, is 13 years old and 35.5kg (that's just over 5 and a half stone). She is taller than I am, and I am slim at 8 stone (51kg).
Her BMI is 13.87 - I have just checked it at Findmybmi.co.uk. This site also tells me that this puts her in the anorexic category. She is a moderate risk of:
- Type 2 diabetes
- Coronary heart disease
- Gallbladder disease
- Sleep apnea
- Endometrial, breast, and colon cancer
Hmmm.... I may take this with a pinch of salt as I see that the recommendation is that she try a free supplement of Acai Berries. Double hmmm.... this site is not one I shall visit again.
Yes, of course I have taken her to the GP, who seems quite unconcerned, which is both comforting he should know what he is talking about shouldn't he?) and worrying (I am sure there is something wrong).
Daughter Mine had got to 39kg after 2 weks of strict 3 meals a day (despite any impact this might have on our day) on holiday in France but that has fallen off in the last fortnight, whcih included a week on a PGL riding holiday where I am guessing she ate hardly anything at all.
Breakfast: she ate a small Pain au chocolat, two slices of peach and drank a carton of OJ.
I am determined to fit in elevensies (some fruit is al she will agree to but is better than notihing) a lunch (picnic in Greenwich park) and supper (roast lamb and veg). I will even now determine to cook an apple crumble for pudding.
I predict that the rest of us inthe faily are going to put on weight! This will be worthwhile if it enables the Waif to get back on track.
Perhaps on Tuesday I will get her back to the GP and demand that he does something ...but what? Surely all she can do is eat more?