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.

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.