At Change Creates Change, we use the Refeeding Hierarchy™️ as a guide for the refeeding process.
What is the Refeeding Process?
The refeeding process is needed when folks who are undernourished increase their caloric intake after consuming little to no food for a prolonged period of time. In eating disorder recovery, the refeeding process is very important as it helps to repair the damage that has occurred to your child’s body as a result of the eating disorder. It is important to remember that the refeeding process must be tailored to each individual’s unique needs.
Refeeding Syndrome
Refeeding syndrome can cause serious harm to your child and is characterized by low electrolyte levels, namely phosphorus, potassium, and magnesium, and in some cases low calcium and sodium levels in your child’s blood work. The risk factors for refeeding syndrome include significant recent weight loss, severe caloric restriction over the past 7-14 days or the presence of a prolonged eating disorder presenting alongside starvation syndrome.
We developed the Refeeding Hierarchy™️ to decrease the risk of folks developing refeeding syndrome during the refeeding process. To reduce the risk, we always say that clients should “start low and go slow”. This means your child should start the refeeding process with a low caloric intake and should slowly increase their caloric intake each day, as tolerated. One of our dietitian nutritionists can guide and your child through this process safely.
The Refeeding Hierarchy™️
Level 1: Foundation of “Enough”
Level 1 is where your child will start at the beginning of the refeeding process. At level 1, our goal is to make sure your child is eating enough. This means your child will only be eating enough to meet their nutritional and fluid needs.
At this level, we don’t focus on how your child is getting the food or what your child is eating. For example, your child may only eat one food for every meal at this stage. That is okay, as long as it is enough to meet their nutritional needs.
Level 2: Macronutrients
Level 2 is where we begin to pay attention to the macronutrients (carbohydrates, fats and proteins) your child is consuming. At this level, we want your child to be consuming an appropriate balance of carbohydrates, fats and proteins. This will allow their body to function optimally.
The Acceptable Macronutrient Distribution Ranges (AMDR) provides a guideline for the caloric amount of each macronutrient an individual should be consuming. AMDRs are a recommended percentage of the daily calories (energy) individuals should consume of each macronutrient. Here is a list of the AMDRs that your child should follow (depending on their age) at this level:
- Males and females 4-18 years of age:
- Carbohydrates: 45-65%
- Fats: 25-35%
- Proteins: 10-30%
- Males and females 19 years of age and older:
- Carbohydrates: 45-65%
- Fats: 20-35%
- Proteins: 10-35%
Level 3: Micronutrients
In level 2, we begin to focus on the micronutrients your child is consuming. This means we start to focus on the vitamins, minerals, fibre and discretionary fluids your child is consuming.
Discretionary fluids refers to fluids that are not essential components of a diet that is balanced in both macronutrients and micronutrients. Examples of discretionary fluids include tea and coffee.
Level 4: Variety
In level 4, we focus on adding variety to your child’s diet. We begin to offer more variety for meals and snacks and encourage your child to eat different kinds of meals and snacks each day.
Level 5: Challenge Foods
Level 5 is when your child can begin to reintroduce their challenge foods back into their diet. Your child should only begin this level when they have successfully completed the previous four levels. Your child’s challenge foods are the foods that they find particularly difficult to consume.
There is no set amount of time that the Refeeding Hierarchy™️ takes to complete because each individual’s recovery looks different. We also have a Creating Change Pathway™️ which outlines how we work through eating disorder recovery with our clients.
If you would like to find out more about how we can support your child in their eating disorder recovery, click below to book a free 15-minute consultation call with us.
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