What is the Refeeding Process?
The refeeding process is necessary when an undernourished individual increases their caloric intake after consuming little to no food for a prolonged period of time. In your child’s eating disorder recovery, the refeeding process is very important because it helps to repair the damage that has occurred to your child’s body as a result of their eating disorder. The general guidelines of the refeeding process for an individual living with an eating disorder can be found below. However, it is important to remember that the process must be tailored to each individual’s unique needs.
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What Happens During Refeeding?
Your child will have physical and psychological challenges when they begin the refeeding process. Possible physical issues include bloating, constipation, and gas. When your child was malnourished, their emotions were likely numbed. However, when your child begins eating regular meals again during the refeeding process, these emotions will no longer be numbered which can cause psychological discomfort. Your child’s healthcare team can help you and your child navigate these challenges.
Refeeding Syndrome
During the refeeding process, your child is also at a higher risk of developing refeeding syndrome. Refeeding syndrome can cause serious harm to your child. In refeeding syndrome, electrolyte levels, specifically phosphorus, potassium, and magnesium, and in some cases low calcium and sodium levels decrease in your child’s blood work. Refeeding syndrome labs will be lower than normal limits.
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. A registered dietitian can help you to determine the appropriate caloric intake for your child in order to decrease their risk of refeeding syndrome.
When your child begins the refeeding process their blood sugar increases. An increase of blood sugar triggers the release of insulin into the blood. Then, insulin signals cells to take up the sugar in the bloodstream in an effort to decrease blood sugar. In the refeeding process, the release of insulin into the bloodstream can decrease phosphorus, potassium, magnesium, calcium and sodium levels in the bloodstream. This causes refeeding syndrome. Symptoms of refeeding syndrome include lightheadedness, fatigues, a drop in blood pressure and a drop in heart rate.
What to Expect During the Refeeding Process
Here at Change Creates Change Eating Disorder Care, we use the motto “start low and go slow” and follow the the hierarchy shown above for our refeeding diet. The Levels of the Refeeding HierarchyTM outlines the way in which foods should be reintroduced into your child’s diet during the refeeding process. Your child will begin at Level 1 where they consume “just enough” food. At this level, your child will follow mechanical eating. Mechanical eating focuses on consuming specific quantities of food at specific times each day, rather than focusing on eating based on hunger cues.
It is important to recognize that at Level 1 your child will not be consuming regular meals or have a high caloric intake. Instead, your child will have a low caloric intake that is still high enough to meet their nutritional needs. A lower caloric intake will reduce the risk that your child develops refeeding syndrome and its complications. At the beginning of the refeeding process, you should closely monitor your child. If they are at risk, their blood work should be regularly monitored. Each day, you can expect your child to slowly increase their caloric intake, as tolerated, until they are able to progress to level 2.
“Start low and go slow!”
Level 2 and 3 begin to focus on your child’s intake of macronutrients (carbohydrates, fat, and protein) and micronutrients (vitamins, minerals, fibre, and water). At Level 4, you will slowly introduce more variety into your child’s diet. Finally, at Level 5, you will introduce challenge foods into your child’s diet. Challenge foods include any foods that are especially difficult for your child to consume. It is important to note that challenge foods should not be introduced until the first four levels of the hierarchy have been successfully completed. The ultimate goal of the Refeeding HierarchyTM is for your child to begin eating intuitively. Intuitive eating refers to eating based on our hunger and fullness cues, rather than based on our emotions.
Who Can Help my Child and I Navigate This Process?
The beginning of the refeeding process focuses on the physical wellbeing of your child by slowly increasing their caloric intake, as tolerated, for the start of eating disorder recovery. A registered dietitian can assist you in navigating the refeeding process. It is important to remember that eating disorders are mental illnesses that require more than just the nutrition rehabilitation of your child. Your child is likely experiencing fear, anxiety, guilt, and shame and nutrition therapy will help to improve your child’s self-esteem and relationship with food.
At Change Creates Change Eating Disorder Care, we have a team of registered dietitians and psychotherapists that can help you navigate the refeeding process with your child, by offering support to both you and your child. Change Creates Change is here for you. If you want to learn more about how we can support you and your child, you can book a free 15-minute consultation call with us.
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