Re-feeding has its own rewards, though there can be misery and challenge to get there.  I know that some of you who have been through this, either at home or with a team not at home, will be able to relate to what I am talking about.  It’s when the smile comes back. It’s hard to predict when the tipping point will come.  For some it’s within the first 48 hours of beginning to eat: the circulation improves, the cheeks fill with more color, the eyes brighten and they just feel better.  You have to imagine this has to do with a more normal blood sugar.  For some it takes about a week, for some many weeks. Today I walked into the PHP/Day Treatment Unit and spoke with a girl recently discharged from the inpatient level of care.  She had been deeply unhappy, resentful and even oppositional.  I’m sure most of you know what I mean.  Today, she was smiling and I could see what a beautiful child she is. Will she stay smiling? It would be nice to think so, although experience has taught us that there will be rough patches ahead.  One of the roughest comes at about 90% weight restoration, when many patients seem to hit a “phobic weight” and begin to panic.  They may insist that the team “has made them fat enough already”, or that “none of my friends need to weigh as much as I do” or even “my Mom weighed less than this (from pictures) when she was my age” or (worst of all) “My Mom (or sister) weighs less than this right now”. And partly because of the way weight distributes during the initial phases of re-feeding and partly because it is so hard to tolerate our own child’s distress, parents may begin to lobby the team to slow weight gain down or to stop it altogether.  This is where our metabolic labs (Weight restoration 2.0) helps us, as the kids know that our weight goals are not arbitrary or based on the doctor’s opinion of what they should weigh.  Parents may need to be re-buttressed at this point, because, damn it!  It’s hard!! The smile may disappear for a while, but it does come back, and to hear parents say “I’ve got my child back!” makes it all worthwhile.