I got off the phone with a college student health doctor last week with the sinking feeling that I get when I have not been able to convey the rationale for what we do here at Kartini Clinic. Let me give you some background: college-aged youth with an eating disorder who graduate from our Day Treatment Program and return to college face many hurdles to remaining in good remission. We long ago learned that we are not able to manage them from afar and therefore make every effort to… Read More

By Julie K. O'Toole MD, MPH

I have decided occasionally to write about topics that may be of more interest to practicing physicians and other providers confronted with difficult or unusual cases related to disordered eating. This is one of those topics.

Food phobia of childhood, primarily seen in pre- or early pubertal children, was first described as such by Bryan Lask (pediatric psychiatrist) and Rachel Bryant-Waugh (psychologist) in the early 1990's as a result of their work at…

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This morning I was reading a mother's cry for help on Laura Collins' blog "Around the Dinner Table." The scared mother spoke of her 10 year old daughter's struggle and her own ambivalence about what to do. There were many supportive responses from other parents and although I have a lot to say on this subject, I did not chime in for fear of sounding self-promoting. Yet the very young child is Kartini Clinic's special area of expertise. So I will take this opportunity to speak to… Read More

Determining "ideal" body weight in children who suffer from anorexia nervosa is complex. Pediatric patients cannot be treated like "little adults". An example of this principle is the way medication is dosed in childhood. The right dose of an antibiotic for a newborn is different than the right dose for a two year old or for a 14 year old. And so it is for setting "weight goals" in pediatric eating disorder patients.

Bear with me then, because this is not simple. And not only is…

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Reporting on a new article

I just reviewed an article which should help us answer the question: how much will my young daughter with anorexia nervosa need to weigh in order to grow normally again and to get a period?

First a few jargon words to know:

Menarche = the first menstrual period
Amenorrhea = no menstrual periods
Primary amenorrhea = never had a menstrual period
Premenarcheal = before menarche
Linear growth = growth in height

Ingemar Swenne of the Uppsala University Children's…

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I have recently received some feedback about our food plan that impels me to add a few details. The food plan has been the backbone of treatment at the Kartini Clinic for many years, but there are some things you should know about it. 1. It was developed to enable families to feed their children without resort to counting calories or exchanges. The child chooses among real food items that have been counted already (by us). Many different food choices are available. 2. Within the… Read More

Most of you will have heard me say that weight restoration is the cornerstone of treatment in childhood anorexia nervosa, without which you get nothing. It makes sense, you say? And yet we still get children referred to us who have been in hospital or residential centers and were discharged well below a restored weight—or even discharged weighing less than when they entered! How can that be? We gnash our teeth.

In my opinion it is a reflection of the general reluctance to accept…

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I have been asked many times to explain why I went into the treatment of pediatric eating disorders.

Did I have an eating disorder myself? Did I have a family member who suffered from one? Does one of my three daughters or my son have one? The answer to all of these suppositions is "no". I have written the following in the introduction to my book Give Food A Chance (to be published in 2008), written for pediatric providers and interested parents of our patients.

In 1980 I graduated…

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Why research matters

We are all busy at the Kartini Clinic, from the front office folks who answer calls, take messages, deal with upset or even irate parents, to the business and management folks who definitely deal with scared, upset and irate parents and uncooperative insurance companies, to the doctors, the therapists, the therapist assistants ….. busy, busy. The core of all our work is taking care of kids. Then after a long day of taking care of kids, we try and balance this…

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Here it goes: my first blog at the age of nearly 58. Yes that's right, kids, if you are reading this, you now know how old your doctor is. See those gray hairs? Cleverly disguised with color, they are the result of suffering, arguing, laughing and crying along with our patients and their families. They are the result of being called to the hospital because a new child's heart has stopped, or called to argue with parents who want to leave "against medical advice" because the "rules…

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