A few words from our founder and medical director:

Dr. Julie O'Toole MD, MPH.

I receive many requests for detailed information about our program at the Kartini Clinic for children and adolescents with childhood onset anorexia nervosa. I am a pediatrician and a parent as well as an eating disorder specialist and the care of these children has been my life work - there is nothing about which I am more passionate than a young child who cannot get adequate care for her/his eating disorder. I would prefer to reply individually to each family's inquiry if I could, but since that is just not possible, I would like to try to explain our program here on the Web page in some detail.

At the Kartini Clinic we have a strong belief that childhood anorexia nervosa is a neurobiological brain disorder with a strong genetic component. Even though we don't yet know precisely what causes anorexia, current scientific evidence is very clear: anorexia is not caused by parents and children do not choose to have it. Boys, as well as girls, can acquire it and it strikes wonderful children and fine families, just as diabetes or cancer do. It is a chronic disease with profound psychological ramifications, one that takes the work of an entire specialized team to get into remission, and one whose treatment - as with all chronic illnesses - is lifelong. That is not to say, however, that children with anorexia cannot live fulfilling, high-achieving lives. Successful management of the illness will allow your child to live the future life they wish for themselves.

But first, the disease must be brought into remission. This will require the concerted efforts of parents and providers, working in close cooperation. Ill children cannot and should not be in charge of their medical care, even very bright children with much to offer in the way of suggestions. We don't ask children with leukemia whether they need medicine or what they think their dose should be, and we don't ask this of our patients with anorexia. The state of the art and science in the treatment of childhood eating disorders today is clear: prompt adequate weight restoration and control of brain nutrition is the prerequisite to getting a child into remission and keeping them from a lifetime of suffering and disability. If this does not seem the correct approach to you, then our program would not be the one for you.

Unfortunately there is no way to evaluate an individual child over the phone or internet. There will be no substitute for bringing your child to the clinic for a medical/eating disorder evaluation. This will need to be scheduled ahead of time and takes both parents whenever possible and lasts between two to three hours. Medical insurance may cover this for most children, but insurance arrangements will need to be made before the initial evaluation except in life-threatening cases referred emergently by a physician. At the time of the initial assessment, one of our pediatricians will decide if your child can safely begin the induction of re-feeding outside the hospital. If not, we will help you arrange for hospitalization on our eating disorder service at Legacy Emanuel Children's Hospital, in Portland. The hospital is located across the street from Kartini Clinic's offices. Should you disagree with our decision to hospitalize your child, you will be referred back to your own physician for further care. In some cases children may qualify medically and psychologically for a less intensive level of care once here in Portland, but all levels of care, whether in-patient, day treatment or out-patient, will require the presence of a parent.

The Ronald McDonald House has been a wonderful resource for many of our families who come from out of town and need a place to stay. Please note, however, that only families whose children are 18 years of age or younger are allowed to stay at the House. Should you not be in a position to participate in your child's care and therefore need residential placement (where the child lives in a facility while the parents remain at home), you will need to investigate other programs. For some names and numbers of residential treatment centers go to the web site of the National Eating Disorder Association (NEDA). For a more detailed description of our services, please go to Kartini Programs.