ARFID Revisited

posted by Julie O'Toole on March 7, 2018 at 12:55pm







The longer I treat children with eating disorders, the more I begin to doubt the usefulness of exact nomenclature.

In 2000, at the founding of our Kartini Day Treatment Unit, now called Kartini Partial Hospitalization Program, nearly 80% of all the patients we saw carried a diagnosis of anorexia nervosa (correct, I think), of which the overwhelming majority had the restricting form. This may have been partially an artifact of the age of the patients we treated…

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The Use of NG tubes in Pediatric Eating Disorder Treatment

posted by Julie O'Toole on January 18, 2018 at 12:14pm

It's funny what one gets criticized for. Recently a couple of young patients have let me know that some other eating disorder providers in our community have tried to steer them away from Kartini Clinic because “Kartini Clinic just shoves a tube in everyone”.  You can imagine this was rather startling to hear. And -- goes without saying, I hope! -- quite untrue.

The history of nasogastric (NG) tube use at Kartini Clinic is this: on our pediatric inpatient unit we have always been…

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Max and Merry Christmas

posted by Julie O'Toole on December 21, 2017 at 3:56pm

We just graduated an 11 year old boy from the Kartini Clinic and on his way out, proudly, he showed me a project he had been working on. He was supposed to build and design his own box of cereal and then promote it.

And since his cereal box is just about the cutest thing I have ever seen, I have to share it with you; he of course gave me permission to do so. Merry Christmas.


The front of his box: "Max's marvelous o[a]ts" with exhortation: "Allwase be coo








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Life Stops Until You Eat

posted by Julie O'Toole on December 5, 2017 at 10:52am

When patients graduate from the Kartini Clinic I am often asked by the anxious/happy parents how they are to deal with any eating disorder symptoms going forward.  What if they refuse to follow their meal plan?  What if they lose weight? Should they see a therapist for this? A dietitian for that? 

What I tell them is this:  You are the expert in your child’s meal plan.  You know far better than any professional what degree of mealtime supervision is still needed (100% at first).…

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Thanksgiving with your child

posted by Julie O'Toole on November 21, 2017 at 10:56am

Here we go into our season of Thanksgiving again. And we, at Kartini Clinic, give thanks for a lot of things: for the healing of our patients, for the continued evolution of  (more) affordable healthcare for families, for enough food to put on the table, for the health and safety of our loved ones. 

That’s the good side of Thanksgiving for us, but there is a challenging side as well.  Thanksgiving is not just about gratitude in this country.  Traditionally it has also been about…

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Meet Ryla

posted by Julie O'Toole on November 9, 2017 at 12:25pm

We had a therapy dog at Kartini Clinic for many years, and when the honorable Cleo, a black standard poodle, died it left a hole in our hearts.

I’ll never forget the day a small boy arrived in our office from another Children’s Hospital. His mother had removed him from the locked psychiatric ward where he had been placed for anorexia nervosa and terrible social anxiety. His transfer records labeled him as, “the worst case they had seen.” His mother was terrified we would say we…

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Building Trust in Food One Sandwich at a Time: Introducing Annastacia Weiss

posted by Julie O'Toole on October 26, 2017 at 1:49pm

It’s lunchtime at Kartini Clinic, and patients in our partial hospitalization program are settling in for their midday meal. Joining them at the table is Nutrition Counselor Annastacia Weiss. Annastacia came to Kartini Clinic with decades of culinary experience. She studied at Western Culinary Institute and the Institute for Integrative Nutrition in New York City, interned at farms, founded the much loved North Portland cafe SweeDeeDee, and incorporated her knowledge of food as…

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posted by Julie O'Toole on October 12, 2017 at 12:32pm

In the treatment of children and adolescents with eating disorders, depression is a not uncommon finding. Sometimes we identify it on admission to Kartini Clinic, sometimes it has already been identified before the patient ever saw us, and sometimes it is a residual of otherwise successful treatment. The latter is especially frustrating.

There is a saying in medicine, “when you leave the appointment feeling depressed, you know the patient's diagnosis.” Which might be why many…

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Back To School And The Risk Of Relapse

posted by Julie O'Toole on September 28, 2017 at 10:51am

When you practice as long as I have in the field of childhood eating disorders, one thing becomes abundantly clear: there are cycles to the frequency with which patients appear on our doorstep for treatment -- and on the doorsteps of all the other treatment centers as well. The trouble is, it has proven difficult to understand the peaks and troughs of these cycles and correlate them to much of anything. But there do seem to be a few tentatively recognizable patterns. And these…

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Mood and Treatment

posted by Julie O'Toole on September 13, 2017 at 1:45pm

Mood is a hard thing to measure, a chimera at times, hard to grasp, hard to define. Good mood, while often eluding exact definition, is obvious to the observer: the step is light, the smile is on, the shoulders are straight, the energy level is high. Low mood is just that: the shoulders are held low, the facial features droop, the light goes out of the eyes and energy is… low.

Depression seems to be expressed as consistently low mood. It is hard to experience and it is hard to be…

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