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Kids are just kids

posted by Julie O'Toole on June 9, 2016 at 8:00am

As some of you already know, at Kartini Clinic we specialize in children and teens with all conditions of disordered eating—but our deepest specialty is children ages 12 and under.

Yesterday I went upstairs to the youngest patient group, which we call the “Fire Group” (Earth, wind and….) to bring them a present I had promised them. At any given time in Fire we have kids with, and those without, nasogastric tubes. We have nine year olds with food phobia, ten year olds with failure to…

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The challenge of family based treatment for college aged youth

posted by Julie O'Toole on May 26, 2016 at 12:52pm

The acceptance and success of family based treatment interventions in the world of eating disorders has been one of the major mental health breakthroughs of the past few decades. Empowering parents to be in charge of re-feeding and in charge of helping their child with anorexia nervosa achieve weight restoration has been a resounding success, especially for the child who is still young enough to be dependent on their parents for schooling, food and shelter. This means children…

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Avoidant Restrictive Food Intake Disorder (ARFID)

posted by Julie O'Toole on May 19, 2016 at 10:31am

In the 2000’s and even earlier, it became apparent that the systems of classifications used to define eating disorders were inadequate to describe the entire spectrum of clinical presentations, especially in children. In the UK, Dasha Nicholls famously wrote: “Children into DSM don’t go,” and I couldn’t have agreed more.

A new classification is established

Then, finally, the DSM was changed to reflect some consensus about pediatric eating disorders among those of us who - across…

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Going Forward: Early Recognition Remains Our Best Defense

posted by Julie O'Toole on May 12, 2016 at 10:40am

June 2nd, 2016 will mark the first World Eating Disorders Action Day, an internationally-recognized day during which members of the eating disorder community, including affected individuals and their families as well as researchers and policy makers, have united virtually to increase access to accurate information, eradicate myths and collectively advocate for resources and policy change. Kartini Clinic is honored to have been asked to submit a blog post about our hopes and goals for…

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Getting Help

posted by Julie O'Toole on May 5, 2016 at 1:17pm

When the care you’re receiving just isn’t good enough

The other day I received a call from a distraught sister-in-law who was visiting my niece, her daughter, in a developing country where this lovely young woman had gone to have adventures and live in a rural setting. My niece had developed a high fever, chills, vomiting and pain in her back, over the kidneys. From a faraway doctor’s point of view, the most likely diagnosis was pyelonephritis or a kidney infection. There followed a…

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As I have said many times in the past, complete weight restoration is the conditio sine qua non of childhood eating disorder treatment -- if you do not get weight restoration, you will get nothing. While facilitating weight restoration, there are a number of biomarkers (in addition to weight gain) we monitor at Kartini Clinic to help ensure our patients' adequate physical and hormonal restoration.

Pubertal Girls: Restoration of Menstruation

In a girl old enough to have periods or…

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Out of the Mouths of Babes

posted by Julie O'Toole on April 21, 2016 at 12:22pm

Coming to terms with the unhealthy side of exercise as the parent of an eating disordered child

One of the most challenging issues faced by all eating disorder providers is that of compulsive and compensatory exercise. Compensatory exercise is where one feels compelled to “exercise food off” even after eating small amounts. Compulsive exercise is less conscious than that, more …well, a compulsion. In children it often looks like they are “jumping out of their skin” with movements…

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Anorexia nervosa and the developing brain

posted by Julie O'Toole on April 14, 2016 at 1:33pm

To say, as adult physicians do, that lifetime mortality from anorexia nervosa is somewhere around ten percent of patients is important and true. It is also, however, an understatement of another toll taken by this illness, particularly in cases of childhood anorexia. Children, more resilient than adults, and having had less time to have developed co-occurring, complicating conditions (e.g. alcohol abuse), are not as likely to die outright, although they can. The most serious effect…

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The treatment of pediatric anorexia nervosa in 2016

posted by Julie O'Toole on April 7, 2016 at 1:13pm

Settings and approaches to treatment

The acute medical management of children with eating disorders can take place in several very different settings, depending on the severity of the illness and the patient’s country of origin. Treatment settings fall, roughly, into three categories: hospital based care; partial or day treatment; and outpatient or home-based care. In the United States, the American Academy of Pediatrics (AAP) has an agreed-upon set of medical criteria, which…

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In few fields have the twin forces of genetics and neurobiology worked as synergistically to profoundly change conceptualization and treatment as they have in the field of eating disorders. And this is particularly true for pediatric eating disorders, where the stakes are so high and the field so new.

The first description of anorexia nervosa in English by Richard Morton (pictured to the right) in 1689 was presented as part of a medical/scientific treatise on wasting diseases (and,…

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