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…Read More
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…Read More
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…Read More
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…Read More
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…Read More
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…Read More
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,…Read More
When the NYTimes prints a story, it tends to generate conversation, whether we live in New York, Florida, Texas, Utah or Oregon; such is its influence and reach.
On March 14 the NYTimes published an article on what it termed “growing concerns” about residential treatment centers; this article joined at least two others on the subject of eating disorder treatment by the same journalist (here and here). The March 14 article reports on the “rapid” growth of new, competing centers…Read More
At Kartini Clinic we have long been aware of the problem of hypophosphatemia (low blood phosphorus) with refeeding. In past decades when nearly all of our patients came to us via an initial hospitalization for medical instability, we were protected from hypophosphatemia in outpatient or day treatment settings by the fact that we had been so aggressive in testing for it and treating it while they were in the hospital. Today the majority of our patients are not hospitalized and…Read More
History is funny. When looking back over social mores and people’s thinking from decades ago, generations ago, even centuries ago, we often find ourselves puzzled. How could nearly everyone have been so benighted, so wrong about, say, forced sterilization of psychiatric patients, or the infamous Tuskegee syphilis experiment? Wasn't the “right answer”, the upstanding answer, the humanitarian answer obvious?
My 5-year-old granddaughter recently said to her mother in amazement "Mom,…Read More