Dr. Brazelton on Self-Esteem in Children

posted by Julie O'Toole on December 19, 2008 at 9:12pm

Happy Holidays and Holy Days to all our Kartini Clinic friends. This blog is a quote from one of my "most admired" pediatricians and another doctor named Joshua Sparrow on the subject of "self esteem", a term I have come to hate for its over-use. As usual, Dr Brazelton has something useful and instructive to say on the subject. I would encourage you to google him for other pearls of wisdom.

I am blogging on self-esteem today because our patients, although they do have eating…

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“Water weight”

posted by Julie O'Toole on October 17, 2008 at 8:35pm

Water Loading Before Appointments

In my previous blog I discussed falsifying weight by wearing weights. This time I would like to discuss a much more common circumstance in which a patient falsifies their weight by trying to drink a lot of water before they are weighed. Often this is done because they know their weight is down (since they have been secretly restricting or exercising), or they are afraid their weight is down and are anxious that the doctor or parents not find out.
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Wearing Weights

posted by Julie O'Toole on October 7, 2008 at 9:41pm
I remember the first time a patient of ours was "caught" wearing weights. I was examining her with her mother and a young resident pediatrician in the room. I noticed that her weight was up, but she looked terrible! So I thought to myself: back to basics, re-examine her carefully in case you have missed some physical sign, maybe she has grown in height and weight has not caught up…..so I repeated her physical exam with an eye to re-assessing her pubertal development. I asked… Read More

Returning to college

posted by Julie O'Toole on September 3, 2008 at 3:28am
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

Food Phobia of Childhood:  a “new” eating disorder

posted by Julie O'Toole on August 26, 2008 at 2:51am

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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The Very Young Patient with Anorexia Nervosa

posted by Julie O'Toole on July 30, 2008 at 9:09pm
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

First Menstruation in very young eating disorder patients

posted by Julie O'Toole on July 3, 2008 at 2:50am


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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More Details about Kartini Clinic’s Meal Plan

posted by Julie O'Toole on March 15, 2008 at 2:21am

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.

  • 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.
  • Within the…
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Ordered Eating and Kartini’s Food Plan

posted by Julie O'Toole on February 29, 2008 at 12:35am

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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Why I went into the treatment of Eating Disorders

posted by Julie O'Toole on November 3, 2007 at 9:12pm

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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