Approximately 1.25 million American children and adults have type 1 diabetes (T1DM), according to the American Diabetes Association. Type 1 diabetes is an autoimmune process whereby the insulin-producing cells of the pancreas are irreversibly destroyed and the ability to use food as energy is impaired. It can lead to growth stunting, intellectual impairment, blindness, vomiting, poor circulation and even limb amputation. It is not the kind of diabetes that you read about in the press…Read More
Viewing blog posts categorized under "Nutrition"
1) Weight loss in children isn’t normal
Imagine you’re a parent of a bright, active 12 year old boy. He gets good grades and has lots of friends. He excels at sports. Then something changes; he begins to lose weight. At his last checkup his pediatrician registers a heart rate in the low 50s. He starts to withdraw, not doing many things he used to enjoy, with the exception of exercise. He now exercises with a new intensity.
His doctor tells you not to worry. “It’s just a stage”, she…Read More
This post was originally published on February 13, 2012.
I (among others) have recently been challenged by Laura Collins to get the message out that weight restoration is critical to psychological recovery in anorexia nervosa. Some authority, Laura says, must declare definitively that psychological recovery is tied to weight restoration.
Some authority… okay… but who?
Since the late 1990’s the AAP (American Academy of Pediatrics) has issued guidelines for hospitalization (after…
This post was originally published on November 13, 2013.
Until I lived in the world of therapists and mental health professionals as part of the Kartini multidisciplinary team treating children with eating disorders, I had never actually heard the phrase “tolerating distress”, particularly as it pertained to parents. Like most parents, I have a very difficult time tolerating pain in my own children, either physical or emotional and, when put in that situation, I immediately get…Read More
This post was originally published on June 12, 2013.
We’ve all heard from parents whose child had (or has) an eating disorder and who re-feed them at home, single-handedly and successfully. The Around the Dinner Table forum is full of such stories from parents who help other parents trying to do the same. But not all children’s illnesses can be so managed. At Kartini Clinic we practice a day treatment model of family-based care (as well as inpatient medical stabilization and…Read More
The canny ability of eating disorders to twist even the most kindly meant words is something that is experienced by almost all our patients. We originally published this post back in the summer of 2011 and have decided to share it again because an awareness of of this facet of ED is so valuable to patients, families and care providers at every stage of recovery.
I find myself explaining this many times to parents and friends of our patients: there is a secret language to eating…Read More
One of the challenges of swimming against the stream -- as when, for example, one insists that parents don’t cause eating disorders when many providers learn and believe otherwise -- is that you become a bit of a pariah. At a minimum, people will prefer to talk to those of their colleagues who think as they do.
So building a web of safety around our patients once they leave the immediacy of Kartini Clinic has been a challenge. What are the needs of our young patients once they leave…Read More
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 peaks…Read More
Setting a goal weight is not simple. And it is never harder than in a growing child, where it is a moving target.
I have written some rather lengthy guidelines for determining ideal body weight in the pediatric patient and about what we at Kartini Clinic call “state not weight.” Today, we use the term “goal weight” rather than “ideal body weight” as “ideal” has so much baggage.
Professor Bryan Lask once asked me to participate in a debate in an international journal about whether…Read More
Everyone in our field knows that the Holiday season provides special challenges to those with eating disorders, be those restricting, bingeing and purging or predominantly bingeing eating disorders. Add to this the fact that this is typically a very important time of year to children and you have, well, a mess. It’s over in January though, and that’s the good news!
What makes it a mess? Holidays raise expectations in everyone, expectations that even for adults are often not met and…Read More