It is understandable for parents to hope treatment for their ill child could be as close to home as possible - and to wish for as little disruption to family life and work as could be managed - but I for one am very unhappy about what I see as a lack of judgment on the part of many physicians when it comes to hospitalization for a very ill eating disordered child.

Hospitalists, who would under any other circumstances adamantly decline to do surgery for which they were not trained - or with which they had no experience - commonly agree to take care of a child with an eating disorder simply because of a family’s wish to have it done in their home town.  Hospitalization at inexperienced centers is also often carried out in response to the parents’, general pediatrician’s or therapist's desire to have such care done close to home, even when such a patient clearly should be transferred elsewhere.

Transferred where you might ask?  Put bluntly: to a eating disorder treatment facility where they know what they are doing.

Is that too much to ask?

Children with recalcitrant weight loss, repeated hospitalizations, profound bradycardia (sometimes as low as 28-29 BPM), hypophosphatemia and other symptoms well delineated by the Academy of Pediatrics and the Society for Adolescent Medicine, need expert care.  Why does it make sense to some people to send patients to a specialist hospital for surgery (including, ironically, weight loss surgery) but not for Anorexia nervosa, with a mortality of 10%? Why are doctors so cavalier about the risks?

We doctors deliver to loving parents difficult news they don't want to hear all the time.  So why do we then find it so hard to tell parents of a medically unstable eating disordered child that it’s not appropriate to put convenience and closeness to home ahead of adequate treatment?

It’s clearly about judgment; let’s hope it’s not about consequences.