Should I be Worried?

At the Kartini Clinic, most of our practitioners are also parents. We understand only too well the anxiety and alarm you face if you suspect your child may have a serious health issue. Therefore we think it is imperative all parents understand how serious eating disorders can be, and, more importantly, how to recognize any early warning signs.

We feel strongly that most parents have very good instincts when it comes to the health of their children. If you think there is a problem, even if you have been told "not to worry," we urge all parents to find out about eating disorders to their own satisfaction. We are here to listen to your concerns; if your child does not have an eating disorder we will be the first to say so. While other people may be experts in their field, you are the expert on your own child.

What do I need to know?

Before we get into the specifics, all parents should know this simple fact: you did not cause this disease, and your child did not choose to have it. Anorexia nervosa, in particular, is a disease of the brain. It is not a result of bad parenting, strife in the family, or too many pictures of thin people on TV. It is not about "control" or a power struggle between parents and children. Clearly these things can negatively affect treatment, but they did not cause the disease.

This realization is critical. If you understand that you did not -- in fact could not -- cause an eating disorder in your child, you are better equipped emotionally and intellectually to proceed with finding the best medical care for your child.

So what are eating disorders?

Briefly, eating disorders (EDs) such as anorexia or bulimia nervosa are very serious brain disorders that affect both men and women, boys and girls. Their cause(s) are not well understood but recent clinical evidence, as well as extensive genetic research, points overwhelmingly to the conclusion that anorexia nervosa is an organic illness like diabetes or childhood leukemia.

Many of you (and quite a few medical providers) may be surprised to hear that we compare certain EDs to cancer, but the evidence is clear: anorexia nervosa is a disease of the brain, it runs in families (and therefore has a strong genetic component) and, while rare, is chronic and deadly. Some researchers refer to it as a "malignant disease of children."** According to the American Medical Association anorexia has a mortality rate exceeding 15%, the highest of all so-called "mental disorders." Many of these deaths are suicides resulting from long-term depression brought on by the illness, or from other physical symptoms that include hypothermia and organ failure.

For more detailed information please see our sections on The Facts About ED, Anorexia, Bulimia, Selective Eating, Food Phobia, Cancer Cachexia, and Obesity.

** Eating Disorders in Childhood and Adolescence 3rd Ed. Lask et al. (p.8) Routledge Pub. 2007 London

What should I be looking for? And what prevents prompt recognition?

(1) EDs exist even in younger children and boys:

Roughly 10% of our patients with an ED are male.

(2) Weight loss:

Don't be fooled into thinking: "My child would be better off losing some weight." Weight loss in children is not normal. Period. While there is much justifiable anxiety these days about childhood obesity, unexplained weight loss in children should always be investigated because children are usually still growing. Even as they are adding to their waist line, they are also adding to their bones, muscles, heart-wall muscles and other vital organs. Brain development is still ongoing in adolescents and a loss of body mass or change in the trajectory of growth in a child can therefore have profound long-term developmental consequences. Do not encourage weight loss in your child, even if your child is of high body weight, unless you are certain you have excluded the possibility of an eating disorder.

(3) Low heart rate:

I've been told my child has a low heart rate, but he/she is very athletic.

Children are by definition not adults, and it is a mistake to attribute adult-level vital signs to them. The American Academy of Pediatrics has issued guidelines for pediatricians who may be to evaluating the need for hospitalization in eating disordered children. It is irrelevant, for example, that some famous athletes may have a resting heart rate of 40 beats per minute. Your child is not an adult. In the course of many hundreds of cases, we have never had a single patient whose heart rate did not rise above 50 BPM after successful weight restoration. If their initial, low heart rate had been "normal for them," one would not expect a rise subsequent to treatment.

What else should I be looking for?

Fainting

Syncope, or fainting, is a common symptom of those suffering from an ED. If your child has had one or more episodes of fainting, even if you feel as if they have been adequately explained, you should be looking for other possible symptoms of an ED.

Change in Behavior

This is a complex area, as every parent can tell you, and one complicated by many normal issues arising during the onset of puberty and adolescence. But most patients with ED undergo very noticeable changes in mood and/or behavior. Some of these changes may even elicit praise from you, such as a new-found emphasis on exercise and "health" foods. Unfortunately, for those with an ED, this could be a prelude to compulsive and harmful levels of exercise and the restriction of adequate calories, especially those from dietary fat. If you eat dinner together it will be obvious if your child's eating habits change dramatically. If you do not eat together, you'll need to find out what your child eats and at what amounts.

The best way to exclude the possibility of a serious ED is to have your child examined by a pediatric ED specialist. We have the utmost respect for general pediatricians, family doctors, nurse practitioners, and metal health therapists but unless they are in a practice that sees many ED cases they simply will not have the experience or perspective of a specialist. At the Kartini Clinic we only treat EDs, and as a result probably see 20 to 50 times as many cases as the average pediatrician, annually.

To recap: if your child exhibits several of the following symptoms we urge you to contact your primary care provider and ask them about your concerns.

- sudden or prolonged weight loss
- fainting spells
- low heart rate (below 50 beats per minute)
- sudden changes in behavior, such as an unusual increase in exercise, or restriction of calories, especially from sources of fat such as meat and cheese
- social isolation or withdrawal

If you can't get a referral or are still uncertain you are doing the prudent thing, contact us immediately with your concerns at help@kartiniclinic.com , or call on 503 249 8851 and ask to speak to our intake coordinator.