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The Very Young Child with Anorexia Nervosa: How are They Different?

Thursday, February 27, 2014: 9:00 AM-12:00 PM
Sawgrass (TradeWinds )

Background: Small children aged 7 to 12 get anorexia nervosa, too. They can present with the adult form of the disease (e.g. body image concerns and distortions) or just with food refusal and behaviors that sabotage all attempts to re-feed them. The new DSM-5 recognizes these age-related differences, do you?

Julie O’Toole MD, MPH

Kartini Clinic


Outline for proposed IAEDP presentation

Childhood Anorexia Nervosa: the very young patient


  1. Normal growth and Development in Children (growth charts) in girls
  2. Normal growth and Development in Children (growth charts)  in boys
  3. Failure to thrive
  4. The overweight child who develops an eating disorder
  5. The genetics of anorexia nervosa
  6. Taking a family history
  7. Assessing the family for family based interventions: what can interfere?
  8. The all-important role of the family therapist
  9. The DSM-5 and you
  10. Weight restoration and setting goals

Increasingly, eating disorder professionals across the spectrum from doctors, nurse practitioners, nutritionists and therapists are being asked to evaluate and treat younger and younger patients with restricting eating disorders.  The consequences of starvation are more dire for very young children and vary from growth retardation, osteopenia, cognitive delays and poor socialization.  The need for complete weight restoration is higher, and setting accurate weight goals more challenging. The need for parental investment in treatment is greater, requiring more guidance from the treatment team. 

Normal growth and development in childhood is a subject often overlooked and poorly taught in training programs, yet a good basic understanding is critical to being able to make the diagnosis of childhood onset anorexia nervosa and recognizing when intervention is warranted.  Early childhood onset anorexia nervosa can look like the adult form or can be markedly different, lacking the body image disturbance professionals are used to.  The DSM-5 now reflects this, but practitioners are not always aware of how this might impact diagnostics as well as treatment.  Since the definitive cause (s) of anorexia nervosa remain unknown, primary prevention is not possible, leaving us with secondary prevention (early recognition and treatment) as our first line of defense in minimizing the effects of these serious conditions.  The goals of this presentation are to arm providers with the basics of recognition and an understanding of treatment essentials, making a difference in the lives of their very youngest clients and patients.

Primary Presenter:
Julie O'Toole, MD, MPH

Julie O’Toole MD, MPH, is founder and Executive Director at Kartini Clinic, in Portland, Oregon. She is member of AED, IAEDP, EDRS, and AAP. She is the author of “Give Food a Chance” and writes a weekly blog. Along with the rest of the staff at Kartini Clinic, Dr. O'Toole specializes in pediatric eating disorders and thus and diagnosed and treated over 2000 children and adolescents since 1998 to present.

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