What would we do without our modern early warning systems?  The terrible weather ravaging New York, New Jersey and all along the East Coast this week has made me reflect a lot on this.  Not only do we at Kartini have treasured colleagues in those places but we also have many patients and former patients there, including one beloved patient currently in a New Jersey hospital.  Our thoughts have been continually with them these past few days.

As terrible as this storm has been, however, imagine what it would have been like without the early warnings provided by weather scientists? Without the preparedness early warning systems make possible, even greater damage would have occurred. Operating in ignorance usually causes more harm than good.

Yet that is exactly how we have been operating when it comes to childhood eating disorders.

How much more swiftly could pediatricians, nurse practitioners and therapists react to a child developing anorexia nervosa if only they paid attention to an early warning system — and one which, ironically, is already have in place?  What “early warning system”, you ask?  Parents.

Every week we hear stories — essentially the same story — from upset parents who have gone to their pediatrician (usually) concerned about their child’s increasing food refusal, or the discrepancy between what they are taking in and how much they are exercising, or about their weight loss.  And they are not listened to.  They are cautioned not to over-react. Sometimes they are even sent away with a lecture about how we are all too fat and need to eat less fat and exercise more anyway.  And you can change “sometimes” to “every time” if their child was overweight in the doctor’s eyes before the symptoms began.  

Nonetheless parents usually persevere and return to the doctor a bit later, their child having lost even more weight.  Does the doctor listen now?  Not always.  “I’ll see you in a month” is common.  The next time the child is seen they are bradycardic.  Does the doctor listen and act then?  Sometimes.  Despite the urging of the AAP’s published guidelines as well as those of the AED, I can’t tell you how often Dr Moshtael and I read chart notes documenting a child to have been bradycardic for weeks and nothing was done about it.  About a third of the time no referral was ever made, the parents having found us themselves.

So what exactly keeps practitioners from utilizing this already-in-place early warning system that parents represent?  After all, parents are the best observers of their own children.

In November I plan to hold a workshop at the 2012 F.E.A.S.T. Symposium in Virginia on this very subject (“educating the pediatricians”) and would welcome any input.  The conference overall should be a good one and well worth your time.