Kartini Clinic for Children and Families

Pediatric Eating Disorder Treatment Program

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Spotting the Tiger: Identifying Early Symptoms of Eating Disorders in Children for Timely Intervention

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In the powerful documentary, “Spotting the Tiger,” narrated by Oscar Award Winner Jamie Lee Curtis, the film emphasizes the importance of recognizing early warning signs of eating disorders in children. As we commemorate its 15th anniversary, the core message of this film remains just as relevant today: early detection of eating disorders in children is vital for successful treatment and long-term recovery.

In “Spotting the Tiger,” primary care providers, doctors, and therapists specializing in pediatric eating disorders reveal how even the most observant parents and medical professionals can miss subtle indications of conditions like anorexia nervosa. The film explains how these signs can often be concealed by the intricate nature of brain-based illnesses such as anorexia.

Genetic Factors and Eating Disorders: The experts in the film also discuss how eating disorders are predominantly genetic brain illnesses, rather than a result of poor parenting or the influence of the media’s obsession with physical appearance. While the media’s portrayal of beauty standards doesn’t help, it’s crucial to understand that parents don’t cause eating disorders, and children don’t choose to have them.

In the powerful documentary, “Spotting the Tiger,” narrated by Oscar Award Winner Jamie Lee Curtis, the film emphasizes the importance of recognizing early warning signs of eating disorders in children. As we commemorate its 15th anniversary, the core message of this film remains just as relevant today: early detection of eating disorders in children is…

In the powerful documentary, “Spotting the Tiger,” narrated by Oscar Award Winner Jamie Lee Curtis, the film emphasizes the importance of recognizing early warning signs of eating disorders in children. As we commemorate its 15th anniversary, the core message of this film remains just as relevant today: early detection of eating disorders in children is…

In the powerful documentary, “Spotting the Tiger,” narrated by Oscar Award Winner Jamie Lee Curtis, the film emphasizes the importance of recognizing early warning signs of eating disorders in children. As we commemorate its 15th anniversary, the core message of this film remains just as relevant today: early detection of eating disorders in children is…

We encourage you to watch “Spotting the Tiger” and learn more about the early signs of anorexia in children. By understanding the warning signs and contributing factors, we can take a more proactive approach to detecting and treating eating disorders. Share this essential film with your friends and family to spread awareness and promote early intervention.

Thank you!

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Are social media platforms making eating disorders in children worse?

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At least one school district in Seattle thinks so. Seattle Public Schools (SPS) has filed a suit in US DIstrict Court alleging that “defendants [social media platforms such as Facebook, TikTok, Instagram, YouTube, and Snapchat] affirmatively recommend and promote harmful content to youth, such as pro-anorexia and eating disorder content.” Essentially it appears SPS is saying such content exacerbates eating disorder symptoms and undermines effective treatment.

Not surprisingly perhaps, the issue is complicated. First some medical facts: eating disorders are biological brain disorders that are highly heritable (estimates – based on twin studies and genome-wide analyses – are as high as 74%; as a reference, that heritability is similar to the heritability of height in humans is estimated around 80%). This means eating disorders run in families and are emphatically NOT lifestyle “choices”, volitional behaviors on the part of patients, the result of bad parenting or the effects of images on social media. Such theories and explanations were once common but have in recent years been completely debunked by rigorous scientific studies (see above).   

At Kartini Clinic we like to put it this way: parents don’t cause eating disorders and children don’t choose to have them. Period.

So what about the role of social media? 

Consider the following analogy: can a child develop type 2 diabetes (T2DM) from looking at pictures of cheeseburgers? I think most of us would agree this sounds implausible and not very scientific. That’s probably because we understand and acknowledge T2DM to be a biological condition caused by complex interactions of genetics and environment. Eating disorders such as anorexia are no different.

This is not to say social media messaging can’t do any harm, for example by triggering behaviors or making children feel worse about themselves, which in turn could undermine effective treatment. After all, SPS is not alleging that social media platforms cause eating disorders but rather that they are contributing meaningfully (and, crucially, knowingly) to the disease burden on children suffering from these potentially devastating and deadly illnesses. 

At Kartini Clinic we certainly do share these concerns, and we would wholeheartedly support efforts such as additional mental health professionals in schools, lesson plans and additional training for teachers  provided they are grounded in a scientific understanding of these illnesses. Ultimately the key is to ensure that eating disorders are diagnosed promptly and treated effectively using evidence-based practices (i.e. grounding diagnosis and treatment in physical medicine and using behavioral health interventions such as family-centered treatment: families are almost always part of the solution to treatment in children, not part of the problem). Could the social media companies do better? Certainly. Perhaps they could “pair” content of concern with objective information about the causes, symptoms and potential for effective, life saving treatment of eating disorders in children. Although they aren’t directly responsible for these terrible illnesses, social media platforms could be powerful allies in helping us address this problem more effectively.

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New to Treatment? Don’t Panic!

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Your child has been diagnosed with an eating disorder by one of the doctors at Kartini Clinic. Whether this is a restricting disorder with fear of fat, a bingeing and purging disorder or what we call ARFID (avoidant restrictive food intake disorder), it matters little.  What matters is that the prospect of treatment is new and intimidating to you.

Before treatment was decided on, you may have struggled with typical and understandable ambivalent feelings:  are we over-reacting? Are we under-reacting? Is this our fault? Will the doctors and therapists blame us? And of course: how on earth are we going to rearrange our lives to accommodate family-based treatment?

Step one:  take a deep breath.  We will walk with you through all the details of treatment.  We will take one step at a time and help you gain confidence in the process, which many families have been through before you, and confidence in the treatment outcome, which is growth and healing.

Step two:  be gentle with each other. Fathers and mothers may react very differently to the information that their child is sick enough to warrant treatment. Often (although these roles certainly can be reversed!) fathers cope with their fear by focusing on the financial picture for the whole family. This is not uncaring, it is responsible. Every fiber of being in the other parent may be screaming: who cares about the cost?  Just treat my child!  And while this is understandable, we are all grown-ups here and we are going to have to find a way—together– to help you keep a roof over your family’s head, pay for health insurance, keep your job and care for other children in the family. So take a second deep breath and listen when our insurance professionals talk. Their job is not to place barriers in front of your child receiving treatment; they are going to be at your side advocating to knock those barriers down. It’s not cold and calculating to listen as they outline your insurance benefits, it’s practical. Take notes if you can, put your smart phone on “record”, if you wish, and take the card they offer you to contact them later when you can clear your head. Knowing you have people truly on your side can decrease your sense of panic.

Step three: Let’s talk about safety. If your child is terrified of treatment (they’re going to make me fat!  I’ll kill myself first!) spend some time before you leave going over a safety plan with our doctor. Are there guns at home that are not locked up? Who will make a plan to take care of this immediately? Are there Costco-sized bottles of Tylenol and Aspirin at home? Lock them up too. Can one of you sleep with her/him or at least sleep in the same room? When you take them anywhere in the car, if they are upset or have made threats against themselves, put them in the back seat with the child locks on. These are some examples of simple plans you can make together. Knowing your child is safe will decrease your panic.

Step four: understand the nature of eating disorders before you take one step out of our office. What I mean by this is that all biology and research point to the fact that eating disorders of every kind are brain disorders and can run in families. Knowing this helps you internalize the most important message of the day: parents do not cause eating disorders and children do not choose to have them. Your child is not “doing this”, it is “happening to them”. It literally does not matter whether or not you have talked negatively about your own weight, have fought with your spouse, have been divorced amicably or horrendously, or have the “perfect family”; you could not cause an eating disorder in a child any more than you could cause autism. Knowing that no one at Kartini Clinic will blame you can also decrease panic.

Step five: be firm but gentle with yourself and your child. Tolerating our own children’s distress is far and away the hardest thing about treatment. Their pain is our pain—no, it is worse than our pain. But only real healing will ultimately take away their pain.You cannot do so by hedging about the need for treatment or eating or weight stabilization. “As your parents we have decided to get treatment for you and for us, and we are going to start now.” Calmly. Lovingly. Firmly. Remember those temper tantrums as a toddler? Deep breath, and ignore. The certainty of doing the right thing can decrease panic in both you and in them.

Step six: make your orientation appointments, your family therapy appointments, your nurse appointments, your medical appointments and attend parent group. Though you may feel like you are thirsty and trying to suck on the end of a fire hose, ultimately more information and more support will make the process go faster and the outcome more assured. And finally, the last step.

Step seven: educate yourself. Kartini Clinic providers do not expect you to know what to do, what to say and whom to tell right out of the box. You will want to know “why” and we encourage this. Why do I have to eat on the meal plan with him? Why can’t she continue to exercise? Why are parents in charge of food? Why are you drawing so many metabolic labs? Why can’t she eat sweets? And when? When will she understand that she is beautiful? When can we be done?  When can I trust her to eat on her own? These, and many more, are perfectly valid questions which you will need to have answered for yourself several times over as you move through treatment. There are not enough hours in the day to answer them all as often as we would like, so we encourage you to do your homework. Folks: do your homework!  Your child and your family are at stake. Read your Parent Handbook, cover to cover. Read the blogs. Send the blogs that you find relevant to your relatives, friends and coaches. Join the FEAST parent forum and talk with other parents. Read Give Food A Chance. Ask the grandparents to read it. You know, the way we all do research on the web when trying to understand the best car to buy, the right food processor, the right college. Surely this deserves the same level of attention and thought? Educating yourself will help you focus your important questions when you do see the doctor or nurse. It will — you guessed it — reduce the panic you feel.

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Kartini School: A Success Story

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[Ed. note: This is one in a series of guest blogs by our Kartini School administrator, Mary Gunesch. With schools returning to at least partial in-person instruction we thought it a good time to focus on this subject.] 

When a student begins treatment at Kartini Clinic, we reach out to their school.  We find out what they should work on in their classes – what the learning objectives are – and we support them as they work to achieve these objectives.  Some teachers tell us to look at Google Classroom where they post assignments; some teachers stay in regular contact and provide extensive information; some teachers provide very little.

We support students, whatever their school’s response (or lack of response) may be.

We had a student who began with us at the end of January.  She was a senior in high school; she had two required classes to graduate.  We told the school that we could contract with them and partner with them to provide this student (who was very sick) with the support she needed to complete these classes.

The girl’s parents were afraid that she might give up and drop out.  They asked for our help.

The patient was in a dark place.  She was eating nothing.  The doctors were worried about her cognition.  They put in an NG tube.

In school, the girl told us she couldn’t concentrate. We gave her a graphic novel to read. She was able to do that.  

When we talked to her district, they said they didn’t need to contract with us; they would provide a tutor.  I told them that the girl was in treatment all day, each day of the week. They said, “No problem, we can get a tutor who will meet with her in the evening or on weekends.” They said the tutor would call me.  When the tutor called, she said, “I can do any day, Monday through Friday.” I asked about evenings or weekends and she said she couldn’t do that.

When I told the school district what I’d heard they said, “Oh, then the student can just wait until she is better, and we’ll give her a tutor then.”  I told them that the student did not want to wait, she wanted to finish what she needed to do and be done.  The student said she would do the district’s online program.  I asked the district about that and they said that program was full so she couldn’t do that.  They said, “But if you create a learning plan for her, we will be happy to accept the work she does with you.” 

So, that’s what we did. We designed an Economics class and a Senior English class.  She read Fahrenheit 451 and wrote an in-depth response.  She talked about how it was interesting that it was written over 50 years ago, but it is relevant today, with us spending so much time on our screens.  She also studied and discussed what was happening to the stock market in response to COVID-19, and she created a plan for economic recovery following the pandemic.

All along, she was recovering physically, slowly but surely. After 11 weeks, she was well enough to go home.  

The Governor had just announced that all seniors who were “on track in their classes and passing” would be done with school and ready to graduate.

Fortunately, we were able to report to her school that she was “on track and passing” in her classes.  They were happy to get our report.

Our student graduated this spring.

Online Reviews

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This post is from Kartini Clinic CEO Morgan O’Toole. 

Online reviews have become part of our everyday lives. Who hasn’t glanced at the star ratings when Googling a new hair salon or looking for a restaurant to try out? Most of the time, online reviews are just another useful data point when trying to make a casual purchasing decision.

But more essential services like doctors’ offices and health clinics come with Facebook and Google ratings these days, too. Kartini Clinic is one of them. Unlike restaurants or hair salons, however, we are strictly limited in our ability to respond to reviews, even when they contain content that is factually untrue or even implies active wrongdoing on the part of clinic staff. While we are always grateful to receive constructive feedback and are eager to work with families to resolve any issues they have during their time at Kartini Clinic, when problems are expressed in the form of an online review, our options are very limited.

These reviews have also sometimes become a way for our young patients to express their frustration during a difficult period in their lives. One example occurred very recently: a spate of negative reviews, at least one of which was written under a pseudonym, claiming to be patients or friends of patients at Kartini Clinic, appeared in a matter of hours. Though treatment is spent working with parents and patients towards a positive, often live-saving goal, there is no question that the day-to-day process of recovery can be difficult. As we have discussed on this blog before, eating disorders are brain disorders. As with any brain disorder, children who suffer from them may be  looking at the world through a distorted perspective — including, in many cases, an inability to acknowledge that their disordered eating is problematic at all. This is a clinical phenomenon called anosognosia.

(Incidentally, this is also partly why Kartini Clinic believes so firmly that weight restoration must be the first step in treatment. Malnourishment only exacerbates these problems. No one’s brain functions properly when they’re starving.)

Parents, we urge you to engage your children on this subject. Please help us to ensure your child is expressing their fear and frustration in a constructive way. And if you have any feedback for Kartini Clinic, we encourage you to reach out to us at help@kartiniclinic.com, where we will be able to directly address your concerns. We always welcome the scrutiny.

We also invite parents to share their family’s experiences at Kartini Clinic, either publicly or privately. Private comments may be directed to an individual staff member, or to help@kartiniclinic.com. If you are willing to share publicly, you may do so on Google or our Facebook page.