I know it is controversial to write about the shortcomings of some of my physician colleagues; in medicine it is rarely done. But if we won’t advocate for children who are ill, who will? The following is an excerpt from my book Give Food A Chance:
As a medical provider and because doctors are famously defensive of one another I write this section reluctantly. I hope that physicians and other practitioners who treat children may learn from the mistakes of those who have gone before them. What follows is a list of common problems that either delay effective treatment or make complete restoration impossible or unlikely. I cannot tell you how often a family tells us that a doctor they trust and admire falsely consoled them about their child’s weight loss until it was too late for them to be re-fed outside the hospital.
Ignoring failure to thrive: Starting with the worst, this is perhaps more commonly a doctor’s failure to look at their own office’s growth charts than anything else. I have had many children referred to me, boys and girls, who have clearly failed to thrive, whose growth charts first show the patients to have crossed over several percentiles (in a downward direction) over the course of some years, followed by a flattening of the growth curve for height. Whether or not this growth stunting is reversible depends on how long it has been allowed to go on and what Tanner stage (pubertal development) the patient has achieved by the time it is diagnosed. I have had more than one boy with a growth curve like this who, when bone age X-rays were taken, was discovered to have no further growth potential. In other words, their growth had been permanently stunted. Usually the parents are so stunned by this bad news and so self-blaming that they do not blame the physician particularly; however, I think all pediatric providers would agree that this represents a severe failure of good care. Please do not let this happen to your child. Either insist that your doctor listen to your concerns or find one who will.
Praising weight loss when it is not clear on what basis this has been achieved: Our clinic is full of angry parents who report that either their doctor or their child’s coach or health teacher told their eating-disordered child, “Good for you, you are exercising and cutting out all fats!” Weight loss might be a good thing for certain people, but it behooves a person, especially one in a position of authority or credibility, to know whereof they speak before they do so.
Giving an unrealistic weight goal to a child who has an eating disorder: I can’t tell you how often a patient tells me, “But my pediatrician (or my coach or my health teacher or my aunt, who is a nurse. . .) said I should weigh 120 pounds because I’m five four,” when that particular child has no periods and is weak at that weight. Pronouncements about where a child’s weight should be are best left to those who know how to do it. Once the words are out: “I think you should weigh . . .”, they are almost impossible to retract.
