Program Incorporates Parents Into All Aspects Of Care

from The Children's Hospital (TCH) News, June 2005

For Shannon Carney, there was no question she would take her daughter anywhere but The Children’s Hospital to treat her anorexia.

Even if it meant traveling 831 miles from Newport Beach, Calif., and taking three weeks off work.

“Our pediatrician told us The Children’s Hospital was the best place for Brittany,” Shannon said.

The family had spoken to their doctor about getting treatment for Brittany closer to home, but because she’s just 9, options were limited. Many programs treat adults or teenagers, but few treat children as young as 9.

Shannon also wanted a medically based program for her daughter, once an aggressive star soccer player and now a girl who had lost 25 percent of her body weight.

Brittany’s parents also wanted to be involved in her treatment and recovery.

“I wasn’t going to ship my 9-year-old daughter somewhere else,” Shannon said. “I was adamant about being involved in her treatment.”

So, for the Carney family, Children’s Eating Disorders Program was the only answer.

Jennifer Hagman, MD, co-director of the program, said Children’s has stressed family involvement in a child’s treatment since the program began. During the past five years, Children’s has strengthened this approach, which puts parents in charge of supporting their child in eating and regaining weight. Publications and research support this approach, first described by The Maudsley Hospital in London, especially for treating younger patients and those without the ability to manage nutrition needs independently.

Treatment at Children’s – where patients range in age from 9 to 21 – incorporates the family into all levels of care, Dr. Hagman said. Patients see an integrated team of doctors, therapists, dietitians and Adolescent Medicine specialists. 

The first step in the program for many patients with anorexia nervosa is an inpatient medical stay, Dr. Hagman said. While the patient gets better, parents meet with a dietitian to learn how to plan meals at home.

Teaching parents to provide supervision and support during meals is an important component of Children’s program, Dr. Hagman said. Dietitians, therapists, mental-health counselors and nurses provide guidance through individual, family and group meetings on how to manage challenges.

“It’s critical that parents understand how difficult this is,” said Matty Wilsey, PsyD. “The kids aren’t strong enough to fight the anorexic thoughts and urges. I stress the primary principle of the Maudsley method: that the child is sick, and the medicine is food.”

Clinical dietitian Sharmila Chakravarti said, “Anorexia and bulimia are diseases. Parents sometimes need to take control, just like the parent of a diabetic child would.”

The next step varies, Dr. Hagman said, and may include the seven-bed Eating Disorder Unit or the Day Treatment program, where patients and families continue learning to manage the eating disorder.

Children’s began incorporating parents years ago after the team discovered that involving parents resulted in better outcomes, especially for younger patients, Dr. Hagman said.

“Parents need to provide enough support structure for the child to get healthier and into recovery,” she said.

The approach has worked for Brittany and her parents, who are now back in California and thriving.

“She’s doing great,” Shannon said. “To this day, she trusts Children’s doctors. She’s very happy. She could have died, but she came out so strong.”