How does working with pediatric EDs differ from adults?
Pediatric eating disorders are often more complex for several reasons. Children may have limited awareness or understanding of their condition due to their age and they are also in a phase of significant physical and emotional development. It’s also important to consider family dynamics, such as who is responsible for meal preparation or whether the child’s parents are divorced or remarried. Fortunately, early intervention greatly improves the chances of recovery. In many cases, treatment is more aggressive in younger children, as it’s generally more effective to intervene at ages 8–10 than later in adolescence. While pediatric eating disorders can present many challenges, successful treatment early on can majorly impact a child’s future health and mental wellbeing.
What is working with kids like?
Working with pediatric eating disorders is challenging but rewarding. At the hospital where I worked, I rotated between inpatient and outpatient settings. In the mornings, I worked with inpatient patients so I attended rounds with the rest of the care team to review each child’s progress, set new goals, and then I would meet with the child and their parents individually. In the afternoons, I saw outpatient patients who were kids coming out of school.
Many parents share that they feel as though the eating disorder has taken over their child, which really highlights the emotional toll these conditions can have on families. We track progress through several indicators: improvements in eating behaviors, successful weight restoration, reduction in physical symptoms, enhanced quality of life, and signs that the child’s true personality is starting to re-emerge.
It’s so rewarding seeing kids recover and go on to live fulfilling lives. I have people who I saw when they were very young and are now starting college or are starting families. When children receive quality treatment, they have a strong chance at a full recovery and go on to lead meaningful and fulfilling lives.
How is work life balance?
During the weekday, I typically worked 10-7pm. This later work schedule is to accomodate parents who don’t want their kids to miss school. I worked on Saturdays for 20 years but this was a personal choice. Fortunately, I always had a weekday off so I still had a weekend.
It can be tough to balance work and personal life when parents are calling, texting, or emailing about their kids. Setting boundaries with parents is an important part of working in this setting.
What are the biggest challenges you face working with pediatric patients?
The biggest challenge I encountered was collaborating with the parents. Parents all want the best for their kids but many times their approach does not align with how we treat eating disorders. It’s important to be patient and compassionate for the parents and realize that they mean well but just do not have the proper education when it comes to treatment.
We use a lot of family based treatment with kids and this allows the parents to be actively involved with the process and support the child’s recovery. This approach empowers families and creates long lasting and consistent habits for when the child leaves our care.
What classes or experiences helped you the most? What supplemental education should students seek to better prepare themselves for this role (e.g. psychiatric disorders, counseling skills, etc)? I was a student back in the 1980s and at that time, RDs didn’t receive training on eating disorders or pediatric nutrition. I learned everything from psychiatrists and psychologists.
What advice would you give to a new RD or student who wants to work with this population?
I would recommend completing a rotation at a pediatric hospital or a residential treatment center that treats adolescents and younger. This way, you can learn from experienced RDs and get hands-on experience. Once you are an RD, working in general pediatrics provides a good base. As you acquire more experience with kids, you can then start specializing in eating disorders. I would recommend at least 2-3 years of experience working in general pediatrics.
