Eating disorders program
The Department of Psychiatry and the Division of Adolescent Medicine in the Department of Paediatrics jointly direct the Eating Disorders Program at The Hospital for Sick Children (SickKids). Together, we have developed a comprehensive, interdisciplinary and specialized program to evaluate and treat children and adolescents with eating disorders. Intensive involvement by parents or primary caregivers is an essential aspect of our care.
The Eating Disorders Program at SickKids is a unique program where medical and psychiatric care are fully integrated and are provided through a combination of inpatient, day hospital and outpatient services. We provide a complete range of services for children and adolescents struggling with these life-threatening and potentially chronic disorders.
This section includes information on:
- Facts about Eating Disorders
- What we do and who we see
- How to make a referral
- How to contact us
- Program staff
- Professional education
Facts and Eating Disorders
Eating disorders, such as anorexia nervosa and bulimia nervosa, are the third most common chronic illness among adolescents. Eating disorders affect young people from all ethnicities, social classes and geographic locations. In North America up to 5 out of 100 adolescents suffer from an eating disorder. Both boys and girls can have eating disorders.
Extreme feelings, attitudes and behaviours about food, eating, body weight and body shape characterize eating disorders. These disorders are associated with serious physical and psychological effects if left untreated, and can result in life-threatening consequences. Up to 15 per of people with eating disorders die. With comprehensive treatment, most young people will recover from their eating disorder.
What we do
We assess and treat children and adolescents for anorexia nervosa, bulimia nervosa or an unspecified eating disorder. We provide this care in several settings:
- A nine-bed inpatient unit
- A day hospital program
- An outpatient clinic.
In addition, we provide consultations for the diagnosis and management of eating disorders for children and adolescents in other parts Canada, either in person or through telemedicine, depending on need.
Any child or adolescent (up to age 18) who, in the opinion of a community health care provider, is struggling with an eating disorder may be assessed at the Eating Disorders Program. An assessment may lead to diagnosis and treatment recommendations that can be managed in community care, or it may lead us to recommend treatment in one of our settings at SickKids.
Patients should meet criteria for eating disorders described in the DSM-IV (The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; American Psychiatric Association, 1994).
Our program is not appropriate for children with pica, rumination, or weight loss management concerns.
Referrals
The young person’s doctor must refer the child or adolescent and family to our program. It is important for a young person with an eating disorder to continue to be followed by her/his doctor. For more information on referring, please contact our Intake Coordinator, Heather Graham, at 416-813-7195 and scroll down to see the How to refer section on this page.
Assessments
We will arrange an appointment for the young person’s initial assessment, once we have received completed referral forms from the doctor.
We conduct two types of complete assessments:
- For urgent concerns (children and adolescents who are medically at risk) the assessment is completed in one full day. This includes medical, psychiatric and nutritional assessment to determine a diagnosis and the patient’s medical condition.
- If the patient is not acutely ill, assessment takes place over several days. Psychiatric assessment is conducted first, followed by medical and nutritional examinations.
Please note that our waiting time for assessments is several months.
The assessment includes a comprehensive evaluation of the young person and family by members of our specialized, interdisciplinary team. The young person receives a medical evaluation by a paediatrician skilled in adolescent medicine and eating disorders treatment. A child psychiatrist meets with the young person for a comprehensive mental health evaluation and to explore the factors that might contribute to the eating disorder. The psychiatrist is also skilled in identifying and treating young people who may have other treatable problems such as depression, anxiety or substance abuse. In addition, the family meets with one of our social workers or psychologists to complete a family assessment. Finally, the young person meets with the dietician who will assess her or his thoughts and feelings about food and eating.
After this initial assessment, our team will set up an appropriate treatment plan for the young person and his/her family.
Inpatient program
Our nine-bed inpatient unit is designed for children and adolescents with medical or psychiatric instability associated with an eating disorder. Interdisciplinary care includes medical and nutritional interventions, as well as intensive psychological and psychiatric components, with a strong focus on family work and group therapy.
The goal of an inpatient stay is to help patients become medically stable and re-nourished, so that they can continue treatment in our outpatient or day treatment program or other community care.
Our priority is to empower and enable the young person and family to work together and combat the eating disorder. In order to achieve this, the team incorporates a variety of treatment methods that are adapted to the needs of the individual patient and family. Treatments include individual and/or family therapy, group therapy, psychopharmacology, psycho education (education about eating disorders and other mental health and psychiatric disorders), art therapy, and milieu therapy (therapy using environmental changes). We believe that open and shared decision-making is the cornerstone to effective treatment.
Day hospital program
This intensive program runs Monday through Friday and is designed for adolescents with eating disorders who:
- Are medically stable and require more support than the outpatient clinic can provide, or
- Have complex mental health issues and require more intensive day support.
The program has a dedicated Toronto District School Board classroom so that patients can attend school in the day hospital. They receive a range of psychotherapeutic interventions as well as full-day nutritional support (three meals daily plus snacks), nutritional counselling, and medical monitoring. The regular and intensive involvement by a parent or primary adult caregiver is expected throughout the program.
The team in the Eating Disorders Day Hospital Program works alongside the young person and family, supporting the individual goals and changes that will enable them to move beyond the severe limitations imposed by the eating disorder. Length of stay in the program is generally about six months.
Outpatient clinic
The outpatient clinic is an interdisciplinary program that provides medical and nutrition monitoring, along with ongoing treatment for the eating disorder. A wide array of psychological and psychiatric interventions are conducted, depending on patient needs and the availability of appropriate groupings:
- Individual therapy
- Family therapy
- Group therapy for patients and families, including:
- Education about eating disorders and their effect on families (psycho education)
- Parent support groups
- Cognitive-behaviour groups for children
- Body image group
- Interpersonal psychotherapy group
- Brief multi-family group therapy
The treatment team works with the young person’s family doctor or paediatrician and other community health care providers in a shared care model. Our goal is to transition the young person to treatment in his or her community.
How to make a referral
A physician’s referral is required. Due to the medical and psychological complexity of eating disorders, we request that families request appointments with us through their family doctor or paediatrician. It is important for a child or adolescent with an eating disorder to continue to be followed by her/his doctor while waiting to be assessed in our program.
Contact our Intake Coordinator to request an intake package:
Heather Graham
Phone: 416-813-7195
Fax: 416-813-7867
e-mail: heather.graham@sickkids.ca
- Or, download our intake package (in pdf format)
The intake package includes (1) a “Dear Doctor” letter with referral checklist, (2) the Eating Disorder Program Referral Form, and (3) Form 14, Mental Health Act, from the Ontario Ministry of Health. - Please note that the Eating Disorders Program has a separate referral form – different from the general referral form for The Hospital for Sick Children.
- Fax the completed forms to Heather Graham, Intake Coordinator, at 416-813-7867.
Contact us
Heather Graham, Intake Coordinator
Phone: 416-813-7195
Fax: 416-813-7867
e-mail: heather.graham@sickkids.ca
Program staff
Leora Pinhas, Psychiatric Director, and Debra Katzman, Medical Director, lead the Eating Disorders team, which also includes staff from these professional areas:
- Child and youth counsellors
- Dieticians
- Group therapist
- Information workers
- Intake coordinator
- Occupational therapist
- Nurses
- Paediatricians
- Psychologists
- School teachers
- Social workers
- Chaplains
- Transition planner and community liaison nurse.
Each patient and family is assigned a contact person to help guide him or her through the many aspects of the Eating Disorders Program.
Professional education
The Eating Disorders Program provides education opportunities in psychiatry, medicine, nursing, child and youth counselling, social work, and other allied health professions.
For further information on medical education in psychiatry, contact:
Tammy Chong
Administrative Assistant, Education
Department of Psychiatry, The Hospital for Sick Children
e-mail: tammy.chong@sickkids.ca
Phone: 416-813-1856
Fax: 416-813-5326
Students training in other health care professions, please contact the appropriate department at SickKids for more information.
For more information, please contact:
Heather Graham
Intake Coordinator - Eating Disorders Program
Psychiatry
The Hospital for Sick Children
Tel: 416-813-7195
Fax: 416-813-7867
e-mail: heather.graham@sickkids.ca