First Do No Harm

I'm eager for some input from my fellow therapists. Yesterday I saw my youngest patient to date, a seven year old. I suppose this isn't breaking news - I've been hearing and reading more about eating disorders in children, and I've attended presentations given by specialized treatment facilities for patients younger than 10. I've also treated several 11 year olds and currently have a 9 year old on my caseload. Still, I found it a bit unsettling to sit across the room from a young girl so tiny her feet dangled over the edge of my easy chair, never reaching the floor. I wondered if I am up to the challenge of helping someone so young. I am determined to intervene slowly and carefully, and above all, to do no harm.

In the interests of protecting the confidentiality of this little girl and her parents I do not want to describe the situation in too much detail; and in fact I have not yet gathered enough information to have a clear picture. But so far I can say there is anxiety about eating and distortion regarding body image. There is a strong fear of fatness, both re: becoming fat herself and being near others she sees as far. Although there has been no weight loss there has been failure to gain such that she has dropped from the 50th percentile to the 25th over the past year. There were no feeding difficulties as an infant or toddler. She describes herself as a very "picky" eater and parents confirm she has eliminated many foods she was eating a year ago.

I would welcome input from anyone experienced with treating children this young. Obviously her parents are important allies in the process; they are clearly invested and capable. Should the primary focus be with parents, supporting them and empowering them to help her? Should we keep her out of the process entirely? Would a family focus be best? Or are there indications for individual therapy as well?

I will welcome your thoughts. Until next time, Gail