Eating Disorders Program At Children’s Hospital & Medical Center

Eating disorders affect how people view and deal with food, eating, and weight. This can mean many things — from not eating at all to eating significantly more than necessary. Over time, these disorders can damage someone’s physical, mental, and social health.

If a child is struggling with an eating disorder, they are not alone — at least 30 million people in the US have an eating disorder.

At Children’s Hospital & Medical Center, our Eating Disorders Program treats children and adolescents up to age 21 on an outpatient basis.

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Phone 402-955-6190 | Fax 402-955-6195

What Sets Children’s Apart?

The Eating Disorders Program at Children’s is the only pediatric program in the area. Because of our pediatric focus, we are equipped to handle the unique needs of our patients and their families.

We realize that by having a child participate in the Eating Disorders Program, parents may have to make some sacrifices, such as taking time off of work for appointments. But this level of care is what the child needs.

When a child comes to Children’s, we don’t just work on recovering from the current disorder — we provide them with tools and empowerment for a healthy relationship with food.

If an eating disorder is not treated in time, it can keep on growing — to a level where a child may be doing irreparable damage to their body. They may eventually get to the point where they need to be transferred out of Children’s and into an inpatient program. However, there are not many inpatient options in the Omaha area, so this may mean going to a hospital out-of-state. That is an expensive path, and it can take a significant toll on the entire family.

Since children with these disorders often have other medical conditions, such as depression, substance abuse, or heart problems, our clinicians are trained to recognize and treat these problems, too.

Our approach to care involves medical teams from several different specialties, including:

Physicians and nurses to monitor medical needs
Dietitians to supervise nutrition and provide education on healthy eating habits
Mental health specialists, such as psychologists, social workers, to work through the mental and emotional impacts of eating disorders
Recreational therapists to oversee exercise education
School staff to keep the child’s education on track

And of course, we can’t forget some of the most important people on the child’s care team: the family. Family participation is key to successful treatment. Our program offers families sessions on nutrition education, family communication, and meal planning, as well as individualized family therapy sessions.

How The Program Works

We have a partial hospitalization (outpatient) program, and a partial hospitalization (outpatient), less-intensive program. The programs have a few differences, but they share the same goal: to help the child overcome their eating disorder and prepare for lifelong success.

Partial Hospitalization Program

This is a 12-hour a day outpatient program. The child will participate in group, individual, pet, and recreational (e.g., art, journaling) therapies. We even offer equine therapy, which is therapeutic horseback riding.
Once the child has completed this program, they have the option of attending our less-intensive program.
Partial Hospitalization Less-Intensive Program

The partial hospitalization less-intensive program is a combination of partial hospital (outpatient) care and individual outpatient treatment. The child will participate in outpatient group therapy sessions, which meet three evenings per week. These are designed to help strengthen the child’s abilities to cope and eat in a healthy way.
Group Therapy

Group therapy is a major part of both of our programs. The child will have the opportunity to meet others who are going through similar struggles, and both provide and receive their support. During these group sessions, we address topics, such as “why is it so hard to receive a compliment?” or, “what should I say when my friends are talking about diets and their own weight?”
We work on developing coping skills while giving the child space to bond with others who understand what it’s like to have an eating disorder.

“When patients come into our program, I tell them, ‘Yes. This is going to be challenging. But we’re going to give you strategies to help you get healthy again. There will be moments when it’s hard, but also moments when it seems easy. We’ll get through this together. We do this with many patients, and we have seen a lot of success.’”

— Michael Vance, MD, Director, Eating Disorders Program, Children’s Hospital & Medical Center

Conditions We Treat — And How To Recognize Them

There are several different types of eating disorders, and each one has its own symptoms and warning signs.

Anorexia Nervosa
If a child loses too much weight or doesn’t maintain a healthy weight for their height and age, they may have anorexia nervosa. They may try to control their weight by extremely limiting the amount of food they eat.
Focus on body weight becomes a significant part of their identity, and they may develop a fear of being overweight — even if they are actually underweight. Over time, anorexia can cause brain damage, bone loss, heart disease, infertility, depression, and organ failure.

Warning signs of anorexia may include:
- Cutting food into tiny pieces or moving food around the plate, rather than eating
- Constantly exercising, even if they are injured or very busy
- Refusing to eat in front of others
- Obsessing over calorie or fat contents in food
- Losing a lot of weight unnecessarily
- Having difficulty sleeping or concentrating
- Always feeling cold
Avoidant/Restrictive Food Intake Disorder (ARFID)
Avoidant/restrictive food intake disorder (ARFID) is similar to anorexia, in that it involves limiting the amount and types of food eaten. However, it does not involve a preoccupation with weight or appearance.
If a child has ARFID, they may not consume enough calories to grow or develop properly, or maintain a functioning immune system. Because of this, they may be at risk of being underweight and short for their age.

Warning signs of ARFID may include:
- Losing a large amount of weight
- Complaining of muscle weakness, abdominal pain, always feeling cold, feeling sluggish, or having too much energy
- Restricting certain types of food, or only eating certain textures of foods
- Picky eating that gets worse over time
- Having a low appetite or lack of interest in food
- Difficulty sleeping or concentrating
Binge Eating Syndrome
Binge eating syndrome involves binging — eating a large amount of food in one sitting. But unlike bulimia, which also involves binging, binge eating syndrome does not include purging (e.g., vomiting, taking laxatives, exercising excessively).
This disorder can cause feelings of shame and distress and may increase the risk of obesity, heart disease, depression, or problems with digestion.

Warning signs of binge eating syndrome may include:
- Eating a large amount of food in a short time frame (less than 2 hours)
- Eating very quickly
- Seeming uncomfortable eating around others
- Showing evidence of binge eating, such as having large amounts of food that seem to disappear quickly, or having lots of empty food wrappers and containers
- Hoarding food in strange places, such as in the closet or under the bed
- Withdrawing from usual activities and social situations
- Dieting frequently
- Expressing low self-esteem
- Having a constantly fluctuating weight
Bulimia Nervosa
Bulimia nervosa is a disorder with patterns of eating a large amount of food in one sitting, then making up for it by vomiting, taking laxatives, exercising excessively.
This binge, purge pattern can cause severe dehydration, dental problems, and damage to the heart and digestive tract. The binging and purging cycle is generally a secret regiment, which can make the child feel guilty, ashamed, or like they lack self-control.

Warning signs of bulimia may include:
- Exercising excessively, even when sick or injured
- Buying large amounts of food that seems to disappear right away
- Regularly using the bathroom right after eating
- Constantly smelling of vomit
- Having packages or wrappers from laxatives or diuretics, which are frequently found in the trash
- Hoarding food in strange places, such as the closet or under the bed
- Using mouthwash, mints, or gum excessively
- Having calluses (hard areas of skin) on the fingers or knuckles from self-induced vomiting
Orthorexia
Orthorexia is an obsession with eating healthy, “pure” foods, without worrying about body weight or the amount of food consumed. If a child has orthorexia, they will want to feel healthy, clean, and pure through their food choices. Orthorexia can cause malnutrition, emotional problems, and social isolation.
Warning signs of orthorexia may include:
- Eliminating entire food groups, such as all sugars or all dairy products
- Avoiding social events involving food
- Showing anxiety about how food is prepared
- Only eating foods they have deemed healthy or pure
- Compulsively following food and health blogs or social media accounts
- Showing high distress levels when healthy food is not available
- Losing interest in activities that are usually enjoyable, and gaining pleasure from eating healthy
- Compulsively checking ingredient lists and nutrition labels
Other Specific Feeding And Eating Disorder (OSFED)
Other specified feeding and eating disorder (OSFED) is a diagnosis given when there are irregular eating habits or thoughts about weight, but they don’t fit the criteria to be diagnosed with a specific disorder. Even though some people call it a “catch-all” term, it is just as serious as any other eating disorder.
Symptoms of OSFED can be similar to those of any eating disorder, so it is difficult to pinpoint specific symptoms that point to OSFED. However, some examples include:
- Atypical Anorexia Nervosa: Characteristics of anorexia, such as skipping meals or not fulfilling nutritional needs, but weight is within or above normal range for the child’s age and height
- Atypical Bulimia Nervosa: Binging and purging behaviors of bulimia, but the behaviors occur less frequently — on average, less than once a week, for less than 3 months
- Purging Disorder: Frequently purging (e.g., vomiting, taking laxatives, exercising excessively) to influence body shape or weight, but without binge eating (eating a large amount of food in a short time frame)

Our Specialists

Kara L. Beals
LIMHP

Eating Disorders

Martin J. Harrington
M.D.

Eating Disorders
Psychiatry

Mike D. Vance
PhD

Behavioral Health
Eating Disorders

Caitlyn Friedrichsen
RD

Eating Disorders

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