Eating Disorders in Medically Complex Children
Some children have restrictive eating, food avoidance, weight changes, or body-image concerns alongside gastrointestinal disease, endocrine conditions, neurological disorders, chronic pain, food allergies, sensory differences, or other medical conditions.
It can be genuinely difficult to determine which symptoms are medically driven, which are part of an eating disorder, and how the two interact. That question is what this work addresses.
Dr. Annabel Kuhn is a board-certified psychiatrist who completed her residency at Harvard and her fellowship at Boston Children's Hospital. Her role here is psychiatric evaluation and treatment as part of a multidisciplinary team, alongside the pediatrician, dietitian, therapist, and specialists already involved.
Every family begins with a brief phone conversation before scheduling an evaluation.
Where Dr. Kuhn Fits In
Dr. Kuhn does
- Provide psychiatric evaluation and treatment as one member of a multidisciplinary team
- Help distinguish medically driven symptoms from eating disorder symptoms and clarify how they interact
- Treat co-occurring anxiety, depression, and related conditions
- Collaborate with pediatricians, adolescent medicine, gastroenterology, dietitians, therapists, and eating disorder programs
- Prescribe psychiatric medication with attention to the child's medical conditions and treatments
Dr. Kuhn does not
- Provide medical monitoring such as weight, vital sign, or laboratory surveillance
- Provide comprehensive standalone eating disorder treatment
- Provide nutrition counseling or meal planning
- Manage refeeding or medical stabilization
What Families Often Notice
When eating problems and medical illness coexist, the presentation is rarely clean. Families often describe:
Dr. Kuhn's Approach
The evaluation is built to hold both stories at once. Dr. Kuhn spends at least two hours, beginning with a separate 60 minute virtual appointment with parents or caregivers, where the medical history and the eating history can both be laid out in full, including what has already been tried.
She then spends about 60 minutes with the child to fully understand their perspective.
The central clinical question is usually how the medical and the psychiatric interact. A child with reflux or a motility disorder who has learned that eating causes pain may restrict for reasons that begin medically and become entrenched behaviorally. A child with sensory differences may have a very narrow diet with no body image component at all.
Because a child with disordered eating and a medical condition needs several kinds of expertise at once, Dr. Kuhn works as one part of a team and coordinates actively with the others rather than working in parallel with them.
Who Dr. Kuhn Coordinates With
This is explicitly team-based care. Depending on your child's needs, that team may include:
Frequently Asked Questions
Is this a full eating disorder treatment program?
No. Dr. Kuhn provides psychiatric evaluation and treatment as one member of a multidisciplinary team. She does not provide medical monitoring such as weight and vital sign surveillance, nutrition counseling, refeeding, or comprehensive standalone eating disorder care. She collaborates with pediatricians, adolescent medicine physicians, gastroenterologists, dietitians, therapists, and eating disorder programs who provide those components.
My child stopped eating because of stomach pain, not body image. Does that count?
Yes, and it is a common reason families come to this page. Restrictive eating driven by fear of pain, vomiting, or choking, or by sensory aversion, is different from restriction driven by body image, and it is frequently misunderstood as one or the other. Clarifying which processes are operating, and how they interact with the underlying medical condition, is the point of the evaluation.
How do you tell what is medical and what is an eating disorder?
By building a detailed timeline of both alongside each other. A child with a gastrointestinal condition who learned that eating causes pain may restrict for reasons that started medically and became entrenched behaviorally, which requires a different approach than either explanation alone. This is why the evaluation includes a long parent appointment covering the full medical and eating history.
Will Dr. Kuhn work with our dietitian and GI doctor?
Yes, and in this area it is essential rather than optional. With your consent she communicates directly with the pediatrician, adolescent medicine physician, gastroenterologist, dietitian, therapist, and any eating disorder program involved, so that the plan is coherent rather than several parallel plans.
How do we start?
Every family begins with a brief ten-minute phone call with a parent or caregiver. Because this area in particular requires the right team configuration, that call is also where Dr. Kuhn confirms whether her practice is the appropriate setting for your child or whether a program with medical monitoring would be a better fit.
Our Location
Brookline, MA 02446
Virtual appointments available throughout Massachusetts
Located on Beacon Street near Coolidge Corner, one mile from Boston Children's Hospital and the Longwood Medical Area.
Start With a 10-Minute Call
Before scheduling an evaluation, Dr. Kuhn speaks with a parent or caregiver by phone for about ten minutes. It is a chance to describe what your child needs, ask about her approach, and decide together whether this practice is the right fit.
Request a Call