At the ILCA Conference in San Diego on August 16, 2007 Dr. Patricia  
McVeagh of Artarmon, Australia, gave a very interesting talk on  
"Challenges and Risks of Mothers with Eating Disorders."  It is a  
very complicated issue, and mothers with eating disorders can exhibit  
a wide range of symptoms.  Effects on the nursing baby can also vary.
The outline for this talk is on pages 104 - 107 of the conference  
syllabus.  Each person attending the conference received a CD as well  
as a syllabus, and the outlines were at one time on the ILCA web site  
area available to members.  I can't find the outlines there now.  
Perhaps you can find someone who attended the conference to share the  
information with you.  There was a bib for this talk with 40  
references on it.

One person from the audience in the question period described a  
toddler who was starting to imitate his mother's habit of vomiting  
after meals, and Dr. McVeagh noted that this is a not-uncommon,  
learned behavior.

One of the most important points in working with these families is to  
be aware of the "splitting mechanism" that is often a major part of  
eating disorders.  This leads to pitting one health care professional  
against another.  We have to be careful not to be drawn into this  
behavior, so open, clear communication with all involved in helping  
the family must be a focus.  Often a multidisciplinary team is  
involved in treatment.  It's helpful to gain the mother's confidence  
and trust before suggesting the possibility of an eating disorder.


Dr. McVeagh suggested considering "a possible eating disorder in a  
mother who:

1. Is very anxious about her weight or shape
2. Has an inappropriate view of a healthy weight for her height or  
weight gain in pregnancy
3. Has a BMI under 19
4. Failed to gain weight at two consecutive prenatal visits
5. Has a history of periods of amenorrhea, infertility, previous  
still birth, premature delivery or past infant feeding problems
6. Has poor circulation; cold or purple fingers
7. Has a history of dental caries (due to frequent vomiting)"

Mothers with bulemia may actually be a normal weight, but can have  
electrolyte imbalances.

An interesting point for today is that these mothers may use the  
internet to access discussion groups and web sites where eating  
disorders become competitive - each trying to outdo the others in  
losing the most weight.

Dr. McVeagh is a Clinical Lecturer in infant nutrition at the  
University of New South Wales and Sydney University, and a  
pediatrician who runs an eating disorder program.

Anne Altshuler, RN, MS, IBCLC, LLLL
Madison, WI

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