Mothers with anorexia nervosa who underfeed their children: their recognition and management.

BACKGROUND: Women with anorexia nervosa have a reduced fertility but they may have borne children before the onset of their illness or after partial recovery. Little is known on how to identify the anorexic mothers who underfeed their children and how to manage them. This article aims to remedy these gaps.
METHODS: The clinical scientific method is the only means of identifying the children of anorexic mothers who are at risk. Eight such mothers were identified as a result of obtaining serial measurements of the children's weights and heights over time. Tanner-Whitehouse charts were used to plot weight for age and height for age. A simple rating scale was devised to measure the acceptance of treatment involving both mother and child.
RESULTS: Nine children (eight boys and one girl) were found to have suffered food deprivation: with severe reduction in weight-for-age in six and in height-for-age in eight. Five siblings were not affected. Catch-up growth was correlated with the degree of engagement in treatment of both mother and child. Long-term treatment of one mother, combining family therapy with admissions to hospital, resulted in catch-up growth in her two sons.
CONCLUSIONS: The mechanisms underlying the privation of the children stem from the anorexic mother's abnormal concerns with body size extending to her children. The children may become unduly accepting of the underfeeding. It is essential to obtain the confidence of anorexic mothers suspected of underfeeding their children and to adopt a whole family approach to treatment.