Patients with severe eating disorders are managed through our strong collaboration with Mental Health within the Regional Eating Disorder Program based at the Children’s Hospital of Eastern Ontario (CHEO). The eating disorder program currently consists of a six-bed inpatient unit, a day program as well as an extremely active outpatient program.

The Gender Diversity Clinic is a collaboration with endocrinology that was initiated in 2011 and addresses a large previously unmet need. 

Outside of these activities, the division’s 4 physicians also work closely with other pediatricians within CHEO to help provide care to youth struggling as a result of a chronic illnesses and/or disability. The division treats and consults approximately 500-600 patients per year, including inpatients and outpatients.

Our program takes a developmental, broad-based approach to initiatives ranging from outreach and early intervention to tertiary intervention. There is a strong focus on building primary support systems through families and/or guardians.

Related links

• Canadian Bioethics Society
• Canadian Paediatric Society
• Canadian Tri-council core skills tutorial for research ethics

Inpatient care

Inpatient adolescent health has four components:

• In collaboration with mental health, we provide acute care to patients admitted to the six beds which constitute the inpatient eating disorders program.
• We manage the eating disorder patients who are admitted off service (average of four at any given time)
• We will undertake care for youth with health care issues, such as avoidant/refusal food intake disorder or conversion, that are often multi-disciplinary, require longer lengths of stay and benefit from the consistency of more consistent MRP
• We do consults to the pediatric and subspecialty services

Outpatient care

The outpatient component of adolescent health comprises six or seven half-day clinics for eating disorder follow-up as well as one clinic for new eating disorder assessments. 

There are one or two clinics designated for sexual assault follow-up. 

There are ten half-day clinics shared by physicians and social work devoted to gender diversity. They are designed to supports children and youth who identify as transgender. 

There are two or three clinics for general adolescent health issues such as: sexuality, substance abuse, adjustment disorders, difficulties with school performance, chronic illness and disability. 

Finally, there is one half-day clinic every two weeks where one of our physicians outreaches to adolescent mothers through the single parent network at St. Mary’s Home. 

Clinical problems and diseases evaluated and followed

• Eating Disorders
  • Anorexia Nervosa
  • Bulimia Nervosa
  • Avoidant / Refusal Food Intake Disorder 

• Sexuality
  • Contraception
  • Menstrual Problems
  • Sexual Orientation
  • Gender Dysphoria
  • Follow-up Post Sexual Assault
  • Teen Pregnancy
  • Chronic Illness Adjustment 

• Complex Adolescent Health Issues
  • Adjustment Disorder
  • School Performance
  • Parent-Child Relationship Problems
  • Conversion Disorder
  • Youth who are Struggling

Diagnostic learning opportunities for trainees focus largely on engaging youth and establishing a developmentally-based conceptualization of their situation. It likewise involves working with the families to establish effective support systems. The HEADDSS mnemonic is fundamental to performing a complete interview.

Laboratory exposure relates primarily to nutritional rehabilitation and monitoring for refeeding in severely malnourished youth, appropriate screening and management related to sexually transmitted infections as well as hormonal screening and monitoring in young people undergoing transition to preferred gender.

The Division of Adolescent Medicine is very involved in education as well as clinical research. Division members have held, or currently hold, multiple peer reviewed grants and present regularly at international and national forums on a variety of topics related to adolescent health.

Through collaborations with the eating disorder program at CHEO, division members have led and co-led innovative initiatives designed to help improve overall outcomes and engage families throughout the treatment process.

The division is also currently participating in multi-centre trials involving issues such as alcohol abuse and medication interactions with illicit substances.

Interested trainees may have opportunities to engage in scholarly activity during clinical rotations depending on their own specific interests and studies that are planned or already underway.

Research areas include:

• Eating disorders
• Gender diversity
• Adolescent pregnancy and parenting
•  Vulnerable youth

Undergraduate training opportunities

Undergraduate students have an opportunity to participate in several areas of adolescent health both within and outside the hospital with the following objectives: 

• To provide an opportunity to gain experience in the interview and assessment of adolescent patients
• To understand the interaction of the process of adolescent development on the biopsychosocial health outcome of youth
• To become comfortable using the HEADDSS - a psychosocial interviewing technique for adolescents
• To gain confidence in engaging and working with adolescents presenting with high risk behaviours.

Experience will include both inpatient and outpatient exposure with patients aged 11 to 18 years in the following areas: 

• Eating disorders - exposure to the full spectrum of eating disorder management including a half-day assessment process, outpatient clinic, day program (maximum of eight patients) and inpatient (averaging four to eight patients).
• General adolescent health issues - exposure to a range of patients presenting with issues related to adolescent development, identity, sexuality, anxiety and depression, school refusal, substance use and abuse. There is a specific focus on sexual health through one adolescent health clinic weekly with emphasis on areas such as sexual histories or sexual assault. Chronic illness patients are reviewed in either the general adolescent health clinic or in concert with various subspecialty clinics such as diabetes or inflammatory bowel disease (IBD).
• There is a particular emphasis on gender diversity.

Students also have the opportunity to become involved with research projects addressing any facet of adolescent health.

Postgraduate training program

The Division of Adolescent Medicine does not offer subspecialty or certified postgraduate training at this time.

Additional postgraduate training

Pediatric residents have the opportunity to develop effective and constructive ways for engaging with and helping youth to improve their overall health. The approach is based on a collaborative developmental approach. They gain competency in identifying the underlying needs of youth that lead to health-threatening behaviours, in establishing support systems that include families, and, an awareness of community resources relevant to this population.

The Division of Adolescent Medicine does not at this time offer fellowship opportunities. We have however offered varied exposures to family medicine residents, psychiatry fellows and to pediatric gynecology fellows who seek specific training that is pertinent to their own fields of study.