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Child Health Guideline Identifier

Eating Disorders - management of

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Introduction

This guideline is intended to assist in the appropriate assessment and management of children and adolescents admitted to Starship with anorexia nervosa and other eating disorders.

Outpatient family-based treatment is the treatment of choice for children and adolescents with eating disorders. However some will need a period of management as an inpatient.

In Auckland, treatment is coordinated by Tupu Ora (formerly the Regional Eating Disorders Service (REDS)) based at Greenlane. 

The outcome for the majority of young people with eating disorders is good. However children and younger adolescents with eating disorders have a higher risk of rapid medical deterioration compared with older adolescents and adults. Young people are also at risk of potentially irreversible complications affecting physical and emotional development. Early and assertive management has been shown to improve outcomes.

Medical and nutritional stabilisation is the first and most important goal of inpatient treatment. This is usually necessary before psychological therapy can be effective. 

The aims of an inpatient admission are to:

  • Achieve physiological stability
  • Commence appropriate refeeding
  • Initiate nutritional recovery
  • Undertake psychiatric assessment
  • Engage young person and family with outpatient treatment

Most patients admitted with an eating disorder stay in hospital for 2-3 weeks.

Initial Assessment

The assessment of a child presenting to CED with a diagnosed or suspected eating disorder should include the following:

(Please complete Section 1 of 'Tupu Ora Starship Assessment' document which can be accessed via Concerto (under Add New Document tab)

History -  Careful eating/dieting behaviour history including:
Amount of weight lost (maximum and minimum weight with approximate dates). Plot as many as possible on electronic growth chart.
Rate of weight loss 
Recent dietary intake (typical daily intake)
Purging / vomiting / laxatives / diuretics (ask about alternative and 'natural' therapies including herbal teas and supplements bought online)
Exercise 
Body image distortion / fear of weight gain 
Symptoms of poor nutrition - dizziness, cold intolerance, weakness (reduced exercise capacity), cognitive slowing
Co-morbid conditions (depression, anxiety, OCD, deliberate self harm and suicidality) 
Menstrual history - primary or secondary amenorrhoea, age of menarche, and weight at which periods ceased (menstrual threshold weight) 
School - Year, academic progress, any recent change
Sleep difficulties
Family composition 
Family history of eating disorders, anxiety and/or depression
Examination:
Height, weight, BMI, BMI centile (plot on electronic growth chart)
Temperature, lying and standing heart rate and blood pressure 
Capillary refill, peripheral perfusion
Cardiac exam - listen for murmurs and assess for cardiac failure
Assess abdomen (including evidence of distended bladder, loaded colon/constipation)
Pubertal status 
Assessment of mental state / HEADSS assessment 
Stigmata of binging/purging/self harm (roughness on knuckle of index finger, enlargement parotid glands, cutting on arms etc) 
Peripheral or sacral oedema 
Presence of lanugo hair, skin changes (dryness, carotenaemia, bruising, infection) thinning of head hair
Investigations:
Bloods
-  FBC
-  U & E, Creatinine, Calcium, Phosphate, Magnesium, Glucose
-  Bicarb & pH on venous gas (metabolic alkalosis may indicate vomiting)
-  LFTs (including albumin)
-  Amylase
-  TFTs (T4, TSH and T3)
-  LH, FSH, oestradiol (or testosterone if male)
-  Vitamin D (1st admission only)
ECG - QT & PR interval (identify risk of sudden death) 
Urine for ketones 
Psychiatric Assessment:
All children (whether admitted or not) who are not already known to Tupu Ora or have not seen a psychiatrist or psychologist recently need a psychiatric assessment to assess risk. They should be referred to the Consult Liaison team or the psychiatric registrar on call (if after hours). 

Admission Criteria

The main indications for admission are:

  • Medically unstable (see medical stability below)
  • Co-morbid medical problems (e.g. diabetes)
  • Rapid weight loss and exhibiting some physical signs
  • Continuing to deteriorate despite maximal outpatient therapy

Admission Criteria WILL be met if patient has ANY of the following:

1 Life-threatening weight loss
Total body weight < 75% expected (for height) 
Acute weight loss of 15-20% in 3 months 
2 Acute medical complications of malnutrition 
Syncope
Seizures
Pancreatitis
Cardiac failure 
Gastric dilatation 
Hypoglycaemia
Fasting hypoglycaemia indicates severe illness and is a poor prognostic indicator. Severe hypoglycemia has been associated with sudden death. It indicates poor compensation due to depletion of liver glycogen to maintain safe blood glucose levels.
NB: Mild, asymptomatic, postprandial hypoglycaemia may occur after a period of increased nutrition (abnormal insulin response) and may not be an indication for admission if fasting glucose is normal
Electrolyte imbalance 
Hypokalaemia (<3.0 mmol/L) 
Hypophosphataemia (anything below normal range)
Physiological instability 
Bradycardia - HR < 50/min 
Hypotension - Systolic BP < 80 mmHg 
Significant postural drop in BP (> 20mmHg) or rise in HR (increase by > 30 bpm)
6 Hypothermia
Temperature <35°C
7 Abnormal ECG 
Arrhythmia
Diminished amplitude of QRS complex and T waves 
Prolonged QTC (>0.44) or PR interval - (see ECG guideline

Admission MAY be necessary if the patient has any of the following:

Complete food refusal for more than 48 hours
For medical assessment for medical stability, bloods and ECG
2 Significant dehydration or complete fluid refusal for more than 24 hours
For medical assessment for medical stability - ketones in urine (creatinine is often normal as muscle mass is decreased) and ECG
3 Significant co-morbid psychiatric states 
Depression, anxiety, obsessive compulsive disorder 
Suicide risk and/or significant deliberate self harm, where this compromises nutrition, may also be an indication for admission after discussion with a psychiatrist .
Admission to the Child and Family Unit (CFU) may be more appropriate in such circumstances if the young person is medically stable.

If a child does not fit the guidelines for admission, but clinicians feel that admission is warranted then clinical judgment and decision-making prevails. Tupu Ora needs to be notified about all of these children on the first weekday after admission, if they are not already known to that service.

Discharge from CED

If the young person is medically stable, they should be discharged back to the care of the GP. The GP should arrange urgent referral to Tupu Ora if this has not already been done. If the young person doesn't have a GP, the family will need to find one and get them to immediately contact Tupu Ora. Tupu Ora will liaise with GPs regarding assessment and treatment, and provide support for GPs as required.

Admission to Ward

All children will be admitted to the General Paediatrics Ward and will be jointly managed with the Consult Liaison team.

Decisions must be made about the following before the child arrives on the ward.

  1. Is a watch needed?
  2. Route of feeding (NG or oral - see Nutrition Plan). If NG feeding is to be used, the tube shoiuld be inserted in CED

If a child with an eating disorder in CFU becomes medically unstable, they should be cared for on a General Paediatric ward, according to this guideline, until stabilisation is achieved. This transfer should occur after consultant to consultant discussion.

All patients should be reviewed by the ward social worker and have a Child Disability Allowance form completed.

Many patients will need input from Northern Health Schools after discharge, and a medical form for NHS will need to be completed.

Most patients will be managed according to the Nutrition Plan and Management Flow Chart below. This plan requires significant input from the family. This will be discussed at the first family meeting. If the family are not able to participate in the inpatient programme they will be discharged once medically stable and an outpatient follow-up plan is made.

Fluids and Electrolytes

For patients with shock, severe malnutrition or ECG abnormalities, PICU review should be considered.

IV fluid should be given if the patient is shocked (0.9% saline). Bolus IV fluid should not be given without discussion with senior as risk of precipitating heart failure.

If not shocked but the child is dehydrated then they should be rehydrated with NG pedialyte.

NG feeding (as per Nutrition Plan below) can commence as long as electrolytes are normal.

Hypoglycaemia can occur post-prandially due to changes in insulin secretion. If the patient is asymptomatic give next feed earlier rather than correcting with intravenous glucose. IV glucose can cause metabolic instability and potentially trigger refeeding syndrome.  If IV glucose is needed (unusual) give thiamine first.

In severe malnutrition, thiamine infusion is recommended prior to refeeding

Medication

All patients requiring inpatient admission should be started on:

  1. Phosphate Sandoz - 1 tablet twice daily for 2 weeks - must start on day of admission before feeding starts
  2. Multivitamin - 1 tablet twice daily for 3 months or more (ensure contains 400 iu vitamin D daily and thiamine)
  3. Discuss other supplements with paediatrician and dietitian (e.g. potassium, zinc,vitamin D to treat deficiency).

Nutrition Plan

First admissions

Admitting doctor to decide if the patient is to follow the Oral Fortisip or NG Pathway. This decision is based on degree of medical instability and discussion with family. If unsure seek advice from a senior.Click here to access a printable pdf version of the Nutrition Plan

Day One of Admission 
Oral Fortisip Pathway NG Pathway
Level One: Medical Stabilisation
  • Check bloods and give Phosphate prior to starting feed
  • Offer oral Fortisip 200ml (1 bottle) in CED
  • Drs to chart Fortisip on medication chart - oral 1 bottle (200ml) Fortisip Q4hourly including overnight. Ideally times are 2pm, 6pm, 10pm, 2 am, 6am 10am.
  • If refuses any oral Fortisip on Day 1 will require an NG and follow NG pathway
  • To drink 750 ml water daily in addition to Fortisip to meet fluid requirements
  • Ward nurse to:
    Order Trendcare diet- Eating Disorder (paediatric) (so meals sent the next day)
    Use spare Fortisip in Tupu Ora kitchen fridge Ward 25
    Notify dietitian of new ED admission and pathway chosen to ensure appropriate feeds are available (Mon-Fri leave message, weekend call weekend dietitian)
Level One: Medical Stabilisation
  • Check bloods and give Phosphate prior to starting feed
  • Insert 8 or 10 French Flexiflo enteral feeding tube
  • Start Nutrison Standard 1.0 at 75 ml/hour continuous feed as soon as possible
  • Admitting Dr to prescribe Nutrison and water on the fluid balance chart
  • Start feed in CED if there for more than 6 hours. It is important to avoid long periods in CED with no food or fluids.
  • To drink 750 ml water daily in addition to NG feed to meet fluid requirements
  • Ward nurse to:
    Order Trendcare diet- No meals required
    Use spare Nutrison in Tupu Ora kitchen on Ward 25
    Notify dietitian of new ED admission and pathway chosen to ensure appropriate feeds are available (Mon-Fri leave message, weekend call weekend dietitian)
Day Two of Admission 
Oral Fortisip Pathway NG Pathway
  • Check bloods
  • Continue 1 bottle Fortisip orally Q4 hourly until morning.
  • If medically stable contact dietitian to start meal plan from morning tea with a Fortisip in dining room.
  • If not medically stable, consider NGT
  • During the week: Dietitian to provide meal plan (3 meals and 3x 200ml Fortisip between meals)
  • In weekend: If patient is admitted after 4 pm Friday dietitian will not have ordered meals for weekend. Nurse will need to use standard meal plan for age and may need to supplement meals with available food from ward.
  • If refuses all or part of meal - to have 400ml (2 bottles) Fortisip orally (to have full 400ml Fortisip orally even if has eaten part of meal).
  • If refuses to consume oral Fortisip see below
  • Ward nurse to supervise all meals and snacks in dining room and record on food chart.
  • CLT to move to Level 2 once eating (if continuing with the programme)
  • Check bloods
  • If bloods normal increase Nutrison NG feed to 100ml/hr once bloods back. If not normal discuss with consultant or dietitian and keep feed rate same.
  • If the patient is <30kg they may need a lower rate eg; 90ml/hr (discuss with paediatrician or dietitian)
  • Ward nurse to:
    Order Trendcare diet- Eating disorder (paediatric) (so meals sent the next day)
Day Three of Admission or next weekday 
Oral Fortisip Pathway NG Pathway
  • Check bloods
  • Once has been eating hospital meals for > 48 hours:
    Dietitian to change Fortisip at snacks to flavoured milk and a snack.
    Some meals from home off ward with parents supervising
  • If Food Refusal see below
  • Check bloods
  • If medically stable contact dietitian to start meals/bolus feeds from lunch time (see below)
  • During the week: dietitian to provide meal plan ( 3 meals and 3 x 200ml oral Fortisip between meals)
  • In weekend: To stay on continuous NG feed at 100ml/hr until Monday. Turn feed off 10 am Monday to start meals from lunch
  • If refuses all or part of meal - to have 400ml (2 bottles) Fortisip orally or if refuses this via NGT. (To have full 400ml Fortisip orally even if has eaten part of meal).
  • If refuses snack Fortisip orally to have 250 ml Fortisip via NGT
  • Ward nurse to supervise all meals and snacks in dining room and record on food chart.
  • CLT to move to Level 2 once eating (if continuing with the programme)
Day Four of Admission onwards or next weekday
Oral Fortisip Pathway NG Pathway
  • Team to decide at MDT or family meeting when to move to Level 3
  • Remove NGT once not used for > 48 hours (not usually removed on weekends)
  • Once NGT out :
    Dietitian to change Fortisip at snacks to flavoured milk and a snack
    Some meals from home off ward with parents supervising
  • If Food Refusal see below
  • Team to decide at MDT or family meeting when to move to Level 3

Parents

  • Provide snacks (600-900 kJ per snack)
  • Provide and be present/supervise for most meals and snacks from Level 2
  • Dietitian to give parents a copy of meal plan to use as a guide to assist with providing suitable meals from home

Food refusal when no NG Tube

If full or part of meal or snack refused after time limit (15 minutes for snacks, 30 minutes for meals):

Offer Fortisip orally - 200ml for snacks and 400ml for meals.

  • If this is consumed: to stay on same level and continue with meal plan
  • If refused for the first time: to move to Level 1 until next meal or snack
  • If refuses 2 or more meals or snacks in 36 hours, and refusing oral Fortisip: For medical review:
    • If medically unstable NG tube to be inserted. For Fortisip via NG: 400ml Fortisip at meals and 250ml at snacks. Keep NGT in until not used for > 48 hours 
    • If medically stable and refuses food, Fortisip or NG go to Level 1 until review
    • If takes the nutrition (food, Fortisip or via NG) then stays on current level.

Management Flow Chart (first admissions)

Click here for a printable pdf of the management flow chart

Medical Daily medical review
Daily refeeding bloods (Na, K, Creat, Gluc, Phosphate, Mg, Ca) for ~4 days, then 2x per week
Nursing Daily weight
If heart rate less than 40/min for continuous heart rate monitoring until consistently >40/min at night
Obs at least q4h (HR, temp, BP). Lying and standing BP twice daily 
Nutrition Oral Fortisip or NG (See Nutrition Plan)
Contact dietitian on day of admission. All intake documented
NG removed once not used for 48 hour 
Activity Bed or chair rest. Wheelchair to bathroom
School work in room at discretion of team
No home leave
Complete referral to Tupu Ora if not already done
Level One - Medical Stabilisation

arrow

Medical Alternate day medical review
Twice weekly refeeding bloods (Na, K, Creat, Gluc, Phosphate, Magnesium, Calcium)
Weekly FBC, bicarb & LFTs
Nursing Weigh Mon, Wed, Fri
Obs at least q4h (HR, temp, BP). Lying and standing BP once daily
Nutrition Meal plan or bolus NG feeds (See Nutrition Plan)
All intake supervised and documented
NG removed once not used for 48 hours
Some meals off ward with parents supervising meals, home or hospital food, on or off ward 
Activity 30 minutes rest after meals and snacks.
Walk to bathroom, school and teen lounge
Go down to school on Level 3
Half day leaves -one meal and one snack at home
Level Two - Supported Eating

arrow

Medical Medical review 2-3 times per week
Weekly bloods (Na, K, Creat, Gluc, Phosphate, Magnesium, Calcium, FBC, LFTS and bicarb).
Extra bloods just prior to discharge (oestradiol or testosterone, T3, T4, TSH)
Nursing Weigh Mon, Wed, Fri
Twice daily obs
Nutrition All intake supervised and documented
Most meals from home, with parents supervising (on or off the ward) 
Activity 30 minutes rest after meals and snacks. 
Walk to bathroom, school and teen lounge
School
Overnight leave (usually two full days + overnight)
Outpatient follow-up plan established
Level Three - Transition home

Readmissions for medical stabilisation

  • Aim is for a brief (2 - 4 day) admission for medical stabilisation only, with quick return home and outpatient treatment. 
  • Check previous discharge summary for any special conditions or recommendations.
  • Level 1 management - no school or teen lounge
  • CLT team will not usually be involved in the care of these patients, however they should be contacted if there is concern about psychiatric comorbidities.
  • Give Phosphate Sandoz as per first admission before starting Fortisip or feeds (discuss duration of phosphate with paediatrician).

Nutrition plan for readmissions

  • Offer oral Fortisip in CED to determine treatment pathway.
  •  Fortisip available from Ward 25 (in Tupu Ora dining room) or CED staff kitchen.
    oral nutrition
  • Please inform dietitian of readmission so more Fortisip or Nutrison can be ordered.
  • Keep on NG feed or oral Fortisip until discharge.
  • Trendcare diet: No meals required (not  Eating Disorder dietcode).
  • Parents may provide food and supervise meals if they want to. This is optional and is over and above the Fortisip or NG feed.

Elective readmissions

Specific goals for admission, and timing of admission, to be clearly defined and agreed upon by consultation between Starship, CLT, outpatient treating team and parents PRIOR to admission.

Management on the Ward

All patients will be discussed at a multidisciplinary team meeting once a week and progress will be discussed according to the Flow Chart above. The decision as to when a patient moves from one level to the next is made by the team and will depend on medical stability, weight gain, eating behaviour, compliance with restrictions on activity and other behaviours. Most first admission patients will proceed to Levels 2 & 3. However, there may be a team decision to discharge once medically stable in some situations.

Medical Issues

Assessment of medical stability

A patient is likely to be medically stable if they have:

  • No evidence of physiological instability
    Bradycardia - HR < 50/min
    Hypotension - Systolic BP < 80 mmHg
    Significant postural drop in BP (> 20mmHg) or rise in HR (increase by > 30 bpm)
  • Normal body temperature
  • Good perfusion and not dehydrated
  • Normal ECG (if acute changes on admission)
  • Normal biochemistry on blood tests

Patients on Level 1 are frequently bradycardic, especially at night. If heart rate is less than 40/min, check that rhythm is regular and perfusion is good. If concerned, arrange medical review, check BP, wake patient and consider checking ECG and bloods.

Blood tests:
During re-feeding (first 1-4 days) bloods should be checked daily (then twice a week) including: 

Na, K, urea, creatinine, glucose, calcium, phosphate, & magnesium. Any abnormalities should be addressed promptly as they may indicate refeeding syndrome which has significant risk. If in doubt it is better to keep the rate of NG feeding the same (i.e. not increase to next step) until the blood tests have normalised. If you are not sure discuss with paediatrician on call.

Bicarbonate should be checked weekly, more often if there is concern about purging 

Full blood count should be checked weekly - neutropenia is common in these patients and takes several weeks to improve. 

Liver function tests should be checked weekly - some patients may have mild derangement of LFTs with refeeding.

A day or two before discharge TFTS (including T3) and oestradiol (females) or testosterone (boys) should be rechecked. 
Other investigations: 
Hand x-ray for Bone Age - All patients with primary amenorrhoea, and those who have had regular periods for less than 2 years (and all boys) should have a hand x-ray for bone age performed in the first week of admission. 

Bone density (DEXA) scan - All new admissions should have a bone density (Dexa) scan performed as an inpatient. Arrange early in the admission as it can take a few days for a time to be available. 
Constipation:
This is a frequent problem and is due to decreased gut motility. A regular dose of lactulose or movicol is generally safe to use but should be administered by nursing staff and not the patient or family. Other laxatives should only be used after discussion with paediatrician. Enemas should be avoided.
Renal impairment: 
Urea and creatinine results should be interpreted with caution. Underweight patients should have a relatively low creatinine because of their reduced muscle mass. A creatinine at the upper range of normal probably indicates some renal impairment or muscle breakdown from exercising. CK is sometimes elevated if exercising excessively. A high urea may indicate fluid restriction or inappropriately high proportion of protein in the diet. 
Acute Illness during admission: 
If a patient with an eating disorder becomes unwell they need prompt medical review.

If they are vomiting (more than once) due to an acute illness then they need to come off their meal plan and have fluid replacement with pedialyte.

Patients should be managed on Level 1 of plan until they have been eating full meal plan for 24 hours. They can then return to the level they were on previously. 

Criteria for Discharge

  • Medically stable.
  • Established follow-up plan and appointments
  • Family developing confidence in ability to manage at home

Please plot admission weight (weight on ward scales first morning after admission) and discharge weight on electronic growth chart. Include admission and discharge weight, height, ideal body weight range and bone density scan results if available (z-score spine, z-score body, % body fat) in discharge letter.

Eating Disorder Cognition and Behaviours

Caring for a patient with an eating disorder can be very challenging. Young people with significant weight loss have impaired cognitive function which can manifest as; mood disturbance, poor concentration and reasoning, abnormal emotional processing, and irritability. Families and friends often report significant changes in personality and loss of sense of humour. Most of these changes will improve as nutrition and body weight improves.

These young people have an extreme fear of gaining weight. Their behaviour in trying to avoid weight gain can be seen to be secretive, irrational, manipulative and deceitful. It is crucial to recognize that these behaviours are a result of the illness NOT the individual. The behaviours should be challenged, but in a non-judgmental and supportive way. The Consult Liaison Team will be able to provide advice on this.

Remember that the families of these patients have often been dealing with these very challenging behaviours at home for months before the child is admitted.

See also related guidelines and policies

  • Behavioural disturbance
  • 'Restraint minimisation and safe practice' accessed via the ADHB policies and guidelines library
  • 'Absent without leave (AWOL)' accessed via the ADHB policies and guidelines library

Calculating Ideal Body Weight

Determination of ideal body weight range (IBW) is a complex process that needs to take into account:

  • Previous height and weight centiles
  • Mid-parental height
  • Bone age
  • Anticipated growth
  • Average weights of healthy adolescents of the same sex, height and sexual maturity
  • Expected catch-up growth after growth arrest
  • Ethnicity
  • Exercise - young people who exercise a lot will have a lower proportion of body fat and the goal weight may need to be adjusted to allow for this

IBW should be calculated early in the admission by a paediatrician or dietitian. It is usually the weight which will give a BMI on the 50th centile. A 2kg weight range is usually given. It is advisable to tell the family that the calculated ideal body weight is an estimate and may need to be adjusted depending on other variables (bone density, menstruation, increasing age, increasing height etc). See WHO BMI tables for girls and boys.

Children and adolescents with eating disorders are different from adults

In children and adolescents, the potential for significant growth retardation, pubertal delay or interruption, and peak bone-mass reduction means that treatment needs to occur early. Amenorrhoea is an important diagnostic feature for anorexia nervosa in post-menarcheal girls, it may be a developmentally inappropriate criterion in young girls, in whom a history of delay in onset of puberty (or pubertal arrest) may be important. Approximately 10% of young people with eating disorders are male.

A normal BMI does not exclude a serious eating disorder. An individual who has previously been overweight and then lost weight rapidly, may have dangerous nutritional and physiological deficiencies despite having a normal BMI.

Weight loss is not necessarily present in younger adolescents with the disorder. They can instead have failure to achieve expected weight gain during a period of growth. Linear growth can also be affected which can lead to underestimating IBW.

Adolescents with anorexia nervosa generally have a better prognosis than adults.

Poorer outcomes are associated with later onset and longer duration of illness, lower minimum weight, failed previous treatment, more disturbed premorbid personality, greater social difficulties, more difficult family relationships, increased somatic or obsessional concerns, and premorbid history of obesity, bulimia, vomiting or laxative abuse. Early intervention is associated with improved prognosis.

Young children may not report fear of weight gain while at a low weight but may do so only when weight has been restored to a more healthy level. Children may be unable to express distress in terms of body shape and self-perception but may instead describe somatic symptoms such as abdominal pain or discomfort once re-feeding commences.

Patients older than 16 years of age

Starship will accept all referrals for patients under 17 residing in the Auckland region. Young people aged 17 years may be considered on a case-by-case basis if they are medically unstable and:

  • There is a bed available (patients under 16 take priority)
  • The young person is enrolled in school
  • The young person lives at home
  • Provision of outpatient management on discharge has been arranged
  • Some patients may be transferred to CFU or Tupu Ora Residential once they are medically stable

Referrals from Outside Auckland

Referrals from Northland may be considered if:

  • The referral is received from the local Eating Disorder Service or via Tupu Ora.
  • There is a medical referral from a local paediatrician to Starship paediatrician (i.e. the patient has been medically assessed)
  • A transition plan must be in place at the time of admission. The referring DHB must be willing to take the patient back for transition (Level 3) and provide outpatient management
  • The parents / caregivers must be willing to come and stay in Auckland
  • Transfer should not happen out of hours. The patient should be medically stabilised prior to transfer.

Information for Families

Download a pamphlet on Tupu Ora Starship Inpatient Eating Disorders Service

References / Further Reading

Eating Disorders. Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. NICE Clinical Guideline. 2004.

Critical points for early recognition and medical risk management in the care of individuals with Eating Disorders. Academy for Eating Disorders Report. 2011.

Hudson LD, Court AJ. What paediatricians should know about eating disorders in children and young people. J Paed Child Health. 2012;48:869-875

Junior MARSIPAN: Management of Really Sick Patients under 18 with Anorexia Nervosa. Royal College of Psychiatrists. October 2015

Healthpoint information on the Regional Eating Disorders Service at Greenlane http://www.healthpoint.co.nz/public/mental-health/regional-eating-disorders-service/

Did you find this information helpful?

Document Control

  • Date last published: 09 October 2018
  • Document type: Clinical Guideline
  • Services responsible: General Paediatrics, Consult Liaison Psychiatry, Eating Disorders Service
  • Author(s): Raewyn Gavin, Louise Webster, Stella Friedlander, Donna Gillard, Noeleen Glubb
  • Owner: Raewyn Gavin
  • Editor: Greg Williams
  • Review frequency: 2 years

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