Eating Disorders (anorexia nervosa / bulimia)

This condition is treated in the Paediatrics clinic.

Pre-referral work-up

History

Clinic Scope: The assessment, diagnosis and management of children and adolescents with a wide range of disordered eating including anorexia nervosa/bulimia are handled in the eating disorder clinic.

• Patients do not need to meet full criteria for a specified eating disorder to be referred.
• Note: Young people's presentations with eating disorders may differ significantly from adults. Common presentations include: concerns about health and fitness, fears of vomiting or abdominal pain, concerns about body shape.
• The physiological effects of malnutrition are more pronounced in young people due to the higher energy demands for growth.
• Young people who have lost weight rapidly from a high weight to a weight in the 'healthy' range may actually be physically compromised and require assistance.
• Consider eating disorders when reviewing children and adolescents of either gender who have lost weight or failed to gain weight.
• Always consider a high level of parent concern regarding a child's eating habits, weight shape or fitness concerns an appropriate trigger for referral.
• Patients with eating disorders may also be at risk of suicide or self-harm. These patients can be discussed with the triage team Clare House / CAMHS for urgent advice. On consultation with the paediatric consultant and the CAMHS team, admission may be considered. The admission is usually of shorter duration than if the patient were physically comprised.
• History to include:
  • The period of time of weight loss and rate of weight loss; dietary habits; exercise including any sports injuries; mental health concerns.

Tests

Examination and Investigations:

All patients require:

1. Bare (or close) weight
2. Accurate height
3. BMI checked against centile chart for age
4. Temperature, pulse
5. Blood pressure: Lying (quietly for five minutes) and standing

Also useful:

• Past weights and heights
• Baseline bloods - UE, Cr, Ca, PO, Mg, FBC, TFT
• ECG
• Menstrual history
• Spot diet history

Interim/GP management

To refer a patient with this condition, please see the Paediatrics clinic page for the full referral process and templates.

Please consider providing an – indefinite referral" addressed to both Dr Michelle Williams and Dr Fiona Wagg.

Possible admission criteria to be discussed via Royal Hobart Hospital Switch with the Eating Disorder Clinical Nurse Specialist (available three days a week) or when unavailable, the Paediatric Registrar via Royal Hobart Hospital switch.

Encourage parents to feed young person as they did pre illness.

Restrict exercise until patient seen and stable.

Follow-up: All patients with eating disorders require close and expert monitoring and long-term therapy. This usually involves a combination of adolescent medicine and psychiatry out-patient support.

For more information please see the HealthPathways Tasmania website.

Clinic appointments

? Red location flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Urgent (Category 1)

Urgent referral if:

? Bradycardia (under 50 bpm)

? Cold hands and feet

? Orthostatic pulse jump - pulse jump of over 30bpm lying to standing

? Dehydration

? Hypothermia (temp. under 35^oC oral)

? Electrolyte abnormalities (eg. hypokalaemia, hypernatraemia, hypophosphataemia)

? Severe weight loss (over 30% of pre-morbid weight)

? BMI under 5th percentile for age

We will endeavour to see these patients within 1 month.

Urgent referrals should be accompanied by a phone call to the Consultant/Registrar to organise urgent review.

For any urgent sexual abuse/assault concerns please phone RHH switchboard and ask Paediatric Sexual Assault Consultant or Registrar on call for advice.

Availability

North

Launceston General Hospital
Level 3 (Western end of Charles Street Corridor)
Paediatric and Adolescent Outpatient Clinics

Phone: 1300 977 694 (select option 3)
Fax: 03 6777 5242

North West

North West Regional Hospital
Phone: 03 6493 6300
Fax: 03 6464 1928

Mersey Community Hospital
Phone: 1800 636 455 
Fax: 03 6441 5928

South

Royal Hobart Hospital
Level 3, D Block (North) - Paediatric Clinics

Phone: 03 6166 0000
Fax: 03 6173 0469

Outreach Clinics are offered at various locations, but referrals should be sent to the Paediatric Clinic.