Children's Eating Disorders
The Children and Young People Eating Disorder Service (CEDS) is a specialist team of Psychiatrists, Therapy Professionals, Dieticians, Paediatricians and Nurses in the community working together to support all young people under the age of 18 years who have restrictive eating disorders of anorexia nervosa (AN) and bulimia nervosa (BN).
The purpose of this guideline is to improve the quality of referral so that we can triage quickly and safely. Lack of bloods and examination (see below for what is expected)will result in your referral being sent back and delay the young person being seen. We need these details to risk stratify and triage effectively.
Eating Disorders have a high mortality rate. Early intervention leads to better outcomes.
Be alert to the possibility of an eating disorder. It can sometimes be a hidden condition. Listen to the parents.
Questions that may be helpful to ask either patient or caregivers:
- Dieting, skipping meals
- Denial of feeling hungry
- Eating more slowly and/or pushing food around the plate
- Wearing baggy clothes
- Increased interest in preparing food
- Distorted body image
- Increased interest in weighing and checking mirrors
- Mood changes
- Increased time in bathroom post meals
- Cold intolerance, bloating, constipation, dizziness, headaches
Email to the CEDS team email: firstname.lastname@example.org.
(CEDS Clinical Lead phone number – 01579 373850).
The CEDS team monitors referrals Mon-Fri 9am-5pm.
Please include a written letter with the following information in your referral, to help the CEDS team prioritise risk:
- Eating disorder history – time of onset, body dysmorphia, purging history (see questions above)
- Historical weights if available
- Relevant past medical and psychiatric history (including psychiatric co-morbidities – low mood, suicidal ideation, self harm)
- Any child protection concerns
Examination (this can take at least 10 mins so consider double/ longer appointment time)
- Current height, weight & BMI
- Heart rate (rest-lying, 1 min standing and 3 minutes standing)
- Orthostatic blood pressure (rest-lying, 1 min standing and 3 minutes standing)
- FBC, U+Es, Bone profile, LFTs, LH, FSH and oestradiol, CK, Vit B12, folate, vit D, glucose, Magnesium, Coeliac Screen and TFTs or search for ‘New Eating Disorder <18 years’ on ICE for the above as an order set.
- If possible, arrange an ECG and calculate QTc interval, see link to help. We usually use the Bazett formula https://litfl.com/qt-interval-ecg-library/
Ongoing physical monitoring will be offered to all patients 8 – 18 years accepted into the service and will be organised by the CEDS team. Please note that we may ask you occasionally to do an extra set of observations if we feel this would be useful and a patient has not yet been seen by the physical monitoring team.
Please note due to pressure on bed capacity within paediatric wards at RCHT, a 16+ patient may need to be admitted under adult medicine. This will be arranged internally by the paediatrician and will not require another call to the adult medical team.
Helpful links to give to patients and parents:
Or download/print the information leaflet for young people and families - what to expect once a request for help has been made including further Eating Disorder information resources. (link)
Author: Dr S Burns, GP
Contributors: Dr Natasha Sauven Consultant Community Paediatrician and Paediatric Eating Disorders Lead.
Date: April 2021 Review Date: April 2022