The number of young people in the UK with eating disorders is rapidly increasing, age of presentation is younger and hospital admissions are rising. Eating disorders are mental health conditions with serious health complications. Associated mortality is higher than in any other mental health disorder and than in most physical disorders treated on general paediatric wards.
Managing eating disorders and their physical effects can be extremely challenging and many see it as beyond the scope of an acute general paediatric ward. However removing young adolescents from their family, school and local community into specialist eating disorder units for extended periods of time and at great expense to the health community has many negative effects and evidence is poor that long term outcome is improved.
From 2008–2010 we had 7 admissions of young people with eating disorders to our general paediatric ward with an average length of stay 79.8 days, 3/9 required NGT feeding and 6/7 ultimately required tier 3 or 4 inpatient admission.
Junior MARSIPAN guidelines recommend close working between paediatric medical and mental health services to maintain young people safely in the community. We report our experience of developing a paediatric inpatient service to support our CAMHS team and work within the resources of our general paediatric ward. In 2011 we introduced a structured 3 week refeeding admission with close working between medical and nursing staff, dietetics and CAMHS.
24 admissions since have all achieved physical stability with the average length of stay 18 days, reduced tier 3 or 4 admissions (9/24) and improved eating compliance (3/24 NGT). Qualitative feedback from nurses and medical staff show that these admissions are easier to manage and have improved their attitudes towards young people with eating disorders. CAMHS and dietetic colleagues will also present their views of the benefits to this way of working.
We identified patient factors (comorbid mental health problems, family disruption) that were more common in those who still required more specialist services.
We conclude that a brief, structured, general paediatric inpatient admission can achieve physical stability, safe refeeding, begin weight restoration and start the path to recovery for the majority of young people with typical anorexia nervosa.