A guide for medical assessment for children and adolescents with
A guide for medical assessment for children and adolescents with an eating disorder Child and adolescents with an eating disorder are at great risk of medical complications, in particular those presenting with Anorexia Nervosa. It is therefore essential to have an initial medical assessment as well as ongoing assessments to ensure the young person remains medical stable in order to engage therapeutically with their outpatient treatment in order to achieve recovery. The cause of medical complications can be due to weight loss, the rapidity of the weight loss and the compensatory behaviours that may be being used. Initial Assessment by a medical practitioner Height, weight and BMI Physical observations: pulse (ECG if <60), BP lying and standing, temperature Urinalysis (ph, SG and ketones) Bloods (EUC, FBC, LFT, TSH, T3, T4, LH, FSH & oestradiol) Self-harm assessment General History: History of presenting illness Minimum and maximum weight Rapidity of weight loss Compensatory behaviours (purging, exercise, laxatives, restriction) Menstrual history Family composition Family history of eating disorders or mental illness Com-morbid conditions (anxiety, depression, self-harm etc…) Ongoing Assessments by a medical practitioner Height, weight and BMI Physical observations: pulse (ECG if <60), BP lying and standing, temperature Urinalysis (ph, SG and ketones) Bloods (if weight loss continuing or suggestion of purging or laxative use) If concerned about medical stability please contact: The Children’s Hospital Westmead: Eating Disorder Service Contact: Jo Titterton (Clinical Nurse Consultant) 9845 0000 pg 7118 Fax 98452515 OR/ Present to your nearest hospital emergency department if the young person meets criteria for admission Eating Disorder Service A/Prof. Michael Kohn Ms. Jo Titterton Dr. Anne Morris Ms. Colleen Alford Dr. Averil Cook Dr. Jane Miskovic - Co-Director - CNC - Staff Specialist - Senior Social Worker - Clinical Psychologist - Research Coordinator Dr. Sloane Madden Mr. Andrew Wallis Dr. Sally Byrne Dr. Annaleise Robertson Dr. Julian Baudinet - Co-Director - Head, Family Therapy - Staff Specialist - Clinical Psychologist - Psychologist MEDICAL ASSESSMENT FORM FOR EATING DISORDER PATIENTS NAME: …………………………………………………………………………………… DATE: ……………………………………………………………………………………… Findings Increase Vigilance Criteria for Admission Pulse 50-60 b/min <50 b/min Temperature 35.5-36.0 C <35.5 C Dizziness present 80/40 or greater than a 20mm/hg drop Blood Pressure Hydration Clinical evidence of dehydration ( cap refill/ urinalysis etc) Urinalysis Persistent low Specific gravity (persisting low 10001005 suggesting possible water loading/falsification of weights ) Ph>8 Ketonuria Oedema Any peripheral oedema Stigmata of purging Hand Palate Salivary Glands Bloods: elevated Amylase, mild hypokalaemia, increased Bicarb Stigmata of exercising Eg erythema over spinous processes from sit ups New onset or increased in frequency or intensity Stigmata of self-harm Unable to guarantee safety Electrolytes – abnormal K+ < 3.5 mmol/L ECG Qtc >450m sec Eating Disorder Service A/Prof. Michael Kohn Ms. Jo Titterton Dr. Anne Morris Ms. Colleen Alford Dr. Averil Cook Dr. Jane Miskovic - Co-Director - CNC - Staff Specialist - Senior Social Worker - Clinical Psychologist - Research Coordinator Dr. Sloane Madden Mr. Andrew Wallis Dr. Sally Byrne Dr. Annaleise Robertson Dr. Julian Baudinet - Co-Director - Head, Family Therapy - Staff Specialist - Clinical Psychologist - Psychologist
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