Even the weighing is not always done sensibly. The success or failure of a treatment programme, at least initially, is determined by weight gain or weight loss. It is therefore vital that these weights are accurate. This means that children should be weighed in their underwear, and checks made to see that they are not hiding weights in their underclothes or under their arms.
Parents need to be warned to supervise their children for at least two hours before their appointment to see that they do no drink water to increase their weight.
Inpatient treatment for children with eating disorders
Outpatient treatment should only continue if consistent weight gains are being made.
Too often a week of weight gain is followed by a week of losing and at the end of six months or a year no progress has been mad at all.
Children should have their weight and height recorded as a weight/height ration not as a body mass index (BMI), which is only useful for adults. Most clinicians treating children with eating disorders agree that a child should be hospitalised when their weight/height ration is 65-70% or below.
Children who are vomiting regularly need to have their blood potassium levels monitored regularly and should be hospitalised if the vomiting cannot be brought under control. Vomiting can cause sudden death even in children whose weight is within normal limits.
Despite a recent report finding a rise in young children suffering from anorexia, most specialised units have empty beds. However, with the NHS under enormous pressure to save money, it is becoming increasingly difficult for clinicians to obtain funding for inpatient treatment.
Restoring weight levels in children with anorexia
Over the twenty years that I have been treating children with eating disorders, I have seen many children whose outpatient treatment has extended into months and years, although no progress was being made. Outpatient treatment must restore weight and periods. It cannot be deemed treatment if it simply stabilises a child at a dangerously low weight.
We need to question the efficacy of continuing an outpatient programme which doesn’t seem to be working. Despite the obvious drawbacks of admitting a child to hospital, eating disorders can be extremely damaging and sometimes difficult decisions have to be made.
If a good unit weight gain is guaranteed and at a safe weight there is much more chance that the child will think more rationally. Do not accept a treatment that is not at least restoring your child’s physical health. Whilst treating the psychological issues of an eating disorder is often difficult, restoring weight is easy and a vital first step.
Be prepared to question decisions you do not agree with, doctors do not always get things right and they should not mind listening to what you want to say. You owe it to your child to see he or she is given the best possible chance to put their illness behind them and start enjoying life.
About Dee Dawson
Dr Dee Dawson BSc. M.B.A. M.B.B.S. is
a medical
practitioner who specialises in the treatment of children and
adolescents with anorexia. Twenty years ago she founded Rhodes Farm Clinic, the first
unit in the UK to specialise in the treatment of children and adolescents with weight loss problems and eating disorders such anorexia. During the last 20 years she has treated hundreds of
children with anorexia and helped their parents keep them at a safe weight.
