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