Eating disroders childhood pediatric.pptx

Eating disordes

1. Eating disorders Anorexia Nervosa Bulimia Nervosa Eating Disorder NOS

2. History: Inquire about how patient feel about their body? Have they tried to lose weight? How have they dieted? Ask about weight history and dietary intake? Purging history (vomiting, laxatives, emetics) Menstrual history (irregular cycles, secondary amenorrhea) Symptoms secondary to malnutrition pr purging (dizziness, syncope, fatigue, hair loss) The adolescent with an eating disorder often has one of these other symptoms without an overt complaint about weight

3. Physical examination The physical examination findings are often normal especially in bulimics who are generally within 10 pounds of ideal body weight. Weigh the patient in gown only after voiding. Hypothermia, bradycardia, hypotension, postural hypotension may be present if the patient is malnourished Coldness and edema of the extremities Hard stool in the rectal vault The patient who has been vomiting may have lost tooth enamel.

4. Lab investigations: Malnutrition can affect virtually every organ system. Abnormalities can include electrolyte alterations alone or with persistent vomiting and diuretic or laxative use. Compromised renal function, bone marrow suppression, mild liver inflammation, suppressed thyroid function with low free T4 and TSH levels Perform electrocardiogram if the patient is hypokalemic

5. Severity of eating disorders: Mild : recent onset of symptoms and physiologically stable and not less than 85% of ideal body weight Moderate : Not less than 75% of ideal body weight Depression without suicidal ideation Physiologic abnormality:hypothermia or hypokalemia Severe : <75% of ideal body weight Evidence of metabolic disorder: Heart rate <40 Temperature <36c Systolic blood pressure <70mmhg Orthostatic hypotension Serum k<3.0 Severe dehydration Severe depression with suicidal ideation Very severe: Dehydration Electrolyte imbalance (depressed serum Mg, P) Arrhythmia

6. Mild : Treat : Nutrition counseling Explain to the patient and family that the patient may be struggling with emotional issues; the focus on eating and weight may be the patient’s attempt to maintain a sense of control in life when feeling is over helmed Consider: Psychiatric assessment Follow-up: Assess in 2-4 weeks If there is no improvement; it’s moderate eating disorder

7. Moderate : Psychiatric assessment Treat: Intensive outpatient management Nutrition Behavioral contact Psychotherapy Follow-up : Assess every 1-2 weeks If improves …follow up assess monthly If relapses :treat intensive outpatient management Consider: Day treatment and residential care If worsens so hospitalize

8. Severe & very severe : Hospitalize Treat: Medical stabilization Begin refeeding Follow-up: Monitor for refeeding syndrome Treat: institute psychotherapy Behavioral contract If Good response : Discharge to intensive outpatient or day treatment program Follow-up : assess weekly If relapses intensive outpatient management If worsens psychiatric hospitalization and residential treatment If poor response: Treat and consider: psychiatric hospitalization and residential treatment

9. References : Pediatric Decision Making (Fourth Edition) by Stephen Berman. Prepared by Dr . Hadia ElAasser Consultant of Public Health & Pediatrics