ABSTRACT
Early onset anorexia nervosa is a serious disorder with a high rate of continuing morbidity after treatment and in the longer term a significant mortality (Steinhausen, 2002). With such a potentially poor prognosis an intensive and comprehensive treatment programme is indicated. The NICE (National Institute for Clinical Excellence) guidelines for the treatment of eating disorders contain recommendations based on a rigorous and comprehensive review of research evidence and expert consensus, including recommendations specific to children and adolescents (NICE, 2004). The guidelines are intended to provide ‘systematically developed statements that assist clinicians and patients in making decisions about appropriate treatment’ (p. 8). Some of the key NICE recommendations regarding the management of children with anorexia nervosa are summarised in Table 9.1. although clinicians working with such patients have a responsibility to refer to the original document. The current chapter aims to describe in more detail an approach to the management of anorexia nervosa, which should preferably be initiated early, before the illness is consolidated. We recommend, consistent with NICE guidance, that such a programme should include:
Provision of information and education
Ensuring that the adults (parents and care-givers) rather than the child are in charge
A decision about in-patient care
Calculation of a target weight range
Weight restoration
Medication where indicated
The use of family therapy and/or parental counselling
The use of motivational techniques and individual therapy (in some instances)
Group therapy (in some instances)
Attention to schooling issues
Main recommendations in the NICE guidelines regarding the management of children and adolescents with anorexia nervosa https://www.niso.org/standards/z39-96/ns/oasis-exchange/table">Treatment should normally involve family members (including siblings) and the effects of AN on other family members should be recognised.
Patients should be offered family interventions that directly address the eating disorder.
Parents/carers should be included in dietary education or meal planning.
Patients should also be offered individual appointments separate from those with their family members or carers, and their right to confidentiality should be respected.
The need for in-patient treatment and the need for urgent weight restoration should be balanced alongside educational and social needs.
In-patient treatment should be provided within reasonable travelling distance to enable the involvement of the family, to maintain social links and to facilitate continuity of care.
Admission should be to age-appropriate facilities, able to provide appropriate educational and related activities.
Feeding against the will of the patient should only be done in the context of the Mental Health Act 1983 or the Children Act 1989.
When a young person refuses treatment considered essential, consider using the Mental Health Act 1983 or the right of those with parental responsibility to override the young person's refusal.
Following weight restoration, ensure that children and adolescents have the increased energy and necessary nutrients available in their diet to support continued growth and development.
Oestrogen administration should not be used to treat bone density problems due to risk of premature fusion of the epiphyses.
