Anorexia nervosa (AN) is a common condition affecting young people. The medical management of AN on a general paediatric ward is challenging. It is important to identify young people who are at risk of medical complications, so early intervention can be instigated. This article aims to review the clinical practice and evidence supporting the current medical management of young people with AN. It provides a system-based approach to potential complications of the disease, guidance on feeding and the management of re-feeding syndrome. Approaches to legal and ethical challenges are also considered. While the importance of psychiatric treatment is recognised, the same is not discussed within this article.

Change in practice from overnight stay to day case surgery for pediatric tonsillectomy requires careful consideration of how to extend effective analgesia for this painful procedure into the home.

Previous publications have suggested that increasing the continuity of consultant working in critical care has a positive effect on patient outcomes. We introduced weekly day-time consultant working in a critical care unit and assessed the impact on mortality after one year. Two critical care units in separate district general hospitals in the same trust, with the same clinical management structure, treatment protocols and equipment, introduced changes in clinical practice at the same time during the study period. Unit one introduced a consultant work pattern of weekly working. Unit two retained the previous pattern of half-day or single full-day consultant working and acted as a control group. The mortality of all admissions and of a subgroup of ventilated admissions were compared for the year before and a year after this change. The mortality of all admissions showed a reduction in both units but this did not achieve statistical significance. The mortality of ventilated admissions in unit one showed a statistically significant reduction. There was a smaller reduction in unit two that was not statistically significant. Consultant weekly working was associated with a reduction in mortality of ventilated admissions to a general critical care unit.