Type of setting for the inpatient adolescent with an eating disorder: Are specialized inpatient clinics a must or will the pediatric ward do?

Abstract

There are a range of different services for treating adolescent eating disorders (ED) but there is no clinical consensus and a paucity of research indicating which type of treatment setting is the best. Although it would be ideal to have a specialized ward for these patients what happens when this is not possible? The aim of this study was to evaluate patients with ED hospitalized on a general pediatric ward. A retrospective chart review for 37 patients hospitalized for an ED and followed by a team consisting of an adolescent medicine specialist, a child and adolescent psychiatrist and a dietician on a pediatric ward were re-evaluated. Twenty-four (64.9%) patients were diagnosed with anorexia nervosa (AN) restricting type, 8 (21.6%) with anorexia nervosa binging purging type, 3 (8.1%) with bulimia nervosa (BN) and 2 (5.4%) with eating disorder otherwise not specified. The mean age at admission was 14.79 ± 1.75 years and 7 (20%) were males. A majority were hospitalized due to medical instability. Mean period of time from admittance to medical stabilization was 6.04 ± 4.79 days. The mean period of admittance was 26.4 ± 11.9 days for AN and 23.7 ± 15.03 days for BN patients. The mean calorie intake of the AN group was 607 ± 333 kcal and 2,358 ± 605 kcal at hospitalization and discharge, respectively. Hypophosphatemia occurred in 2 patients during refeeding. Mean total weight gained during the whole hospitalization period was 3,950 ± 3,524grs. This study shows that although not ideal, EDs can successfully be followed on general pediatric wards and could have implications at centers with no specialized wards.

The lived experience of working with people with eating disorders: A meta‐ethnography

“…In 13 studies, the necessity of close observation of service users – particularly in inpatient environments (Akgül et al, ) – and a sense of being observed in turn, resulted in interpersonal mistrust amid a culture of surveillance. Participants described feeling awkward about intently monitoring service users to prevent ED behaviors: “They have to have somebody sitting in their room all day long with them….I feel uncomfortable for them” (nurse; Harken et al, , p. e38).…”

When Food is Feared: A Systematic Review of Enteral Feeding by Nasogastric Tube in Young People with Eating Disorders

“…Conversely to this, Akgul and colleagues 24 stated that the average time YP required NG feeding was 2.5 days when treated on a paediatric ward.…”

“…In 13 studies in which NG was not the independent variable, the proportion of ED YP requiring NG feeding was between 6% -66%. 3,7,17,[22][23][24][25][26][31][32][33]38,42 Nehring and colleagues 26 found that NG feeding was more likely to be required in: patients of a lower age at admission (14.3 compared to 15.3 years old, P<0.05), those with a shorter time period between disease onset and admission to hospital (P<0.0001), and longer time since last discharge (P<0.05). NG feeding is required more commonly in Early onset (EO) AN than adult onset (20% compared to 0%, P<0.05).…”

“…7 studies implemented supplementary oral phosphate either to reduce risk of hypophosphatemia or to treat it once detected to prevent the development of refeeding syndrome. This is summarised in Table 3. 3.8 Setting 3 studies 20,22,24 reviewed NG treatment for YP in different settings. Fuller and colleagues 20 demonstrated discrepancies in treatment provided to YP in different settings with specialist ED units being less likely to use pumps to deliver continuous feeds, tending to give bolus feeds of higher volume.…”

“…Fuller and colleagues 20 demonstrated discrepancies in treatment provided to YP in different settings with specialist ED units being less likely to use pumps to deliver continuous feeds, tending to give bolus feeds of higher volume. Akgul and colleagues 24 concluded the paediatric ward was a viable alternative for treatment (including NG) of YP with ED when specialist units are not available. In contrast Robb 29 discovered that YP staying on a general hospital ward had a longer duration of admission in total than those on a specialist psychiatric ward.…”