P405 Children with eating disorders presenting to non-tertiary paediatric units in ireland – a case series

The number of young people with eating disorders is rapidly increasing and hospital admissions are rising. We describe a case series of seven females who required admission to a paediatric unit in a non-tertiary centre over a 3 year period, highlighting the challenges presented. 7 patients had a total of 12 in-patient stays on a general paediatric ward. Length of stay ranged from 6 to 84 days, mean 44 days, median 55 days. Initial presentations were all unscheduled episodes of care. Age at initial presentation ranged from 10 to 14 years. Restrictive type eating disorder was the working diagnosis initial presentation in 5 of 7 cases. All were managed according to the Junior MARSIPAN Guidelines (Royal College of Psychiatrists). In the 2 youngest patients, both 10 years, the diagnosis of an eating disorder was made after medical investigation of weight loss. 5 of 7 children required nasogastric re-feeding during their first admission. 4 of 7 required transfer to a tertiary unit specializing in eating disorder management. Only one of these four was successfully discharged home by 6 months, the others have required repeat admissions over 3 years. Diagnosis in all 7 was restrictive eating pattern, non-bulimic. Medical complications included profound bradycardia and hypotension at presentation in 7/7 and re-feeding syndrome in 1/7. 2/7 manifested extreme behavioural challenge on a general paediatric ward. 1/7 self-harmed. 24 hour supervision including meal support was required by Health Care Assistants in 5/7. No adolescent/child segregation could be provided. There are no nursing staff with training in managing the child with an eating disorder on our ward. Paediatric dietetic support was available but no other specialist treatment was possible. This cohort is small in number relative to the overall admissions to our unit. Prolonged and repeat admissions have significant implications for the limited budget of a small hospital. Total length of stay of 489 days cost 400,000 euro for basic care alone. This unscheduled care group also represents a considerable work load for general paediatricians. Best practice management of Anorexia Nervosa prompts the need for a multi-disciplinary approach from a paediatrician, psychiatrist, psychologist, and speciality trained dietician and nursing staff. The increasing incidence and prevalence of eating disorders among older children and adolescents is an increasing burden of care for general paediatric units in Ireland compounded by an under-resourced community Child and Adolescent Mental Health service.