Eating Disorders Management at Children's Healthcare of Atlanta

Laura Elizabeth Doerr, MD, FAAP

When Karen Carpenter died of heart failure in 1983 from Anorexia nervosa, it raised awareness about the complications of eating disorders. Before her death there wasn’t much discussion about eating disorders and the dangers of rapid weight loss. Until recently, eating disorders were considered the most lethal of the mental health disorders. Now it is only second to opiate abuse as the most lethal of these conditions. 

Eating Disorder Admissions at Children’s Healthcare of Atlanta
            Recently, we have seen an exponential increase in the admissions of patients with Eating Disorders at Children’s Healthcare of Atlanta. The incidence has increased exponentially from 18 admissions in 2010 to over 110 in 2018. Eating Disorders are mental illnesses that can have serious medical complications that can affect almost every organ system. The median age of onset is 12-13 years of age, and it can affect both genders. There has also been an increase in the diagnosis of eating disorders among the transgender population.
            At Children’s Healthcare of Atlanta, there are protocols in place for the management of these patients in the ED and inpatient services. This assists in early recognition and triage of these patients as they are evaluated to see if they warrant admission for medical stabilization (see chart end of article). The American Academy of Pediatrics has come up with a list of objective criteria to help with determining who warrants admission to the hospital. This includes such objective measures as vital signs (i.e. heart rates < 50 beats per minute), electrolyte criteria (such as phosphorus < 3.0), and consideration of patients that are most at risk of refeeding syndrome. It is the hope that this triage system will help with early recognition of patients with these disorders and help with admitting those who warrant medical stabilization.

Atypical Anorexia Nervosa
            Some of the most challenging patients to recognize are those with atypical Anorexia nervosa. By definition these patients would meet DSM-V criteria for the condition except that they may present with a normal weight and/or BMI. This can make it a challenge to recognized and this is why these patients may present later or more ill-appearing, given if they are looked at as a single plot on the growth chart they may look like their weight or BMI is within normal range. 
            In conclusion, it is important to ask questions when a symptom raises a concern about an eating disorder. Is the patient overly concerned about his or her weight? Have they recently adopted a radical diet change, such as converting to a vegan diet? Have they developed primary or secondary amenorrhea? Or on their growth chart, have they plateaued or failed to achieve appropriate increases in their growth over time.?
            If you do have concerns about a patient that may have an eating disorder, it may be worth having them triaged at one of our Children’s Healthcare of Atlanta facilities. There if they meet criteria for medical stabilization, they can be admitted to our inpatient unit at Scottish Rite. We have a multidisciplinary team that includes psychiatry, hospitalist medicine, case management, nutrition and child life. Our goal is to help manage these patients medically and then transition them to an appropriate level of care post-discharge that could involve inpatient eating disorder treatment or outpatient therapy, depending on the needs of the patient and family. 
Contact information: Laura Doerr, MD, FAAP.

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