Adolescent Eating Disorders Inpatient Program
The adolescent eating disorder program at Westmead Hospital has been operating since 1983 and offers a uniform and comprehensive approach to assessment and treatment of adolescents aged fourteen years and nine months till the end of high school.
The philosophy of the inpatient program is to provide a safe, supportive and therapeutic environment that enhances the opportunity for return to a healthy weight and healthy eating patterns within the context of individual, group and family support.
The program is supported by five adolescent physicians, a clinical nurse consultant and experienced ward nursing staff, social worker, dietician, clinical psychologist, occupational therapist, physiotherapists and school teachers.
Referral process
Doctors and other clinical services with referrals for eating disordered patients will need to complete the following form for our triage services.
Information for GPs regarding referral of an eating disordered adolescent
The referral and Eating Disorder triage form can be emailed (
[email protected]) or faxed (02 8890 9062). INCOMPLETE REFERRALS WILL NOT BE ACCEPTED. The clinic will be in direct contact with the patient and/or family as soon as possible with an outcome.
However, if the patient is medically compromised as defined by (but not limited to) any one of the following, they should be sent immediately to their nearest hospital’s Accident and Emergency Department.
- Blood Pressure < 90 mmHg Systolic or < 50 mmHg Diastolic
- Pulse < 50/min
- Temperature < 35.5 C
- Abnormal ECG or an ECG with a corrected QT interval of > 0.44sec or a HR of < 50/min
- Significant electrolyte abnormalities
If a patient presents to Westmead Hospital Accident and Emergency Department requiring admission, the on call adolescent consultant should be contacted and treatment discussed.
Criteria for admission
1. The patient has a diagnosis of eating disorder that is associated with any of the following:
- Medical instability as defined above
- Co-morbid medical problems complicating the management of the anorexia nervosa, e.g. insulin dependent diabetes mellitus
2. Aged between fourteen years nine months and eighteen years and still attending high school
3. A patient will only be accepted into the program after fully informed consent and engagement in all aspects of the program by parents.
NOTE:A patient with anorexia nervosa may be excluded from the program if he / she has another psychiatric disorder that makes management within the program difficult, e.g. severe depression or self harm, acute suicide risk or psychosis, aggressive / violent behaviour or significant personality disorder.
Inpatient management
Phase One of the admission has as its primary focus, the treatment of the medical complications of anorexia nervosa and the commencement of the most appropriate form of refeeding to attain medical stabilisation and initiate nutritional recovery.
Generally patients are medically compromised on admission and require cardiac monitoring and continuous supplemental feeding through a nasogastric tube for the first 48 to 72 hours. Once the patient is medically stable, the patient moves into phase Two of the admission – nutritional rehabilitation and education of patient and family.
Phase Two – Nutritional rehabilitation and education. In this phase, the supplemental nasogastric feeds are given overnight only and the patient is encouraged to eat a prescribed, fully supervised meal plan during the day. The overnight supplemental feeds are slowly weaned as the patient regains weight and progresses in their ability to eat in a timely fashion. This enables the patient to re-learn healthy and safe eating prior to discharge home. This re-learning is further enhanced by weekend gate passes to enable patients to practise eating with their parents.
Patients are weighed Monday, Wednesday, Friday to monitor their progress in the program. The treating team will meet with the patient on each of these days to discuss any prescribed changes and answer questions, in a person-centred care approach. The multidisciplinary team also meets with each family weekly, to review the program and patient progress, answer questions and provide education for parents.
Supervised eating
In phase two, meals are eaten at a dining table and supervised by nursing staff who encourage safe and healthy eating and normalisation of eating behaviours with therapeutic meal support.
High school
A NSW Department of Education school room is situated on the AYA Ward. The school is staffed by specially trained high school teachers and aims to help keep young people up to date with their school studies whilst they are an inpatient.
Inpatient group therapy
Activity based group interventions are held on the ward after lunch from Monday to Thursday. These groups are compulsory for all patients who are well enough to attend. The patients attend physiotherapy twice weekly. The Clinical Psychologist, and Social Worker manage the Group Therapy program. From time to time parent support and education groups are also run.
Follow up care
As eating disorders are chronic illnesses requiring ongoing care after hospitalisation, appropriate medical and psychological follow up care for all inpatients is arranged prior to discharge.
Family based therapy
Whenever possible, families with an eating disordered child are linked into their closest local service offering Family Based therapy for their child’s ongoing psychological care prior to discharge from hospital.
For more information on evidencebased family therapy read the suggested resources in “Useful links and resources for families” on this web site.