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 four adolescent physicians, clinical nurse consultant and experienced ward nursing staff, social worker, dietician, clinical psychologist, occupational therapist, physiotherapists and school teachers.
Referral for inpatient admission is made to the Department of Adolescent and Young Adult Medicine during office hours (02 8890 6788) or via Westmead Hospital (02 8890 5555) to the on call Adolescent Medicine Consultant after hours. Where possible an initial assessment should be scheduled for the New Patient Eating Disorder Assessment Clinic at Westmead Hospital.
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.
The primary focus of initial management is 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 hours. Once the patient is more medically stable, overnight supplemental nasogastric feeds are commenced and the patient is encouraged to eat a prescribed diet during the day. These supplemental feeds are slowly weaned to enable the patient to relearn healthy and safe eating prior to discharge home.
Patients are weighed on Monday, Wednesday and Friday mornings to monitor their progress. The treating team also meet on these days to discuss progress and prescribe changes in management. The patient attends these meetings and is consulted about their care and progress. Families attend a meeting with the multidisciplinary team on Fridays.
Once the patient is medically stable and no longer requiring continuous cardiac monitoring, meals are eaten at a dinning table and supervised by nursing staff who encourage safe and healthy eating and normalization of eating behaviours with therapeutic meal support.
A NSW Department of Education schoolroom is situated on the Adolescent 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 ill in hospital.
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 Clinical Psychologist, Occupational Therapist and Social Worker manage the Group Therapy program.
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 evidenced based family therapy, read the suggested resources in “Useful links and resources for families” on this web site.