Eating Disorders

Question 1

Define meal refusal

Answer 1

Occurs in otherwise healthy child

Well-nourished pre-school child, typically within normal limits on growth chart

Question 2

Risk factors for meal refusal

Answer 2

History of force-feeding

Irregular meals (hence unpredictably hungry)

Unsuitable meals

Unreasonably large portions

Distraction during meal times

Question 3

Investigations/history for meal refusal

Answer 3

Nutrition and growth

Issues with discipline and parenting

Food diary to discover food between meals

Question 4

Management of meal refusal

Answer 4

Wholesome food with adequate range

Avoid confrontation at meal time

Relaxed atmosphere

Use favourite foods as a reward, reward for compliance

Reduce eating between meals if needed

Question 5

Clinical features of anorexia nervosa

Answer 5

Excessive weight loss

Amenorrhoea

Lanugo hairis fine, soft hair across most of the body

Hypokalaemia

Hypotension

Hypothermia

Changes in mood, anxiety and depression

Solitude

Question 6

Definition of bulimia nervosa

Answer 6

Binge eating followed by purging by inducing vomiting or taking laxatives to prevent calories being absorbed

Question 7

Clinical features of bulimia nervosa

Answer 7

Alkalosis (due to vomiting)

Hypokalaemia

Erosion of teeth

Swollensalivary glands

Mouth ulcers

Gastro-oesophageal reflux and irritation

Calluses on the knuckleswhere they have been scraped across the teeth (Russell’s sign)

Question 8

Definition of binge-eating disorder

Answer 8

Episodes where person excessively overeats, often as expression of underlying psychological distress

Patients likely to be overweight

Question 9

Cardiac complications of anorexia nervosa

Answer 9

Arrhythmia

Cardiac atrophy

Sudden cardiac death

Question 10

Describe “bingeing”

Answer 10

A planned binge involving “binge foods”

Eating very quickly

Unrelated to whether they are hungry or not

Becoming uncomfortably full

Eating in a “dazed state”

Question 11

Management of eating disorders in children

Answer 11

Patient and carer education is key

Self help resources

Counselling

Cognitive behavioural therapy (CBT)

Addressing other areas of life, such as relationships and past experiences

Severe cases may requireadmissionfor observed refeeding and monitoring forrefeeding syndrome

SSRImay be used by a specialist in child and adolescent mental health