The Royal Free London (RFL) Child and Adolescent Mental Health Service (CAMHS) provides a specialist eating disorder service that aims to help young people with:

• anorexia nervosa
• bulimia nervosa
• atypical variations of these disorders
• binge eating disorders
• complex ARFID (Avoidant Restrictive Food Intake Disorder)

Supporting recovery fully in the community and to avoid unnecessary inpatient admissions into eating disorder units. There is evidence for early intervention for eating disorders. We encourage discussion and/or referral if an eating disorder is suspected.

Research suggests that inpatient care for eating disorders offers no advantages over community treatment and has more disadvantages. The majority of patients make a full recovery in the community.

Outpatient treatment includes family and individual evidence-based treatment approaches. For more unwell patients, the Eating Disorders Intensive Service (EDIS) offers outpatient and day treatments at a higher intensity, including medical stabilisation.

Assessment of urgency

If the young person has weight loss of 1kg/week and one or more of the following, they will require the emergency/urgent referral pathway or possible paediatric admission:

• weight loss (1kg/week)
• < 70% mBMI (weight for height)
• systolic blood pressure (sitting blood pressure, BP) <90mmHg
• postural tachycardia (standing pulse - sitting pulse)
• postural hypotension (sitting BP - standing BP)
• pulse (sitting) <40bpm
• temperature <35°C
• fluid refusal or severe fluid restriction (e.g. 10% dehydration)
• food refusal for at least 2 days
• multiple daily episodes of vomiting and/or laxative abuse

Refer to the Medical Emergencies in Eating Disorders (MEED) guidelines to assess urgency for admission (page 40).

Contact the duty clinician (t: 020 7830 2093) to discuss if needed or, if out of hours, send the patient to local A&E.

While the young person is waiting for an assessment with the eating disorder service, it is recommended that you consider arranging for a set of baseline blood tests for them (to support nutritional assessment and aid differential diagnosis). The service suggests that you consider the following blood investigations:

• FBC
• serum iron
• U&Es
• bone profile
• vitamin D
• coeliac disease antibodies
• immunoglobulin A
• TFTs

Send the results to rf-tr.camhsadmin@nhs.net so that they can be reviewed prior to the assessment. This is not essential for all young people and should not delay referral, especially where clear eating disorder symptoms are reported.

Monitoring until assessment

If there are concerns about deterioration while the young person is waiting for the assessment please consider further physical monitoring. If you notice further deterioration or you become more concerned, contact the duty clinician (t: 020 7830 2093) or advise the young person and their parents to attend A&E, depending on the urgency and risk (refer to page 40 of the MEED guidelines).

Eligibility Criteria

Inclusions

• children (over 8 years) and young people under the age of 18 (if aged 17 and nine months, refer to the adult service at St Ann's)
• registered with an NCL GP
• has anorexia nervosa, bulimia nervosa, or atypical variations of these disorders (this includes meeting the criteria for anorexia nervosa except that despite significant weight loss, the individual's weight is within or above the normal range)
• binge eating disorder: we accept referrals for binge eating (defined as eating a large amount of food in a short amount of time with a sense of loss of control and associated guilt and shame occurring at least once per week for 3 months) in the absence of compensatory behaviours
• complex or severe Avoidant Restrictive Food Intake Disorder (ARFID) - see decision making aid here) (see criteria)

Exclusions

• aged 18+
• for mild to moderate Eating Difficulties and ARFID please refer to the Tavistock team here (and use decision making aid)
• we do not accept referrals for emotional eating (young people who are overeating but not bingeing) or infrequent bingeing (less than once per week), please refer to the Tavistock team here
• we do not accept referrals for weight management.

How to Refer