Eating Disorders Care Pathway – under 18 yrs (Norfolk and Waveney)

Junior MARSIPAN

The summary version of the Junior MARSIPAN: Management of Really Sick Patients under 18 with Anorexia Nervosa can be accessed using the following URL:

https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr168.pdf?sfvrsn=e38d0c3b_2

*Junior MARSIPAN Red alert: Refer any young person with one or more Red alert criteria to Paediatric CAU / AMU / Gastroenterology at the Norfolk and Norwich University Hospital (NNUH) with simultaneous referral to CEN-CAEDS to facilitate early assessment of eating difficulties which may commence during acute stabilisation admission at the NNUH.

Low threshold for medical stabilisation for Amber alerts.

** CAEDS risk factors checklist:

Emaciation / wasting
BMI: less than 70% median BMI (approximately less than 0.4th BMI centile)
Acute food refusal: for more than 2 days or estimated calorie intake 400-600kcal per day
Pulse: 40bpm or less
Blood pressure: low or orthostatic changes as per pathway
Na: <130mmol/L
K: <3mmol/L
Glucose: <4mmol/L
Phosphate: below normal range for age, see current range from biochemistry
White cell count: low
Albumin: <35g/L
Temperature: <35°C
Peripheral cyanosis
Other biochemical abnormalities
ECG: bradycardia / tachycardia; QTC >460ms in females; QTC >450ms in males
Engagement with management plan: severe agitation / aggression when parents try to encourage food or fluid intake of limit compensatory behaviours; poor insight / motivation to engage with nutritional plan
Self harm / suicide: ideation with moderate to high risk of deliberate self-harm / suicide
Complex co-morbidity: severe obsessive compulsive disorder (OCD); major depressive disorder (MDD), severe emotional dysregulation; anxiety disorder; psychosis