Hospitalization Criteria
According to updated 2021 guidelines from the American Academy of Pediatrics and the Society of Adolescent Health and Medicine, one or more of the following criteria justify hospitalization (note: other criteria may pertain, clinical judgment required):
1. ≤75% median BMI for age and sex (percent median BMI calculated as patient BMI/50th percentile BMI for age and sex in reference population)
2. Dehydration
3. Electrolyte disturbance (hypokalemia, hyponatremia, hypophosphatemia)
4. ECG abnormalities (eg, prolonged QTc or severe bradycardia)
5. Physiologic instability:
— a. Severe bradycardia (HR ,50 beats per min daytime; ,45 beats per min at night);
— b. Hypotension (90/45 mm Hg);
— c. Hypothermia (body temperature ,96°F, 35.6°C);
— d. Orthostatic increase in pulse (.20 beats per min) or decrease in BP (.20 mm Hg systolic or .10 mm Hg diastolic)
6. Arrested growth and development
7. Failure of outpatient treatment
8. Acute food refusal
9. Uncontrollable binge eating and purging
10. Acute medical complications of malnutrition (eg, syncope, seizures, cardiac failure, pancreatitis and so forth)
11. Comorbid psychiatric or medical condition that prohibits or limits appropriate outpatient treatment (eg, severe depression, suicidal ideation, obsessivecompulsive disorder, type 1 diabetes mellitus)
*note: AAP and SAHM no longer distinguish hospitalization criteria by diagnosis (e.g. anorexia, bulimia, ARFID, etc.)
Determining Ideal Body Weight
Determining “ideal” body weight in children who suffer from anorexia nervosa is complex. Pediatric patients should not be treated like “little adults”. An example is the way medication is dosed in childhood. The right dose of an antibiotic for a newborn is different than the right dose for a two year old or for a 14 year old. And so it is for setting “weight goals” in pediatric eating disorder patients.
Childhood Development
A true discussion of goal weights cannot be separated from knowledge of a child’s developmental stage. Have they gone through puberty? If so, is puberty complete? Has breast development begun (if a girl)? Has she ever had a period?
Children, like adults, will fall along some kind of a bell curve of normal weights: the vast majority will be in the average range with some being in the “obese” range and some being in the “growth-stunted” range where the eating disorder struck at a very young age causing stunting of both height and weight (and probably brain growth). I will address these groups below:
For a more indepth discussion on how to determine “ideal” body weight in context of a suspected eating disorder, please read this.
How to Refer to Kartini Clinic
If you would like to speak to one of our physicians directly please call our office at 503-249-8851 and identify yourself as a physician or referring provider. If one of our pediatricians is not available immediately, we will return your call the same day.
