Hospitalization Criteria
According to the American Academy of Pediatrics patients who meet any one of the following criteria should be re-fed in hospital rather than an outpatient setting (other criteria may pertain, clinical judgment required):
- < 75% ideal body weight, or ongoing weight loss despite intensive management
- Refusal to eat
- Body fat < 10%
- Heart rate < 50 per minute daytime; < 45 bpm nighttime
- Systolic pressure < 90
- Orthostatic changes in pulse (> 20 bpm) or blood pressure (> 10 mm Hg)
- Temperature < 96 F
- Arrhythmia
AAP Admission Criteria: Bulimia Nervosa
- Syncope
- Serum potassium concentration <3.2 mmol/L
- Serum chloride concentration <88 mmol/L
- Esophageal tears
- Cardiac arrhythmias including prolonged QTc
- Hypothermia
- Suicide Risk
- Intractable vomiting
- Hematemesis
- Failure to respond to outpatient treatment
Criteria as of 1 January, 2003. See Pediatrics, Vol. 111, pp. 204-11.
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.
