Get Adobe Flash player
NEDA TOOLKIT for Parents Feeding Against the Will of the Patient C — Feeding against the will of the patient should be an intervention of last resort in the care and management of anorexia nervosa. C — Feeding against the will of the patient is a highly specialized procedure requiring expertise in the care and management of those with severe eating disorders and the physical complications associated with it. This should only be done in the context of the Mental Health Act 1983 or Children Act 1989. C — Health care professionals without specialist experience of eating disorders, or in situations of uncertainty, should consider seeking advice from an appropriate specialist when contemplating a compulsory admission for a patient with anorexia nervosa, regardless of the age of the patient. C — Health care professionals managing patients with anorexia nervosa, especially that of the binge purging sub-type, should be aware of the increased risk of self- harm and suicide, particularly at times of transition between services or service settings. C — When making the decision to feed against the will of the patient, the legal basis for any such action must be clear. Additional Considerations for Children and Adolescents Service Interventions for Anorexia Nervosa C — Health care professionals should ensure that children and adolescents with anorexia nervosa who have reached a healthy weight have the increased energy and necessary nutrients available in their diet to support further growth and development. This section considers those aspects of the service system relevant to the treatment and management of anorexia nervosa. C — Most people with anorexia nervosa should be treated on an outpatient basis. C — Where inpatient management is required, this should be provided within reasonable travelling distance to enable the involvement of relatives and carers in treatment, to maintain social and occupational links, and to avoid difficulty in transition between primary and secondary care services. This is particularly important in the treatment of children and adolescents. C — Inpatient treatment should be considered for people with anorexia nervosa whose disorder is associated with high or moderate physical risk. C — People with anorexia nervosa requiring inpatient treatment should be admitted to a setting that can provide the skilled implementation of refeeding with careful physical monitoring (particularly in the first few days of refeeding), in combination with psychosocial interventions. C — Inpatient treatment or day patient treatment should be considered for people with anorexia nervosa whose disorder has not improved with appropriate outpatient treatment, or for whom there is a significant risk of suicide or severe self-harm. C — In the nutritional management of children and adolescents with anorexia nervosa, carers should be included in any dietary education or meal planning. C — Admission of children and adolescents with anorexia nervosa should be to age-appropriate facilities (with the potential for separate children and adolescent services), which have the capacity to provide appropriate educational and related activities. C — When a young person with anorexia nervosa refuses treatment that is deemed essential, consideration should be given to the use of the Mental Health Act 1983 or the right of those with parental responsibility to override the young person’s refusal. C — Relying indefinitely on parental consent to treatment should be avoided. It is recommended that the legal basis under which treatment is being carried out should be recorded in the patient’s case notes, and this is particularly important in the case of children and adolescents. C — For children and adolescents with anorexia nervosa, where issues of consent to treatment are highlighted, health care professionals should consider seeking a second opinion from an eating disorders specialist. Page | 39