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NEDA TOOLKIT for Parents C — People with type 1 diabetes and an eating disorder should have intensive regular physical monitoring, because they are at high risk of retinopathy and other complications. C — Pregnant women with eating disorders require careful monitoring throughout the pregnancy and in the postpartum period. C — Patients with an eating disorder who are vomiting should have regular dental reviews. C — Patients who are vomiting should be given appropriate advice on dental hygiene, which should include avoiding brushing after vomiting; rinsing with a nonacid mouthwash after vomiting; and reducing an acid oral environment (for example, limiting acidic foods). C — Healthcare professionals should advise people with eating disorders and osteoporosis or related bone disorders to refrain from physical activities that significantly increase the likelihood of falls. Additional Considerations for Children and Adolescents C — Family members, including siblings, should normally be included in the treatment of children and adolescents with eating disorders. Interventions may include sharing of information, advice on behavioral management, and facilitating communication. C — In children and adolescents with eating disorders, growth and development should be closely monitored. Where development is delayed or growth is stunted despite adequate nutrition, pediatric advice should be sought. C — Healthcare professionals assessing children and adolescents with eating disorders should be alert to indicators of abuse (emotional, physical and sexual) and should remain so throughout treatment. C — The right to confidentiality of children and adolescents with eating disorders should be respected. C — Health care professionals working with children and adolescents with eating disorders should familiarize themselves with national guidelines and their employers’ policies in the area of confidentiality. Identification and Screening of Eating Disorders in Primary Care and Non-Mental Health Settings C — Target groups for screening should include young women with low body mass index (BMI) compared with age norms, patients consulting with weight concerns who are not overweight, women with menstrual disturbances or amenorrhea, patients with gastrointestinal symptoms, patients with physical signs of starvation or repeated vomiting, and children with poor growth. C — When screening for eating disorders one or two simple questions should be considered for use with specific target groups (for example, “Do you think you have an eating problem?” and “Do you worry excessively about your weight?”). C — Young people with type 1 diabetes and poor treatment adherence should be screened and assessed for the presence of an eating disorder. Management of Anorexia Nervosa in Primary Care C —In anorexia nervosa, although weight and BMI are important indicators of physical risk they should not be considered the sole indicators (as they are unreliable in adults and especially in children). C — In assessing whether a person has anorexia nervosa, attention should be paid to the overall clinical assessment (repeated over time), including rate of weight loss, growth rates in children, objective physical signs, and appropriate laboratory tests. C — Patients with enduring anorexia nervosa not under the care of a secondary care service should be offered an annual physical and mental health review by their GP. Psychological Interventions for Anorexia Nervosa The delivery of psychological interventions should be accompanied by regular monitoring of a patient’s physical state including weight and specific indicators of increased physical risk. Page | 36