Synopsis
Recognise eating disorders across body sizes and presentations, detect cardiovascular, metabolic, behavioural and psychiatric instability early, arrange safe same-day paediatric and mental-health care, begin cautious nutrition support, and coordinate evidence-based family, psychological and physical recovery.
- Ask about recent weight trajectory, restriction, binge episodes, vomiting, exercise, laxatives, diuretics, insulin manipulation, body concerns, sensory avoidance and feared consequences of eating.
- Do not screen by appearance or BMI alone: atypical anorexia, bulimia, binge-eating disorder and avoidant restrictive food intake disorder can cause major medical and psychosocial harm across body sizes.
- Record pulse, blood pressure lying and standing, temperature, hydration, weight and height on appropriate growth charts; interpret trends, pubertal stage and previous trajectory.
- Medical warning features include syncope, chest pain, weakness, acute refusal, poor perfusion, bradycardia, postural change, hypothermia, hypoglycaemia, electrolyte abnormality and ECG disturbance.
- Use same-day paediatric or acute medical assessment when instability is possible and involve a specialist eating-disorder service early rather than waiting for diagnostic certainty.
- Nutrition is essential treatment; establish a specialist meal and fluid plan with electrolyte monitoring based on risk, and do not underfeed solely from fear of refeeding syndrome.
- Family-based treatment is central for many children and adolescents with anorexia nervosa; avoid blaming relatives and give carers practical responsibility and support matched to development.
- Assess suicide, self-harm, abuse, bullying, substance use, exercise compulsion and treatment resistance directly, with supervised safety and legal advice when life-saving care is refused.
- Manage comorbid anxiety, depression, diabetes and neurodevelopmental needs without allowing them to fragment physical monitoring, nutrition restoration or safeguarding.
Key red flags
Rapid recent weight loss, minimal intake or acute food and fluid refusal can cause serious instability even when weight remains within or above a population reference range.
Syncope, chest pain, profound weakness, confusion, seizures, bradycardia, postural hypotension, hypothermia or poor peripheral perfusion requires urgent medical assessment.
Hypoglycaemia, hypokalaemia, hypophosphataemia, hypomagnesaemia, acute kidney injury, transaminitis or prolonged QTc raises concern for metabolic decompensation and arrhythmia.
Frequent vomiting, laxative or diuretic misuse, excessive exercise, water loading, insulin omission or concealed substances can make apparently stable measurements misleading.
Suicidal intent, severe self-harm, psychosis, inability to maintain safety, abuse or coercive control requires an urgent parallel mental-health and safeguarding response.
Investigation priorities
Quantify trajectory relative to the young person's developmental baseline.
Management branches
Physical observations, bloods, ECG, intake or psychiatric assessment suggests acute instability.
- Use ABCDE, check glucose, obtain ECG and urgent laboratory tests and involve senior paediatrics or acute medicine immediately.
- Supervise the young person, stop unsafe exercise or purging opportunities proportionately and complete direct suicide and safeguarding assessment.
- Correct immediately dangerous abnormalities under specialist protocol while establishing a monitored nutrition and fluid plan.
- Seek eating-disorder psychiatry, dietetic and legal input early when essential care is refused or coercion may be necessary.