Anorexia nervosa is a very serious illness. If left untreated, it can lead to problems in all parts of the body, including the heart, bowels, liver and bones. Because of the potentially serious medical complications, anorexia nervosa requires both medical and psychological treatment.
In-hospital medical treatment
If your child is at an extremely low weight and has a slow or irregular heart rate or low blood pressure, they will need to be admitted to hospital so their heart rate, blood pressure and weight can be monitored closely.
The goal of inpatient treatment is to:
- ensure that the patient is medically safe
- achieve a weight and medical stability that guarantees the patient can be treated safely as an outpatient
- begin to help manage any emotions about eating, including any worries about weight
- prepare for outpatient treatment
Most people with anorexia nervosa have experienced substantial weight loss and food restriction. As a result, it is important to provide nutritional treatment to help your child regain weight and restore the body's nutrients to appropriate levels.
While in hospital, your child will receive the nutrition they need to help them return to health. Your child's health-care team will adjust the amount of nutrition and activity throughout the stay, so your child regains weight in a steady, regular pattern. The goal is for your child to receive the amount of nutrition that their body requires to gain weight and reintroduce a variety of foods that they may have cut out during their illness.
As a parent, you will typically be involved in mealtimes by helping to supervise meals with your child. The goal for discharge is for your child to be at a medical status that is considered safe to be out of hospital (at a safe weight and with regular heart rate and blood pressure).
Outpatient treatment with a care team
If your child with anorexia nervosa is medically stable and does not require an in-hospital stay, they will participate in an outpatient eating disorders program. There, your child will be cared for by a team of specialists, including a psychiatrist, psychologist, dietitian, adolescent medicine doctor or paediatrician, nurse or social worker. These experts will work together to come up with the best possible care plan to meet your child's unique needs.
Your child will visit the hospital or clinic to come to appointments, but they will not stay overnight. These appointments will include psychological treatment to address your child's eating disorder and regular checks of your child's weight, heart rate and blood pressure. The weight checks help your child's team see how much weight your child is gaining. Weight gain is a vital part of returning the body back to health.
The first treatment recommended for outpatients is called family-based treatment, which focuses on recovery of the eating disorder. Parents/caregivers play an essential role in the treatment and recovery of their child. Family-based treatment includes 3 treatment phases.
- Phase 1 focuses on weight restoration. Parents, supported by the therapist, take responsibility for making sure that the patient is eating sufficiently, and takes on all meal planning and preparation.
- Phase 2 is when substantial weight recovery has occurred, and the patient gradually assumes responsibility for their own eating.
- Phase 3 is when weight is restored, and the focus is on general issues of development.
Nutritional treatment as an outpatient
Families can sometimes be surprised by how much nutrition their child needs just for their body to start to rebuild and get back to a healthy weight. If your child is receiving treatment, it is best to reintroduce all the foods that your child cut out while they developed the eating disorder and have them eat a variety of foods from all food groups.
Psychological treatment
Treatment for anorexia nervosa generally takes a ‘whole family' approach. This means that a child's care team will include the entire family in the therapy. The type of treatment most commonly provided is family-based therapy or treatment (FBT). Some teens may receive cognitive behavioural therapy (CBT) or may take part in other types of family therapy. Whichever therapy is used, it starts once your child is medically stable.
The purpose of including the family is to help parents support the child with re-feeding at home and any related anxiety the child might express at mealtimes. Recovery from anorexia nervosa does not happen overnight; it may take years of treatment to fully recover.
Medications
Some children and teens with anorexia nervosa may also experience depression and/or anxiety. If these interfere with a person's ability to function or take part in their eating disorder treatment, they may be prescribed medication along with psychological therapy. The most common medications prescribed are antidepressants, but sometimes people with anorexia nervosa may also be prescribed anti-psychotic medications to help manage obsessive thoughts. Antidepressants are less effective when someone is at an extremely low weight, so your child's team might not suggest them until your child is at a weight where they may have a benefit.
At SickKids
SickKids has an eating disorder program that treats children and teens who are struggling with symptoms of anorexia nervosa, bulimia nervosa and avoidant restrictive food intake disorder. For more information on our program visit: www.sickkids.ca/adolescentmedicine/eating-disorders-program
Further information
For more information on anorexia nervosa, please see the following pages:
Anorexia nervosa: Signs and symptoms
Anorexia nervosa: Medical complications
Anorexia nervosa: How to help your child at home
Please visit our teen mental health hub for teen-specific resources on treatment and long-term outcomes in anorexia.
Resources
NEDIC – National Eating Disorder Information Centre (Canada)
NEDA – National Eating Disorder Association (United States)
American Academy of Pediatrics – Eating Disorders in Children
BEAT – Beating Eating Disorders (United Kingdom)
Kelty Eating Disorders (Kelty Mental Health Resource Centre, BC Children's Hospital)
Children's Hospital of Eastern Ontario – Eating Disorders
ANAD – National Association of Anorexia Nervosa and Associated Disorders (United States)
