Growth charts have played an integral part in the monitoring and assessment of children's health for the past 50 years, but their use is now under threat as paperless electronic systems become more widely used. While the obvious solution is to adopt electronic charting systems, this can prove challenging in practice. This article describes the key issues to consider in planning this transition and the charting options available, ranging from bespoke local systems to commercial packages and a new initiative by the Royal College of Paediatrics and Child Health.

BACKGROUND:Recognition of atypical anorexia nervosa (AAN) has challenged underweight as a defining factor of illness severity in anorexia nervosa (AN). The present study aimed to compare rates of medical instability in adolescents with underweight (AN) and non-underweight (AAN) anorexia nervosa. METHODS:The study examined assessment data from specialist eating disorder services in the UK between January and December 2022. Participants (n = 205) aged 11-18 years were recruited across eight eating disorder clinics and diagnosed with AN (n = 113) or AAN (n = 92) after clinical assessment. Parameters associated with risk of medical instability were compared between AN and AAN groups, using t tests and regression analysis. RESULTS:Rates of bradycardia and hypotension did not differ significantly between AN and AAN groups (p = 0.239 and p = 0.289). Although white blood cell counts were lower in the AN group, rates of leukopaenia could not be statistically compared as a result of there being too few counts in at least one group. No incidences of hypophosphataemia were found in the sample. A significant regression equation was found for percentage median body mass index, but not rate of weight loss, as a predictor of blood pressure, serum phosphorous and magnesium. CONCLUSIONS:Our findings indicate that medical instability occurs across a range of body weights in young people with AN and AAN. Although certain parameters of risk such as blood pressure, serum phosphorous and magnesium may be worsened at lower weight, both AN and AAN are serious mental health conditions that can lead to medical instability.

Hospital admissions for eating disorders (ED) are rapidly increasing. Limited research exists evidencing the factors that lead to hospital admissions or their outcomes. The current study aimed to identify predictors of hospital admission in adolescents with anorexia nervosa (AN) or atypical anorexia nervosa (AAN). Prospective observational study including participants (n = 205) aged 11-18 and diagnosed with AN or AAN at initial ED assessment, across eight London clinics. Physical health parameters at assessment, including heart rate, blood pressure, temperature and rate of weight loss, were compared between adolescents who were admitted to a paediatric ward following assessment and those who were not admitted. The mean rate of weight loss prior to assessment was significantly higher, and mean energy intake significantly lower, in the admitted vs not admitted groups (1.2 vs 0.6kg/week, p < 0.001 and 565 kcal/day vs 857 kcal/day, p < 0.001), independent of degree of underweight. No significant differences were identified between groups in all other parameters of physical risk. Underweight adolescents with AN were equally likely to be admitted as non-underweight adolescents with AAN. Conclusion: This study provides evidence on predictors of hospital admission, from a sample representing the London area. The assessment of weight loss speed, duration and magnitude are recommended as priority parameters that inform the risk of deterioration and the likelihood of hospital admission in adolescent AN and AAN. Further research investigating outcomes of these hospital admission is needed.

Eating disorders have the highest mortality rate of any psychiatric condition. Since the COVID-19 pandemic, the number of patients who have required medical stabilisation on paediatric wards has increased significantly. Likewise, the number of patients who have required medical stabilisation against their will as a lifesaving intervention has increased. This paper highlights a fictional case study aiming to explore the legal, ethical and practical considerations a trainee should be aware of. By the end of this article, readers will be more aware of this complex issue and how it might be managed, as well as the impact it can have on the patient, their family and ward staff.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

A 2019 survey reported that 6% of the general paediatric inpatient beds in the UK were occupied by children and young people (CYP) with a primary mental health disorder.1 Data suggest a significant impact of COVID-19 on the mental health of CYP,2 3 with anecdotal reports of increased CYP with mental health problems in acute paediatric care, although the impact on inpatient care has not been studied. We surveyed a network of paediatricians with an interest in eating disorders about their experiences of inpatient admissions for mental health reasons in the first quarter of 2021. This is an anonymous online survey, circulated in April 2021, to an established network of 62 paediatricians from 62 paediatric units in England. We asked for estimates of numbers, proportions and clinical care required for patients admitted with primary …

INTRODUCTION It will not have escaped any paediatrician that the COVID19 pandemic has seen a marked rise in presentations of children and young people with restrictive eating disorders. The surge has spilled onto paediatric wards, with young people in distress often admitted for weeks at a time awaiting more specialist care. In some centres in the UK, however, admission rates have been lower through closer collaboration between paediatricians and eating disorder teams who offer a different, more preemptive approach to the medical management of affected young people and their families. We discuss how paediatricians and the proactive paediatric admission, sanctioned and supported by the eating disorder team, can influence the journey to recovery of a young person with a restrictive eating disorder.

Background: Adolescence is a challenging time for young people with Type 1 diabetes, associated with worsening glycaemia and disengagement with care. To improve support, we co-designed with young people a novel psychosocially modelled programme of diabetes education (the Youth Empowerment Skills [YES] programme). This study aimed to estimate the clinical impact and feasibility (recruitment, retention and participant experiences) of this programme. Methods: A pilot study using mixed-methods was conducted to assess process and outcomes, involving a pre- and post-exposure assessment of glycaemic control, programme participation data, service utilisation and qualitative semi-structured interviews (analysed using Framework Analysis). Participants were recruited from two hospital diabetes centres in Southeast London. The intervention was conducted in local community centres. Participants were young people with Type 1 diabetes aged 15–21 years. The YES programme involves contact with an outreach youth worker and attending a 3-day psychologically modelled course encompassing social learning, peer facilitation and simulation exercises. The primary outcome was change in HbA1c at 6 and 12-months post-intervention. Secondary outcomes included diabetes-related hospital admissions and incident diabetic ketoacidosis (DKA). Results: Twenty-six young people participated in the programme, mean age 18 (±1.7) years. Uptake was 34% (n = 26) of those approached, with 96% (n = 25) programme completion. Pre-exposure (12 month mean) HbA1c was 93.5 (±29.7) mmol/mol (10.7%), and at 12 months post-exposure, it was 85.1 (±25.4) mmol/mol (10%) (P = 0.01), with 46% (n = 12) of participants achieving a reduction in their HbA1c ≥5.5 mmol/mol (0.5%). Unplanned hospital admissions and DKA rates reduced by 38 and 30%, respectively. The qualitative data identified positive psychosocial impacts including increased diabetes engagement and activation. Active ingredients were social learning, peer support and experiential learning. Participants emphasised the importance of the youth worker in engaging with the programme. Conclusion: The evaluation indicates that the YES programme helps improve young people’s self-confidence in managing diabetes, enhances diabetes engagement and improves clinical outcomes.

Background: Refeeding syndrome (RS) is a serious clinical syndrome, its early identification is key to safe management of adolescent anorexia nervosa. The aim of this study was to evaluate existing practices in a highly specialist centre for eating disorders and compare refeeding management, nutritional, and clinical outcomes in cases admitted to a medical stabilisation unit with those managed in outpatient care. Methods: Retrospective analysis of electronic case records of 59 adolescent patients at high risk of developing refeeding syndrome and treated for anorexia nervosa by a specialist eating disorder centre in London over a 5-year period. Statistical analysis compared refeeding methods used in this population to establish if there were differences in refeeding methods used between the inpatient and outpatient groups. Results: The inpatient group (n=19) had significantly lower baseline energy intakes, prior to assessment (374 kcal/d ± 205 compared with 621 kcal/d ± 348, p=0.001) and higher rates of weight loss at leading up to assessment (0.86 kg/week ± 0.7 compared with 0.38 kg/week ± 0.7, p=0.003), than the outpatient group (n=40). Incidence of RS symptoms did not differ significantly between groups. Conclusions: These findings support recent evidence that advocates a less conservative refeeding approach for moderately malnourished adolescents with AN and a review of current national guidance.

Background/objectives Epidemiological evidence indicates obesity in childhood and adolescence to be an independent risk factor for cancer and premature mortality in adulthood. Pathological implications from excess adiposity may begin early in life. Obesity is concurrent with a state of chronic inflammation, a well-known aetiological factor for DNA damage. In addition, obesity has been associated with micro-nutritional deficiencies. Vitamin D has attracted attention for its anti-inflammatory properties and role in genomic integrity and stability. The aim of this study was to determine a novel approach for predicting genomic instability via the combined assessment of adiposity, DNA damage, systemic inflammation, and vitamin D status. Subjects/methods We carried out a cross-sectional study with 132 participants, aged 10–18, recruited from schools and paediatric obesity clinics in London. Anthropometric assessments included BMI Z-score, waist and hip circumference, and body fat percentage via bioelectrical impedance. Inflammation and vitamin D levels in saliva were assessed by enzyme-linked immunosorbent assay. Oxidative DNA damage was determined via quantification of 8-hydroxy-2′-deoxyguanosine in urine. Exfoliated cells from the oral cavity were scored for genomic instability via the buccal cytome assay. Results As expected, comparisons between participants with obesity and normal range BMI showed significant differences in anthropometric measures ( p < 0.001). Significant differences were also observed in some measures of genomic instability ( p < 0.001). When examining relationships between variables for all participants, markers of adiposity positively correlated with acquired oxidative DNA damage ( p < 0.01) and genomic instability ( p < 0.001), and negatively correlated with vitamin D ( p < 0.01). Multiple regression analyses identified obesity ( p < 0.001), vitamin D ( p < 0.001), and oxidative DNA damage ( p < 0.05) as the three significant predictors of genomic instability. Conclusions Obesity, oxidative DNA damage, and vitamin D deficiency are significant predictors of genomic instability. Non-invasive biomonitoring and predictive modelling of genomic instability in young patients with obesity may contribute to the prioritisation and severity of clinical intervention measures.

Purpose: The objective of the study was to examine (1) the effect of restrictive eating disorders (EDs) on growth and pubertal development in children and young people (CYP) and (2) potential reversibility of this with recovery and associated factors. EDs can impact growth and puberty in CYP, but reports have conflicted over effect on height and permanence of growth impairment and pubertal delay. Methods: This is a systematic review and meta-analysis, searching PubMed, EMBASE, PsycINFO, and Web of Science from May 31, 2018, to inception. We included observational studies or systematic reviews regarding growth and puberty in EDs in CYP aged <18 years or in studies reporting outcomes in adults known to have had an ED under age 18 years. Cross-sectional studies were pooled for meta-analysis for effects on height. Results: A total of 27 studies were included. Growth and pubertal delay were commonly reported, but evidence for catch-up growth found in the majority. However, catch-up growth was not seen in all and may be suboptimal. Meta-analysis of 459 subjects (213 with anorexia nervosa and 246 controls) found no significant difference in height at baseline, with weighted mean difference -.13 cm (95% CI 2.64 to 2.38 cm; p =.9; I-2 = 68.5%). Younger age and longer duration of illness are potential risks for growth delay; weight gain appears protective for catch-up growth. Findings are primarily generalisable to females, given limited data on males. Conclusions: CYP with restrictive EDs are at risk of growth impairment and pubertal delay, though potentially reversible. Attention to growth in EDs is important, especially in the young. Weight restoration should be encouraged to avoid adverse effects and allow opportunity for catch-up. (C) 2019 Society for Adolescent Health and Medicine. All rights reserved.