I asked these questions of an ED Unit that has been mentioned for my daughter - she already spent 8 months in one and now they want to put her in another - Im trying to get her home but its been complicated due to suicidal and serious SH incidents
anyway just looking at their replies make my heart sink. MAkes me think they won't be any different to the first lot - they will keep her where she is and in this tortured state... HAVE TO GET HER OUT !! WHY WONT THEY LISTEN
* Exactly what information do you use in order to set a weight band for your pediatric patients? please give me all the details - I need to know exactly how you do this. I understand weight for height charts and age related BMI calculations and I would like to know your technical process for establishing bands
Setting an appropriate individualised healthy weight range during adolescence is more complex than with adults, and we describe individualised healthy weight range in terms of percentage expected BMI for age (using a computer program to compare with normal centile charts for this for girls), so the actual healthy weight range at this age increases with both increases in height, and increases in age (up to the age of 18). We need to take into account whether menstruation has already begun (whether or not this has subsequently ceased with weight loss). At this age if there is primary amenorrhoea (i.e. never previously had a menstrual period) we would aim for a healthy weight range of 95-100% expected BMI for age (i.e. the slimmer half of the normal range of weight for that age and height). If menstruation has previously begun but has ceased with weight loss then we would use a pelvic ultrasound scan once weight has been restored to 90% expected BMI for age to determine the level of oestrogenisation of the uterus and ovaries at that stage, which allows us to predict at what percent expected BMI range oestrogen levels are likely to return to normal. This is a highly individualised and important measure of restoration of functionally normal weight, particularly with regards to future health/quality of life in terms of both bone mineral density/osteoporosis risk and future fertility.
* to what extent do you work with families to determine healthy weight range bands and to what extent are those decisions made without family input?
We work closely with families to ensure the best possible outcome, particularly as all the research evidence and clinical experience points to family involvement in treatment at this age being the most powerful single factor in determining prognosis. To achieve this we and parents need to respect our particular areas of expertise, for example that parents know their child as individuals in much greater detail than the professional part of the team does, and have a unique and uniquely powerful role in their child's life now and the future, while the professional team have a depth of specialist professional knowledge of eating disorders and their treatment, including the many issues around identifying an individualised healthy weight range that will support an overall positive recovery in every sense. While it is important that we discuss and come to an agreement about important aspects of treatment and care, we would expect parents to support medical recommendations based on our expertise, just as we would be guided by parents on decisions within the parental domain, and would work closely together to discover with parents how best they can support their child as they move from hospital back to home while continuing their recovery (bringing together their expertise and ours to learn and develop potentially new strategies in order to achieve this).