FEEDYOURINSTINCT
GP Report
GP Report
FEEDYOURINSTINCT
Feed Your Instinct (FYI) is an interactive tool designed by the Victorian Centre of Excellence in Eating Disorders in consultation with experts in the field and parents. It aims to support and inform parents of children experiencing eating and/or body image problems. This parent has observed the following warning signs of an eating disorder:
Weight gain is normal in growing children and adolescents. Any weight LOSS should be taken seriously.

This report is part of FYI (Feed Your Instinct), an online family early intervention resource for parents who are concerned about their child’s eating difficulties, behaviours that interfere with weight or body dissatisfaction (or a combination of these). It has been provided because a family member has indicated that their child is displaying the above early warning signs which may indicate an eating disorder.

It is important to take parents' concerns seriously, as they see their child's behaviours every day. The young person may not recognise a problem.

It is imperative to recognise when a young person may have an eating disorder, as it is a severe mental illness which has serious medical complications.  Many eating disorder diagnoses are missed, delaying essential treatment and potentially increasing the severity and duration of the illness. Rapid weight loss, even in overweight or normal weight children and adolescents can be dangerous and requires medical assessment.

It is not safe to watch and wait. Early identification of an eating disorder is vital and can save a life.

A GP’s role is critically important to provide an assessment of current medical risk. This includes conducting investigations to look for alternative causes and complications of weight loss or to exclude other serious illnesses. Eating disorders can be complicated to identify as investigations may be NORMAL in a child or young person who is very unwell. Therefore diagnosis is made primarily through obtaining a history and examination. 

The aim of the medical assessment and investigations is to provide critical information which will help GP’s direct the young person and their family to access the right level of support via a care pathway. If there is some uncertainty about what is the right pathway, you can directly contact Eating Disorder Clinical Nurse Consultants at Monash, Austin and the Royal Children’s Hospital.

GP’s can refer immediately to a local mental health service via centralised triage for the local area if a young person is engaging in self harm or expressing suicidal thoughts, or if a young person has a suspected eating disorder and is medically safe.  The mental health service can work collaboratively with GP’s to provide further advice, assessment, support and treatment.
  

Red Pathway – Immediate redirection to emergency department
Cardiac instability:

Refer ViCTOR charts for age specific observations:
12-18yo: https://www.victor​.org.au/victor-charts/
5-11yo: https://www.victor​.org.au/victor-charts/
Heart rate (pulse): <50 bpm

Blood pressure <80/50mm

Postural changes ( lying to standing)
Tachycardia >30 bpm
Postural Blood Pressure drop >20 mm

Recurrent syncope

Arrhythmia (including sinus bradycardia less than <50bpm)
Electrolyte changes:
Hypokalaemia -Present

Abnormal renal function
Other:
Hypothermia <35.5 deg C
Amber Pathway – Urgent referral to local specialist medical service and mental health service
Abnormal other investigations (Neutropenia, Thyroid Function Test)
Ongoing weight loss (move to red pathway if more than 500gm-1kg per week for consecutive weeks)

Amenorrhea (change of menstrual pattern because of weight loss)

Monitor weight, vital signs (including postural changes) with pulse rate and blood pressure regularly (weekly-fortnightly)
Green pathway - Referral to local specialist ED service or mental health service
Medically stable but warning signs present.

Mental Health assessment to determine if Eating Disorder present and begin evidence based treatment.

Monitor weight, vital signs (including postural changes) with pulse rate and blood pressure regularly.
Screening, Examination or investigation
Purpose
Acute complications
ECG
Check bradycardia; prolonged QTc
Electrolytes
Potential hypokalaemia if purging;
hyponatraemia if water loading;
impaired renal function if dehydrated
Rarely may reveal other medical cause of weight loss eg Addison's disease
LFT
May have biliary sludging with increased bilirubin
Calcium​/​Magnesium​/​Phosphate
Abnormalities with refeeding; low calcium if low albumin
BSL
Hypoglycaemia
Excludes diabetes as a cause of weight loss
FBC
Nutritional anaemia ( micro or macrocytic)
Neutropenia
Low platelets may occur with malnutrition
To detect other possible cause or comorbidity
ESR
Inflammatory bowel disease
Rheumatological disease
Chronic infection
TFT
Abnormalities may reflect sick euthyroid or hyperthyroid as rare cause of weight loss
Coeliac screen
May present with weight loss
Determine chronic complications of malnutrition
B12/folate
Iron studies
Vitamin D
FSH/LH/Oestradiol
Low levels reflect malnourishment
If amenorrhoea post puberty
Bone density (not urgent)
Determine effect of malnourishment on growing bones or after period of a menorrhoea. (PBS subsidy if >6 months)
Bone age x-ray necessary in conjunction with bone density for <18yo