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Why you have been admitted to the paediatrics ward
You have been admitted to the paediatric ward for treatment due to medical concerns about your anorexia.
About your care plan
Your care plan is aimed at stabilising your medical condition. An important aspect of this will involve making sure you have adequate daily amounts of food and drink.
We know that this can be a very distressing time for you and your family or carer. We realise it is likely that they have been extremely worried about you in the weeks leading up to your admission.
The nature of your illness will mean that you may feel a strong urge to resist treatment. With this in mind, we believe it is most helpful if you are fully informed of your care plan when you are admitted.
Although your care plan may appear strict and rigid, the aim is to reduce any confusion. We want to make sure that everyone knows what will happen during your time on the ward.
Use the drop-down menu for more information on:
- what happens when you arrive
- meal plans
- types of food we offer
- when to eat
- supervision on the ward
- mealtime time limits
- if you do not eat your food
- going to the toilet
- visitors.
What happens when you arrive on the ward
When you first arrive, you will be on bed rest and will not be allowed to move around the ward. This allows us to monitor your heart.
Staff will not negotiate with you about this.
Meal plans
All meal plans are devised by our team to ensure adequate nutrition. Your meal plans will change throughout your stay. All food will be taken from hospital ward menus.
It may be helpful if you think about your eating regime as representing your prescribed medicine or treatment.
- You will be allowed some choice from the meal plans, but you will not be allowed to prepare or serve food yourself.
- The ward hostess will take your meal choices each morning.
- Your nurse or parents or carer will dish up your food and bring it to you.
Staff will not negotiate with you regarding choices.
Types of food we will offer you
We expect you to eat a full range of foods.
You will only be allowed a vegetarian diet if you were vegetarian before your eating disorder started. Vegan diets are not permitted as they are not safe for someone who is critically underweight.
Staff will not negotiate with you about this.
Can you choose whether to eat at mealtimes?
No, you cannot choose whether or not to eat at mealtimes.
We understand that eating can be distressing. We find the most effective approach is to be supportive but firm in our expectation that you eat all the food we give you.
Staff know your eating disorder means you will want to reduce food intake whenever possible.
Staff will need to stick rigidly to your meal plans because being underweight is having a serious impact on your physical health.
Supervision on the ward
We will allocate nurses to you who will help make sure you can follow your meal plan. They will supervise your eating, drinking, care and activity. You may have a different nurse every day.
Your parents or carer will be the main people supervising you at most mealtimes. Staff on the ward will support them.
You may feel high levels of distress and anger at mealtimes. Before your admission to the ward, your parents or carer will often have found themselves backing down for fear of making you worse. For this reason, staff, parents and carers will be firm with you at mealtimes. They will be clear that they expect you to eat everything served.
Staff will also talk to you to find out what is most helpful to make sure you can eat. For example some form of distraction, conversation, music, specific phrases or words of support.
Mealtime time limits
All meals are supervised and the following time limits are followed:
- 30 minutes for the main meal
- 20 minutes for dessert or snacks or oral nutrition drink.
At the end of these time periods, leftover food will be removed.
If you have not completely eaten your meal, we will give you a nutrition drink.
The amount of this drink will be decided by nursing staff, based on your meal plan.
If you do not eat your food
If you do not manage to eat the food we give you, we will consider using a tube to feed you directly.
We sometimes need to do this to make sure you get the treatment you need.
We will give you 24 hours to try and follow the meal plan before we begin direct feeding with a tube.
If we decide on direct feeding, we will explain this to you, your parents or carer before we start.
Going to the toilet
You may need to use a bedside commode to go to the toilet.
You may be allowed to use the ward toilet while a nurse listens at the door to make sure you are safe.
We will discuss these options with you.
If you are allowed to go to the toilet you will not be allowed to go more than once every 2 hours.
You will not be allowed to go until 30 minutes after you have eaten food. This is to ensure you are safe and supported in resisting the urge to exercise or purge after eating.
Visitors on the ward
Mealtimes can be distressing, so visitors will be able to come to the ward between or after the main mealtimes of the day. They may be asked to leave the ward until the meal or snack is completed.
Other treatment we will you offer you on the ward
You may need medicines, blood tests and ECG tests because you are malnourished. (An ECG is a simple test to check your heart’s rhythm and electrical activity.) These are important to make sure you do not develop any serious complications from your illness.
The ward medical team will see you daily to check your physical progress and carry out any tests that are needed. They will be supervised by a named consultant paediatrician. If necessary, we will also involve a consultant psychiatrist.
We will discuss these medicines and tests with you, your parents or carer.
Therapy
The first step in making psychological recovery from an eating disorder is establishing regular eating patterns. This is because a starving brain and body cannot recover.
Initial therapy will focus on how your family or carer can support you to eat.
It will also make sure that you, your parents and carers understand eating disorders.
A nurse or therapist from the Young Person’s Eating Disorders Service will be in contact with you to discuss how you are getting on. Ideally this will happen while you are in hospital, but this is not always necessary or possible. They will also discuss what happens when you are discharged from hospital.
The whole team, including you and your family or carers, will discuss decisions about your progress. These decisions will only be changed if it is medically necessary after review by a consultant.
If you have questions
Speak to the nurse in charge of the ward or your consultant if you have questions or concerns about your treatment.
They will share these questions or concerns with your medical team.
Advice for families and carers supporting a young person with anorexia nervosa
The following advice may be helpful to anyone supporting a young person with anorexia nervosa.
More information
Information from Beat Eating disorders on supporting someone with anorexia
Information from FEAST to help families of people affected by eating disorders
The patient information used here is adapted, with thanks to Dr Lucinda Etheridge, St George’s University Hospitals NHS Foundation Trust.
Contact information
Kingston Hospital Sunshine ward (for inpatients)
or
Kingston Hospital Paediatrics Department, Monday to Friday 9am to 5pm