Anorexia

[JenTheSchoolRN, BSN, RN]

I would love to poke the folks here who have more experience than I working with a student with anorexia.

I have a middle school girl who was inpatient this summer, back to school on first day of school. Bi-weekly weigh-ins at doctors, scheduled 2x daily snacks with me. Any beverage consumed must have a calorie (no water). Concern about continuing tachycardia. Student has 504 plan in place.

Student's weight has moved +/- 5 or so pounds since beginning of school, currently stable. She never checks in for snacks unless reminded, but when I can peer in at lunch, is eating lunch consistently (though not always extra snacks that are packed). Parent reports student does not eat much at home.

Tachycardia still a concern at weight-ins. I'm trying to see what else I can do. I've offered to have student eat with me, but bringing attention to student's eating just makes student less likely to eat.

[OldDude]

Just be supportive and positive. Otherwise it's out of your realm of intervention.

[MrNurse(x2), ADN]

Interesting that blood sugar checks aren't part of the plan. In acute care we had to awaken the girl at 4AM, this seems to be when they would die when the body pulls from glycogen stores. You are absolutely correct to not draw attention to any aspect of eating. An aside on this discussion is that I noticed almost all the psychiatrists treating these girls were females with ultra thin bodies. Hard to tell someone about body image when the one treating you has 2" wrists. Very tough situation, good luck.

[cooties_are_real]

I have had one Little Darling with eating issues, but not to this extent. LD was a cheerleader who was a base in pyramid stunts, whose sister was the top of the pyramid. Two totally different body types. LD wanted to be the top, so she would starve herself from time to time. Right before she graduated she got bad and mom was trying to get her into counseling. I would encourage her and we would talk about the issues she had seen with her sister (who got banned from the college gym because she was to skinny and working out excessively).

I guess she is doing okay now. I saw her the other day in town and she looked healthy.

Keep on being supportive and encouraging.

[JenTheSchoolRN, BSN, RN]

This student also has weekly counseling at school, so that support is also in place. Parent calls to check in regularly, but I've got nothing too unusual to report. I've asked teachers to reach out if they notice her not eating, but no teachers have reported this and it is nearly impossible for me to monitor remotely from my office with the traffic I get. Also, again, drawing attention to it is upsetting for student. Though I have reported to parent that student often reports not eating breakfast that was packed for her in the morning. I've offered her a space to eat if she needs in my office as she arrives to school rather early and no one would know she was with me because of the location of my office, but no go.

[Farawyn]

I've had a few girls come from inpatient and relapse. Both are doing great now, but each one took about 2 years.

They did sometimes eat in here, but only if stressed.

[Flare, ASN, BSN]

How much input does the student have over when and where she can eat these snacks? Anorexia is largely about control. Perhaps if she is not comfortable coming to your office and there is another staff member involved in her care like a counselor or social worker, she may be more comfortable eating there. She should understand that she has choices, but is still accountable for consuming the food.

[JenTheSchoolRN, BSN, RN]

How much input does the student have over when and where she can eat these snacks? Anorexia is largely about control. Perhaps if she is not comfortable coming to your office and there is another staff member involved in her care like a counselor or social worker, she may be more comfortable eating there. She should understand that she has choices, but is still accountable for consuming the food.

Very valid point, Flare.

Our full-time counselor is booked pretty solid nearly every single day with students (we have a very high need and I often handle the overflow when counselor is in session with a student), so there isn't often a time she can eat there regularly. When she does check in, I gave her the option of what she wants for a snack (parent provided a variety) and she will eat it without any issues. I check in with her, don't mention food, usually chat about her interests, etc while she eats. She is generally very comfortable with me as I am also a close contact to her sibling. The counselor she meets with at school is part-time and not there every day.

I hate calling up to require her to visit me as I don't think it works, but I have reached out to some teachers to do a quick discrete reminder to visit me (and call it a visit, not mention snack/food at all) and that did help for a time, but then didn't.

Her parent is just worried and trying very hard, has her connected to resources, trying to keep her out of inpatient again. I worry perhaps I need to check in more with parent, but again, have little to report and have told parent this.

Side note: there also may have been an issue the previous year (prior to my taking care of student) with another adult that was a previous anorexic that shared her stories with student and was trying to be helpful and student read it more as "tips" she could try. Therefore, I have asked staff not to discuss student's eating habits or weight with her at all.

[Farawyn]

Teachers can be pretty dumb.

Anorexia gets triggered very quickly.

[ruby_jane, BSN, RN]

Anorexia is largely about control.

That right there. So...is she on any medication (anxiolytic or such)? Is it working? Can you get permission to talk to the psychiatrist about plan of treatment? The monitoring you're doing is critically important because if she's not eating snack (and can control that) she may derail.

We treated a recovering anorexic at summer camp last year. Very intensive daily stuff. Compliant kid, parents presented as the ones with the control issues (and I am not judging - lord help me if that happened to my kid). We all survived, and she gained a few pounds (and was OK with that.) She was good about coming to get protein shakes, almost resigned, but we had some nice conversations (not about diet) in the 15 minutes it took her to get that down, and we'd walk her back to wherever her group was to make sure it stayed down.

You're doing really well by her. Hang in there.

[JenTheSchoolRN, BSN, RN]

That right there. So...is she on any medication (anxiolytic or such)? Is it working? Can you get permission to talk to the psychiatrist about plan of treatment? The monitoring you're doing is critically important because if she's not eating snack (and can control that) she may derail.

We treated a recovering anorexic at summer camp last year. Very intensive daily stuff. Compliant kid, parents presented as the ones with the control issues (and I am not judging - lord help me if that happened to my kid). We all survived, and she gained a few pounds (and was OK with that.) She was good about coming to get protein shakes, almost resigned, but we had some nice conversations (not about diet) in the 15 minutes it took her to get that down, and we'd walk her back to wherever her group was to make sure it stayed down.

You're doing really well by her. Hang in there.

I did talk with clinic she was at in-patient at beginning of school year, student on no meds I am aware of and does not have a psychiatrist, just counselor. But despite the fact that parent will call me regularly, getting any paperwork from parent is a nightmare. I can poke and poke and get nada. Finally got the student's latest physical from last month with immunizations.

And physical says student is healthy and NO MENTION of student's on-going monitoring for anorexia and this is the pedi office she was getting weighed at. Parent has since taken student to an official eating disorder clinic for weight-ins.

I did ask about protein shakes but none are part of plan. Student was a super picky eating prior to concern and diagnosis (parent says she has been a picky eater her whole life), which does make things a bit trickier.

[ruby_jane, BSN, RN]

does not have a psychiatrist, just counselor. But despite the fact that parent will call me regularly, getting any paperwork from parent is a nightmare. I can poke and poke and get nada. Finally got the student's latest physical from last month with immunizations.

And physical says student is healthy and NO MENTION of student's on-going monitoring for anorexia

OK....my hackles just went up. This is...odd.