Eating disorders

• NHS Tayside CAMHS Outpatient Eating Disorder Service (TayCEDS) is based within the Centre for Child Health premises at 15 Dudhope Terrace, Dundee.
• We provide a specialist service for all children and young people with eating disorders under the age of 18 years old in Tayside and who are still on a school role.
• The Service provides specialist outpatient assessment and treatment of eating disorders primarily, Anorexia Nervosa, Bulimia Nervosa, and their variants, having access to psychological, psychiatric, nursing and dietetic interventions.
• We also have close links with the Ninewells paediatric ward and the Dudhope Young Peoples Unit.
• Although eating disorders can develop at any age, be aware that the risk is highest for young men and women between 13 and 17 years of age.
• We would recommend that screening tools (for example, SCOFF) are not used as the sole method to determine whether or not people have an eating disorder.

• Children up to the age of 18 years old where eating disorder symptoms are the primary concern and would include the following acceptance criteria:
  • A persistent pattern of restrictive eating or other behaviours aimed at establishing or maintaining abnormally low body weight
  • Unusually low weight or weight less than expected for age
  • Rapid weight loss or failure to gain weight as expected for age
  • Physical signs of malnutrition, including poor circulation, dizziness, palpitations, fainting or pallor
  • Fear of gaining weight or becoming fat
  • Behaviour that interferes with weight gain (self-induced vomiting, excessive exercise, abuse of laxatives/diuretics, omission of insulin doses)
  • Impairing body image disturbance or excessive preoccupation with body weight or shape.

• Where initial assessment suggests a primary physical cause for low weight/weight loss (refer to paediatrics). 

Please include the following essential information. To help establish the patient's risk, it would be very helpful to have:

• Baseline bloods (FBC, U&Es, LFT, fasting glucose and TSH)
• Temperature, pulse, sitting and standing blood pressure. ECG (if clinically indicated based on blood pressure and pulse). 
• Current weight, height and BMI: please document if the patient refuses to be weighed and provide some information on their weight status.
• Any recent weight loss and historical measurements. 
• Does the patient:
  • restrict their food intake/ count calories/avoid social eating?
  • self-induce vomiting/take laxatives or diuretics?
  • Binge (eat a large amount in a short period)?
  • Exercise to excess?
• Please provide a brief summary of diet consumed
• Any fear of weight gain?
• Any episodes of amenorrhoea or delayed puberty?

Medical emergencies
If you feel that the young person you have assessed is acutely unwell, we would advise you initially discuss this with Paediatrics. Physical signs of when this could be required may include: bradycardia, hypothermia or significantly deranged blood results. The team will then assess the patient on the ward if they are admitted or at an outpatient appointment within 5 working days.

Urgent referrals
Must meet one of the following criteria and will be seen for an initial assessment within 5 working days:

• BMI below the 1st Centile (See link to calculator below)
• Rapid weight loss (>1kg per week for 2 consecutive weeks)
• Heart rate <50bpm
• Acute food refusal
• Dizziness/syncope
• Abnormal biochemistry (FBC, U&Es, LFT, fasting glucose and TSH)
• Hypothermic
• Daily episodes of vomiting and/or laxative abuse
• Physical health condition which would increase risk e.g. Type 1 Diabetes

See above under 'medical emergencies' if you feel they are acutely unwell requiring paediatric physical assessment.

Routine Referrals

• Patients who meet the referral criteria (see “who to refer” section) but not the medical emergency or urgent criteria will be considered routine and seen for an initial assessment within 4 weeks.

The service is happy to receive referrals either electronically, via SCI-Gateway listed under CAMHS or via email:

• Dundee - tay.dundeecamhsadmin@nhs.scot
• Angus - tay.anguscamhsadmin@nhs.scot
• Perth - tay.perthcamhsadmin@nhs.scot

Telephone: 01382 204004
Email: tay.camhseatingdisorders@nhs.scot

• BMI Calculator - check the BMI of children and teenagers aged between 2 and 17. (We are aware the website states not to use this tool if the patient has been diagnosed with an eating disorder or thinks they may have one however, we are happy for professionals to use this tool to calculate BMI centile which will support assessment of nutritional risk aid referral triage).
• MEED - Medical emergencies in eating disorders: Professional guidance on recognition and management
• NICE - Eating disorders: recognition and treatment
• BEAT-  Beating eating disorders website. This site provides help on all aspects of eating disorders including Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder and related eating disorders and have a helpline number to call.
• CARED- Designed for parents and carers of young people (aged up to 25) in Scotland who have recently received a diagnosis of an eating disorder
• SIGN- Best practice in the management of people with eating disorders of all ages and gender groups.