6814 Paediatric involvement to support management of young people with restricted eating at home, pre, during and post COVID

Objectives The Specialist Paediatric Eating Disorder (SPEED) team was established in North Wales in 2016 with the aim of empowering families to refeed their children at home. It consists of a centralised assessment involving a multidisciplinary team (MDT) with embedded paediatric practitioners. Despite rising numbers of young people with eating disorders, including a significant escalation during COVID-19,¹ the SPEED team maintained face-to-face contact, and continued to support recovery at home. A review was undertaken to examine outcomes between 2017–2022. Methods Family-based treatment is the gold-standard for anorexia nervosa (AN) during adolescence.² The SPEED assessment provides a single front-loaded initiation of therapy by the MDT, followed by community care at home. Retrospective data was collected using notes from all SPEED assessments performed between 2017–2022. The study assessed the number of patients admitted to acute paediatric and tier-4 inpatient beds and numbers requiring nasogastric (NG) feeding. Results During the study period 422 patients were assessed (91% female). The mean age was 15.1 years (range 9 to 18 years). The mean BMI at presentation was 17.85kg/m2 (range 11.3 – 31.0kg/m2). Mean percentage of ideal body weight was 89.7% (range 60.3% – 159.1%). 206 (48.82%) had AN and 216 (51.18%) had disordered eating (DE). Figure 1 shows the diagnostic outcome of the referrals. 36 patients (8.5%) were admitted to an acute paediatric bed; 27 (6.4%) had AN and 9 (2.1%) had DE. Mean length of stay (LOS) was 14 days (range 1 to 29 days). 18 patients (4.2%) were admitted to a tier-4 in-patient unit; 15 (3.6%) had AN and 3 (0.7%) had DE. The mean LOS was 144 days (range 21 to 307 days). NG feeding was rarely required (4 patients, 0.95%), with no patient requiring restraint. Figure 2 shows the need for admission and NG feeding. Conclusion There is a growing trend across the UK to electively admit patients with restrictive eating to an acute ward for 3 weeks³ which has significant resource and financial implications. Despite increased demand and a tendency since the COVID pandemic towards admitting young people with an eating disorder for NG feeding⁴ SPEED has continued to effectively support individuals with restricted eating to recover at home with their family. In the 6 years of the service, there has been a minimal need for NG feeding and restraint, preventing the potential life-long trauma associated with NG tube use.⁴ Our model presents a sustainable alternative which continues to work well in North Wales. References Press Release: Hospital admissions for eating disorders increased by 84% in the last five years, Royal College of Psychiatrists, 2022. Lock J, et al. Treatment Manual for Anorexia Nervosa: A Family-Based Approach 2nd ed. New York, NY: Guilford Press. 2012. Street K, et al. Structured, supported feeding admissions for restrictive eating disorders on paediatric wards, 2016. Fuller S, et al. Nasogastric tube feeding under physical restraints. Comprehensive audit and case series across in-patient mental health units in England. BJPsych Bulletin, 2023:1–6.