A referral from the primary care provider may be required for the adolescent medicine office. The first visit is with the adolescent medicine physician to establish the diagnosis and determine the need for in-patient versus out-patient care. Appointments with the psychologist and nutritionist will be arranged then. The clinic appointment may last two hours.
Patients who are not medically stable are cared for on an inpatient medical unit. The goal of hospitalization is to achieve medical stability and evaluate further treatment needs. There will be a care assistant by the bedside 24 hours a day to observe for activities such as attempts to binge and purge, over-exercising and hiding food, as well as documentation of progress with eating. Medical care includes bed rest, gradual increase in caloric intake and round the clock cardiac monitoring as the heart rate is often very low from malnutrition. The re-feeding process can be associated with complications so the clinical status is carefully monitored along with blood chemistries. As patients continue to make medical progress, our child life specialist and physical therapist will add walks, stretching and toning activities to their daily regimen.
While in-patient, the nutritionist meets with the patient daily, to work to normalize food patterns and address distorted beliefs about nutrition. The care assistant provides supervision and support as patients work to normalize eating patterns and work through anxiety related to food and weight. When census allows, therapeutic group meals will be provided by doctoral staff to address underlying issues related to food. This therapeutic group process allows the child/adolescent an avenue to express feelings related to their meals and stressful events throughout the day among their peers to encourage supportive feedback.
Transition from the In-Patient Floor
As patients become medically stable and needs less intensive care the need for further psychological therapy while in-patient will be determined. If deemed necessary, transfer to the psychiatry floor will be discussed. If this is not needed, then arrangements for further care as an out-patient will be made.
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