STARSHIP INPATIENT EATING DISORDERS SERVICE

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STARSHIP INPATIENT EATING DISORDERS SERVICE INFORMATION FOR PARENTS/CAREGIVERS AND FAMILY/WHANAU . 2 ... together to plan treatment …
STARSHIP INPATIENT EATING DISORDERS SERVICE INFORMATION FOR PARENTS/CAREGIVERS AND FAMILY/WHANAU

Welcome to Starship Eating Disorders Programme This information is for you as parents/caregivers. It will explain your options and give some information about supports available to you and your child in hospital and help with the transition to outpatient services on discharge. The inpatient service multidisciplinary team have a lot of experience with eating disorders and most people make a full recovery. Secondly, you may feel anxious or upset about your child being admitted to hospital. Please let the staff know if this is the case; they are here to support you. Thirdly, eating disorders are not caused by families/whanau, or by any one thing. Mostly, eating problems happen after a combination of many different stresses that are certainly not anyone’s fault. Recovery from eating disorders can take some time. The first phase of recovery is weight restoration: and parents taking charge of their child’s eating so they can get back to a healthy weight. This is so body functions such as temperature control, blood pressure and heart rate normalise. Young people who are seriously physically ill cannot participate in therapies aimed at helping with underlying causes of eating problems: they are simply too sick. However, as they physically improve, staff will help identify therapies that will be helpful, either individually or in a group. Most young people will need at least 6-12 months of outpatient treatment after an admission. This is most likely to involve the whole family/whanau. Our experience with helping young people with eating problems is that we can be most helpful when we are all in partnership. Your weekly meetings with the treating team are essential for this. Overcoming eating problems is hard work! The inpatient staff are here to support parents to establish eating patterns required for weight recovery, in preparation for discharge. Young people are in hospital because there are serious concerns about their physical and/or emotional safety, we aim for your child’s stay in hospital to be as short and helpful as possible. Please tell us anything that we need to know to help with recovery. With all our families/whanau care is taken that our approach meets your personal and cultural needs.

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Who we are – the team… The Starship team has a lot of expertise in inpatient work with young people with eating disorders. We are a multi-disciplinary team and we meet weekly together to plan treatment and monitor progress. Young people who are admitted to Starship Children’s Health are cared for on the general paediatric ward 25, positioned on the 5th floor. The medical team, lead by Dr Raewyn Gavin, paediatrician, monitor patients’ physical status and order medical tests as needed. A paediatric registrar or house officer will look after your child day-to-day. Ward Nursing staff are lead by a Charge Nurse/Manager and supported by the Nurse Educator The staff nurses in the medical wards provide day-to-day medical care, support and supervision. The Consult Liaison Team provides emotional and behavioural support and will meet weekly with you and your child. The team is lead by Dr Louise Webster. The team has psychiatrists, a clinical psychologist, and nurse specialists also paediatric and psychiatric registrars. The Starship dietitians develop healthy meal plans in conjunction with you and provide education and support for transition home. See the separate section titled “Nutritional Care of Eating Disorders Patients”. The Starship physiotherapy service meets the young person between one and three times a week. The physio programme also provides education and support around breathing patterns, relaxation and healthy exercise, attitudes and behaviours.

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Play Specialists work daily with young people with eating disorders, providing a programme of arts, crafts, and creative activities. Play Specialists also support young people and their families/whanau with preparation for procedures if this is required. The Play Specialist, in conjunction with our young people in the programme, has put together a list of arts, craft, and activities. Families/whanau and friends are able to support the programme by resourcing their young people from this list if they wish.

Beading (threading materials, beads)/origami (origami paper)/diaries & journals/tie dye (white t-shirts, muslin for scarves)/scrapbooking/ knitting (needles & wool)/ painting & drawing (paint brushes/ canvas/drawing pencils)/friendship bracelets (embroidery cotton)/board games and playing cards/photo frames for decorating/gift boxes for decorating/pillow cases & textile paints/plaster of paris moulds/macramé belt string/DVDs/play station games…… School  School is a very important part of recovery. Qualified teachers in Northern Health School, Starship, headed by the Associate Principal Cushla Brown, help your child maintain their schoolwork while in hospital.  

Contact is made with your child’s school (with your permission) so that work provided can be aligned with what they would be doing in school NB: Te Kura, (correspondence) may be an option. Educational expectations are discussed with you at a mutually suitable time.

If your child is on bed rest then the hospital school teachers can help with doing work in their hospital room. Classroom hours: 10am – 11.45am 1.30pm-2.45pm (the classroom is on the 3rd floor of the Starship)

Other Team Members Available As Needed Kai Atawhai, Pacific Island Support, Asian Mental Health Services, Social Worker, Hospital Grandparents, Interpreters, and Chaplain

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Inpatient Management Medical Stabilisation Often when young people present to hospital they are medically compromised because they have had trouble eating enough food at home. We have found that inserting a nasogastric tube and feeding through this for a few days is a medically safe treatment. Young people have also told us they have found this useful as it has given them a rest from the struggles against the eating disorder. After a few days we have found most young people start to eat and the nasogastric tube is able to be removed. Medical Management Because eating disorders can cause dangerous effects on many body systems, when people are very ill they will need to rest on their beds. At times medical management may also include medicines to help with calmness and to control strong thoughts. If this is suggested for your child we will discuss the advantages and disadvantages of any proposed medicine. Medicines for this purpose cannot be used without discussion and agreement of parents unless in an emergency. Observations and Blood Tests If eating disorders have lead to admission, there is always a need for blood tests and observations such as blood pressure, pulse rate, and temperature. These help staff monitor medical stability and recovery. Weighing Weight recovery is an essential part of getting better from eating disorders. Once medically stabilised, inpatients are weighed three times per week, in hospital gown and underwear so that the weight is as accurate as possible. Random weighs may also be needed if there are concerns about weight variation. Weights will be discussed at the weekly meeting. Staff nurses will not discuss weight.

Photo With your permission a photo is taken of your child shortly after admission. This is put in their file and remains a part of their notes.

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Bed Rest Bed rest involves minimal use of energy, since it means sitting or lying on the bed at all times aside from using the bathroom, in a wheelchair. Bed rest is usually required if a young person is medically unstable, so most people have a period of bed rest on admission. If staff are very concerned about the young person’s medical state, bedpans may be required. Post Meal/Snack Rest Time We also ask that everyone rest for 30 minutes on their bed or chair after each meal/snack, with no use of the bathroom at this time. Attending school is considered ok during rest time. Levels of Nursing Care We use a ‘level of care’ system in hospital, ranging from needing bed-rest and medical monitoring to spending lots of time out of hospital and practising eating at home with family. These levels of care are outlined in the following pages. The idea is that as the young person gets ready for discharge parents have an opportunity to establish meals and routines that can be successfully transitioned home. These are planned and reviewed in the weekly family meetings. After your child is medically stable on level one (usually a week) then there will be discussion between you and the treating team whether it will be helpful for you and your child to continue through levels 2 and 3. When working through the levels  On Levels 2 and 3 parents are able to become familiar with size, portions and variety of foods  These levels are focused on parents being able to practise supporting their child to eat enough to restore a healthy weight  For practical reasons parents must be present if providing food from home otherwise hospital meals are provided



While in hospital there are numerous opportunities to problem solve. W e encourage you to use the Eating Disorders Team to discuss any issues arising. The weekly family meeting is an opportunity to discuss how home leave went. If it is helpful, write things down and bring it to the meetings.

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LEVEL ONE MEDICAL STABILISATION

NAME: DATE: Activity

 Bed rest

 Wheelchair to toilet  Activities on bed  Start physio

 Schoolwork on bed NB: if you have a NG tube in once the medical staff have said you are medically stable and you have eaten a full meal plan for 24 hours you can attend school (in a wheelchair)

Ward Leave:  NIL

Home Leave  NIL

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LEVEL TWO

NAME: DATE: Activity  

Meals and snacks at communal dining table or out with parents (walking)



30 minutes rest after meals/snacks



Walk to school once NG is out (otherwise wheelchair)



Walk to toilet



Walk to teen lounge once NG is out (till 4pm) Physio

Ward Leave:     

Once nasogastric out 20 min walk with parents once a day when in hospital Lunch supervised by parents 4 times a week, on or off the ward (in a wheelchair) Parents to provide all snacks and most meals from home Parents to be present at most lunches and any other meal they can attend Home leave, e.g. a half day leave with eating a snack and one main meal at home (details discussed in family meetings)

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LEVEL THREE

NAME: DATE:

Activity  

Meals and snacks at communal dining table or out with parents (walking)



30 minutes rest after meals/snacks



Walk to school (use lift)



Walk to toilet



Walk to teen lounge (until 5pm) Physio

Ward Leave:  

Leave ward for 40 minute walk once a day with parent when in hospital (not when on home leave)



Most meals supervised by parents on or off the ward (walking)



Parents to attend lunches and either breakfast or dinner



Parents to provide all snacks and most meals from home Home leave – overnight leave as discussed in the family meeting (eating main meals and snacks at home)

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Hospital Meals and Food… Meal times are usually very stressful for young people with an eating disorder and their families/whanau. To help overcome abnormal eating habits, we try to make our meal times as structured and supportive as possible.        

In hospital we aim to reduce disordered behaviours and restore healthy eating patterns and social interactions Parents participate in as many meals as possible. However parents do need to be aware that other patients and their parents will also be present most of the time. Once off medical stabilisation all main meals and snacks when eaten on the ward need to be eaten in the dining area when this is available. Since recovery from eating disorders needs a team approach, if you have any concerns about meals/snacks please address these outside of the dining room. Please do not discuss food, weight, or body image in the dining room. Feel free to talk about any other topics!! (current events/pets/movies etc) Nursing staff can support you /your child while eating, but this will work best if you are able to listen to their guidance. Again, if you have concerns please address these at another time with the relevant staff. Meals need to be eaten within 30 minutes and snacks within 15 minutes. This is because longer meal times don’t usually help with the process of beating eating disorders: longer meal times often increase distress We will work with you to identify barriers to re-establishing normal eating and ways of tackling these. Since everyone is different these strategies will vary. They often include using distraction, relaxation or breathing and calm, firm insistence from family/whanau members. Notice strategies which seem to make eating easier and build on these.. Adequate nutrition is the focus of recovery and if your child continually takes more than the allotted time for a meal/snack or if any part of the meal is not eaten, they will be on bed rest until the next meal/snack is completed in the allotted time. The insertion of a nasogastric tube is considered if clinically indicated.

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Privacy/Safety and Risk Having an eating disorder can mean that toileting, showering, and after meals can be risky times for vomiting or exercise. Because of this, we ask young people to refrain from using the toilet for half an hour after meals and snacks. We also limit time in the shower to 10 minutes once a day prior to 7pm. At times we may need to monitor toilet and shower use more closely. We will do our best to respect your child’s privacy while doing this. Eating disorders can make people behave secretively, making it difficult to share information about thoughts and behaviours. For example, sometimes young people don’t want their parents to share the full extent of their troubles with eating or exercise with the team. However, in order to promote recovery, it is important that we work together. Please tell us everything so we can be as helpful as possible. At times young people can become very distressed during their recovery from an eating disorder. It may be necessary to have a ‘watch’ (1:1 supervision) for some or all of the day if this occurs. This will be discussed with family/whanau at the time. Belongings and patient’s rooms will be searched if there are any safety concerns. While the young person is medically unstable we suggest minimal use of cell phones and internet as this assists in providing a space to focus on recovery.

Mobile Phone Use Bedtime is a time for rest especially if sharing rooms. To help promote this we collect mobile phones at 9 pm and return them in the morning. As with any school setting, mobile phones should also not be used in the schoolroom. Internet Use/ Personal Laptops We are aware that internet and computers are an important part of young people’s lives. Parents may sign permission for wireless internet access in the Starship. However due to the nature of some internet sites we expect parents to monitor their child’s site access. While staff will intervene if they observe a child looking at inappropriate material, they are not able to directly monitor a child’s web browsing. Patients are not allowed to share their personal laptops or internet access with other patients. Please talk to the staff if you have any questions.

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Dress Code/Warmth All clothing worn should be appropriate for a hospital setting (this may be different from what your child is used to at home): nothing too skimpy or revealing please! No shorts or singlet tops. Since being underweight dangerously affects temperature control, extra attention is paid to keeping your child warm and covered, especially when leaving the ward. As a rule of thumb, people with eating disorders who are at low weight need an extra layer of clothing, with arms and legs covered. Please also make sure they wear socks and shoes or slippers in the colder times of year and shoes or jandals at all other times: bare feet are at risk in a hospital! What does your child need? Clothes: casual, comfortable and warm. Pyjamas and toiletries. Bedding if you want: most people like to have their own duvet and pillow. Schoolwork, especially if they are working on a project. Extras: activities, books, craft activities. Please note: sadly, despite our best efforts, items are regularly stolen from patients at Starship. We cannot be responsible for valuables, (except when mobile phones are collected for night-time keeping) so keep this in mind when bringing items from home. Hospital Orientation Please ask the ward nurse for the hospital-wide orientation information if it is not in your room. This contains information that is useful during your child’s stay e.g. parking. Visiting Parents and immediate family/whanau members can visit the hospital at any time. Overnight stays by a parent are also possible especially early in admission: Nurses encourage lights out around 9.30pm. Please discuss with your nurse. Other family/whanau members and friends need to visit during regular Starship visiting hours (8am to 8pm.). Please ask visitors to avoid visiting during school times and meal times. Many young people at low weight need a lot of rest to recover: It may be necessary to limit number of visitors and the length of their visit. RONALD MCDONALD family room on level 3 is available for family/whanau to make a cup of coffee and tea and have time off the ward. Ask the ward nurse for details.

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Helpful websites and resources Local support network EDANZ http://www.ed.org.nz/ Their website includes resources, including recommended books, websites, and pamphlets for young people, family/whanau, and supporters and contact details for support groups. We especially recommend "Help your Teenager beat an Eating Disorder" by James Lock and Daniel Le Grange (a practical guide for parents and carers). (ISBN: 9781572309081) “Skills-based Learning for Caring for a Loved One with an Eating Disorder" The New Maudsley Method by Janet Treasure, Grainne Smith and Anna Crane. (ISBN: 9780415431583)

WINZ Subsidies If your child’s illness has continued over a long period, you may be eligible for assistance to help with the costs of care. The ward social worker can advise on this and on other allowances: ask the nursing staff to make contact with him/her if you would like further information.

Follow up after Starship Evidence-based treatment for a young person with an eating disorder is family based therapy. The Starship team doesn’t provide ongoing outpatient followup so we will work with your new service to ensure that the transition is as seamless as possible. The outpatient service you attend continue to support you to take the lead on your child’s recovery. Follow-up after discharge will depend on the age and issues of your child. Outpatient follow-up may be provided by Regional Eating Disorders Service (REDS) based at Greenlane Hospital or at a Child and Adolescent Mental Health Service (CAMHS).

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Nutritional Care of Eating Disorders Patients in Hospital Initially the dietitian is responsible for looking after your child’s nutrition while in hospital. The dietitian will meet with you in the first few days of admission. After your child is medically stable you as parents will take over this role. If you wish to contact the dietitian to discuss any part of your child’s nutrition, please email at [email protected] NASOGASTRIC (NG) FEEDS Usually your child will be fed through a tube through their nose (nasogastric tube) when first admitted because this is medically the safest way to re-feed. Initially the NG feed will run continuously - The rate will be increased daily over the first few days. Your child also needs to drink 750 ml water each day. The dietitian will let you know if food intake is recommended during this time but full meals are usually not recommended. Once medically stable the continuous NG feed will be stopped. At meal and snack times your child will be supported to eat the meal/snack as on the meal plan. If unable to do so they will be given Fortisip via the NG tube (bolus). If only part of the meal/snack is eaten, the full amount of Fortisip will still be given via the NG tube. Once the NG tube has not been used for 48 hours it will be removed, except if the 48 hours is completed during the weekend, the NGT will remain in until Monday. All meals are supervised and normal eating behaviour is expected. MEAL TIMES Breakfast Morning Tea Lunch Afternoon Tea Dinner Supper:

8.00 am 9.30 am 12.30 pm 3.00 pm 5.30 pm 8.00 pm

30 minutes is allowed for meals and 15 minutes for snacks. MEAL PLAN The dietitian provides a meal plan comprising three meals and three snacks, to be followed when eating hospital meals. Everything on the plan needs to be eaten. The dietitian will check with you if your child has any long term dislikes that pre-date the eating disorder, as she may take these into account when organising hospital meals. When parents are providing the meals and snacks, the meal plan is a guide only. To allow for smoother transition home it is helpful if meals from home are typical of what your family usually eats and are varied.

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SNACKS A named plastic box is kept in the ward kitchen for your child’s snacks for use when the nurses are supervising snacks. Please bring a variety (at least 3 different types) of snacks. See list below. These may include foods your child has not eaten for a while to encourage them to return to normal eating. When you are supervising a snack it can be helpful to bring in food not on the list below to further increase exposure to foods not eaten for a while. Snacks are expected to be at least 600kJ to 900kJ. Parents please provide a range of snacks from the following groups  Muesli Bars – regular full sized bars, not mini or light  Biscuits – please bring in the whole packet The usual portion will be approximately 5 if round wine type biscuits 2-4 if shrewsbury/gingernut/cream filled  Home baking – wrapped individually in cling film such as biscuits, slices, muffins  Dried fruit and nuts – please pre-pack in snaplock bags containing around ⅓ cup per bag Please leave the packaging of bought snacks for kJ to be viewed

MEALS OFF THE WARD AND MEALS FROM HOME Recovery from an eating disorder is not just about weight recovery. Social eating with friends and an ability to eat out of the home environment is also part of recovery. From Level 2 the focus is on supporting parents to support their child during meals and snacks, in preparation for discharge home. Meal supervision will need to continue for some time after discharge. Levels 2 and 3 eating lunch at a café in the hospital grounds i.e. Muffin Break, Subway or Tiny Bites on some days each week is an opportunity to practice increased exposure. Other places to go with a lunch bought from home are the domain and Ronald McDonald lounge. You may take some items from the hospital lunch (such as fruit, yoghurt, juice or milk) if you wish, for your child to eat with the purchased lunch. It is up to you if you decide whether or not to give your child some limited choice such as asking if they would prefer a subway or a slice of quiche. It is not helpful to choose “light” or “low fat” items for your child. To conserve energy we ask that the total time off the ward for lunch is no more than one hour and please use a wheelchair (on Level 2). At Level 2 parents provide some meals and (all) snacks from home. As most staff are available during the day it is helpful if parents attend most lunches. From Level 3 most meals and snacks will come from home and be supervised by parents, on or off the ward. The meals should be typical family meals for your family. The dietitian can discuss this with you if necessary.

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HOME MEALS AND SNACKS Other parents have found the following guidelines helpful  As the parent you are in charge of what is served for each meal and quantities served, and your child needs to eat the full meal  It is more helpful if initially your child does not assist in meal preparations  Your child needs to eat normal family meals, the same as the rest of the family are eating  A child who needs to regain weight needs to eat a lot of food. The meals need to be large, and may need to be larger than others in the household or larger than what your child previously/normally ate.  Dinner needs to include protein (meat, fish, chicken, vegetarian protein), carbohydrate (potato, kumara, rice, pasta, bread, roti etc) and vegetables/salad  It is normal that portion sizes vary from one dinner to the next  Snacks will be required at morning and afternoon tea (and maybe supper too) to ensure your child regains weight.  It is not helpful to use diet or W eight W atchers food  Ensure your child drinks adequate fluid, 1500-2000ml a day  Aim to increase the variety of foods back to what was normal for them before the eating disorder  Aim to include foods that are appropriate to situation and occasion, such as special foods on special occasions

Examples of Meals: Breakfast Cereal, milk, yoghurt, toast, spreads and juice

Lunch Sandwiches, filled, wraps, quiche Fruit Yoghurt Muesli bar, baking Milk or juice

Dinner Meat, fish, chicken, potato/rice/pasta/ kumara/other vegetables Dessert Milk or juice Snacks Milk, flavoured milk or juice Bread, baking, biscuits, Muffins, crumpets

ON DISCHARGE The hospital dietitian will refer your child on to the Regional Eating Disorder’s dietitian.

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Note To Parents To Support Your Child’s Recovery In order to support your child to recover, it is important to make sure that you do not take sides with the eating disorder. Here are some ways you may unintentionally be taking the side of the eating disorder, and alternative strategies: • Thinking that the restrictions at each level do not apply to your child Instead: Assist your child to adhere to the restrictions of the level they are on so that they can regain lost weight. We find that children who can stick to the programme are more likely to get better faster and stay well after discharge. • Arguing for a lower goal weight range Instead: Do not discuss weight with your child. You can say that the doctors have a lot of experience and know what is healthy, and then change the subject. Later when the eating disorder is not such a big part of your child’s life, there can be more discussion about weight. • Providing meals and snacks that are too small because that is all your child says they will eat Instead: Provide meals and snacks of a similar size to those the hospital provides. If the meals and snacks are too small they will not regain weight and recovery time will be extended. • Giving in to the bargaining tactics of an eating disorder Instead: Utilise the inpatient staff for Levels 2 & 3 to problem solve prior to discharge. This is a chance to try new strategies to increase success at home. • Not acknowledging the need for restricted activity Instead: Limiting activity is very important for recovery from an eating disorder. We understand that this is difficult but if your child is more active than recommended they will not regain weight and recovery time will be extended. The restrictions are in place to reduce the energy used by activity, and to provide incentives to eat.

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What your child needs for support When feeling anxious it is helpful to have someone supportive Support refers to having someone there in a helpful and constructive way. These are the things that you can provide for support: Structure, patience, encouragement, soothing, and consistency.

STRUCTURE:

Eating at similar times each day, keeping to a reasonable time limit. The support person being there throughout the meal-time.

PATIENCE:

The support person is to approach the meal with steady perseverance, and even-tempered care. The child being encouraged to continue despite difficulties. Being reassured that they can. Having someone nearby being consistent and supportive is soothing especially when some one is feeling anxious. That the messages received are compatible with those from other family members and REDS.

ENCOURAGEMENT:

SOOTHING:

CONSISTENCY:

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Helping your child to learn how to ‘breathe’ Everyone knows that breathing is an essential part of life, but did you know that breathing plays an essential role in anxiety? Breathing is a powerful determinant of physical state. When our breathing rate becomes elevated, a number of physiological changes begin to occur. Anxious breathing You might already know that we breathe in oxygen - which is used by the body and we breathe out carbon dioxide. In order for the body to run efficiently, there needs to be a balance between oxygen and carbon dioxide, and this balance is maintained through how fast and how deeply we breathe. Of course, the body needs different amounts of oxygen depending on our level of activity. When we exercise, there is an increase in both oxygen and carbon dioxide; in relaxation there is a decrease in both oxygen and carbon dioxide. In both cases the balance is maintained. When we are anxious though, this balance is disrupted. Essentially, we take in more oxygen than the body needs - in other words we over breathe, or hyperventilate. When this imbalance is detected, the body responds with a number of chemical changes that produce symptoms such as dizziness, light-headedness, confusion, breathlessness, blurred vision, increase in heart rate to pump more blood around, numbness and tingling in the extremities, cold clammy hands and muscle stiffness. The normal rate of breathing is 10-12 breaths per minute - what’s your breathing rate? The Calming Technique While over breathing and hyperventilation are not specifically dangerous (it’s even used in medical testing!), continued over breathing can leave you feeling exhausted or ‘on edge” so that you’re more likely to respond to stressful situations with intense anxiety and panic. Gaining control over your breathing involves both slowing your rate of breathing and changing your breathing style. Use the calming technique by following these steps and you’ll be on your way to developing a better breathing habit. Diaphragmatic Breathing • Breathe out and empty your lungs, especially your chest. • Focus only on breathing out and the following pause • Let your body breathe in by itself without any effort. • As you breathe through your nose into your belly, your stomach will gently rise as your diaphragm moves down. • Find your own rhythm and flow. To help you focus you may use counting out on exhalation, (3-2-1-pause) or a word or phrase or image or sensation. (Your therapist may assist you finding what works best for you) • Relax your jaw, a few “Aaaohhh” breaths on your exhalation may assist this.

By using the calming technique, you can slow your breathing down and reduce your general level of anxiety. With enough practice, it can even help to reduce your anxiety when you are in an anxious situation.

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Distraction We spend a great deal of time listening to our thoughts; we accept many of these thoughts as true, without really questioning them, especially the negative or eating disordered ones. The eating disordered thoughts then become louder, it becomes harder to turn the volume down and hear other thoughts. The more we listen, the more unpleasant feelings we experience. At these times, your child may need help with some short term relief, and this is where distraction techniques may be helpful.  

Distraction helps to take your child’s mind off eating disordered thoughts by keeping their mind busy Helps to take control of thoughts by focusing and thinking about something else.

Distraction can be achieved in different ways: Discuss the following with your child. With Activities: Do something! Play board or computer games, read a book or magazine, watch TV or a favourite movie, call, email or visit a friend, do art, do a hobby (weaving/ painting/knitting), go for a short walk, do a crossword or puzzle, listen to music, play an instrument, learn something new. Helping Others: Contribute and do something nice for someone, do some volunteer work, make something for someone, help a friend or sibling with homework, do the dishes or other chore, do a surprising or thoughtful thing, play with your pet. With Opposite Emotions: Create different emotions: watch scary movies or comedies, listen to loud music that inspires you or soothing music that chills you out. Practice breathing techniques, talk to somebody. With Other Thoughts: Replace your thoughts with other things! Count to 10, count backwards from 100, do crossword puzzles, repeat the words to a song in your mind, play music/singstar. With Other Sensations: Focus on other sensations: squeeze a rubber ball or toy; listen to music, cuddle or groom your pet, have a warm bubble bath, do your hair and makeup (or someone else’s).

*Thank you to REDS ADHB for their contribution to this publication.*

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Letter to Parents It is often a hard decision to bring your child into hospital with an eating disorder. We know that most parents in your situation have tried a number of things to help their child eat at home, endured numerous challenges from an eating disorder and wondered if they would ever have a happy family again. Feelings of failure and blame are common at such times. Worries about abandoning parental responsibilities and needing a break to regain one’s strength are also usual, as are strained adult relationships and sibling welfare. If any or all of the above sounds familiar, we would like to let you know a few things: - We appreciate your decision to ask for more help to look after your child who is experiencing an eating disorder. We know it’s not easy to do, and -

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that your child needs to be here We respect your role as parents and do not wish to undermine this in any way while your child is on the ward We see our role as providing extra “back up” to you, your child’s GP and community treatment team (if they already have one) at a time of increased need We shall endeavour to communicate with all of you throughout your child’s stay in hospital, by way of regular meetings, telephone calls and professional liaison with other services on an at least weekly basis.

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You will probably meet with a number of the hospital team including doctors (psychiatrists), psychologists, consult liaison nurses, dietitians, paediatricians, paediatric nurses, play therapists and health school teachers. We recognize that you may be exhausted and need a break to regain your strength. Let us know, we are here to support you Worries can settle as people get used to being in hospital, but resurface around the time of discharge. This is normal and we know how to deal with them After you leave hospital, you will receive extra assistance from community services, so things don’t go right back to how they used to be We are aware how sneaky and destructive eating disorders can be, but also know that if we all work together as a team, we can usually beat them. So don’t give up hope. Things will get better!

Thank you for trusting us to help your child. We look forward to getting to know you better over the coming few weeks.

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CHILDREN’S HOSPITAL OF NEW ZEALAND: INPATIENT EATING DISORDERS SERVICE PAEDIATRIC CONSULT LIAISON TEAM July 2013

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