Eating disorders are serious mental health disorders that cannot be appropriately managed without both physical and mental healthcare. These illnesses, including anorexia nervosa, have the highest avoidable mortality rates of all mental health conditions. Paediatricians should be aware that the risk of death in children with eating disorders is comparable to that of asthma and diabetes.1

The COVID-19 pandemic and its aftermath have had a significant impact in terms of increased incidence as well as acuity of presentations of children with eating disorders, which has contributed to a 90% increase in hospital admissions in the last 5 years.2

All paediatricians will encounter children with eating disorders in the acute inpatient setting. We acknowledge the anxiety that may be generated when caring for these children.

Medical Emergencies in Eating Disorders (MEED): Guidance on Recognition and Management, was published by the Royal College of Psychiatry, and endorsed by the Academy of Medical Royal Colleges, in May 2022. It provides an important framework for caring for patients with eating disorder when they are most unwell. It is a joint guideline for adults, children and adolescents and succeeds the 2012 Junior MARSIPAN (Management of Really Sick Patients with Anorexia Nervosa) guidance, which most clinicians will have familiarity with.

The development of MEED arose from the recognition that medical care for eating disorders was still at times lacking, resulting in preventable deaths, despite admission to hospital.

MEED builds on the MARSIPAN guidance by providing:

An up-to-date traffic light risk assessment tool.

Summary sheets for target clinical groups (including paediatric physicians).

New advice around more higher calorie refeeding.

MEED presents a range of physical and psychological parameters that are rated on a traffic light system as red (high impending risk to life), amber (alert to high impending risk to life) or green (low …