A new role is set to improve the nutritional care of children and adolescents with eating disorders or mental illnesses, writes Michelle McDonagh.
CHILDREN AND adolescents with mental health problems are at an increased risk of developing chronic diseases such as diabetes, cardiovascular disease and osteoporosis in adulthood due to their inability to maintain a healthy diet.
That's according to the Republic's first senior dietician for child and mental health services, Ruth Kilcawley whose role is to provide support for young people regarding their nutritional care and to intervene to help families cope in often difficult situations around food.
Some young people are not getting adequate nutrition due to eating disorders such as anorexia and bulimia, she explains, while others experience problems with weight gain or loss as side effects of long-term medication to treat illness.
Kilcawley says: "My overall aim is to improve the nutritional care of children and adolescents with eating disorders and other problems or mental illnesses. For example, the medications for ADHD can suppress the appetite and young people can find it difficult to eat so there are issues around maintaining weight and diet adequacy.
"On the other hand, anti-psychotic drugs tend to have an appetite-stimulating effect and can cause patients to put on weight which creates major issues around compliance in teenagers for whom body image is so important. They don't want to take drugs that will make them gain weight which is understandable."
Based in the HSE West, Kilcawley works from St Anne's Child and Adolescent Centre in Galway city on both an inpatient and outpatient basis.
Part of her role is working with young people, mainly girls, with serious eating disorders who attend the centre on an inpatient basis.
"Many of the girls I see as inpatients have fairly severe anorexia. When they come in first, they are started on a refeeding programme which is quite medically based to avoid refeeding syndrome as many of the girls are dehydrated and may not have eaten in weeks.
"My role is to support them in learning to trust food again and to change their eating habits. I do nutritional assessments and education with the girls around dietary and nutritional intake and do a lot of work with their families, particularly coming up to discharge."
Once the patient has started to gain weight through the refeeding programme, Kilcawley steps in to provide support which includes developing an eating plan for going home. She works as part of a multidisciplinary team that includes psychiatry, psychology and social work.
She comments: "It's not like the old days where patients with anorexia were sent home and told to put on two stone, it's a far more holistic approach. I encourage the girls to use food diaries and explore a lot of the myths they have around certain foods with them."
In her outpatient role, Kilcawley can follow the progress of her inpatients long term in the community once they have been discharged. She points out that it is extremely beneficial for children and teenagers to have continuity of care by the same health professionals as this helps to develop a relationship of trust and support over time.
The side effects of medication for conditions such as ADHD and mental illnesses such as depression and schizophrenia can be very distressing for children and particularly adolescents, explains Kilcawley.
"People with mental health problems are more at risk of developing obesity and chronic disease in adulthood such as diabetes and cardiovascular disease due to their ability to eat an adequate diet. This may be due to the side effects of their medication or to a lack of basic skills in buying and preparing food.
"It's very important to provide support for them and to get their diet right from the early days," she advises.
The shortage of beds for the treatment of eating disorders in Ireland has been recognised by the Government and those working in the field and there are plans afoot to develop new 20-bed units in Galway and Cork and to increase the number of beds in Dublin.
This will, in turn, lead to the demand for more dietitians working in this area and Kilcawley is hoping that she will not be the only one in the country for too much longer.
"It's amazing to think that we have been treating eating disorders in Galway for more than 20 years and have never had a dietitian in this area," she says.
Her role also involves providing nutritional and dietary service to the five child and mental health service teams throughout the HSE West region, three in Galway and one each in Mayo and Roscommon. She provides training for the teams on the vital role of nutrition in the mental health of children and teens and on the right advice to give to families.
Although she works on the basis of the food pyramid, Kilcawley explains that she often has to try to work around very challenging food behaviours.
"For example, a lot of children with autism have difficult feeding behaviour. They might only eat foods of a certain colour, for instance, which can be very hard for parents. I act as a support in trying to ensure that they get an adequate diet within the limits of what they will eat."
The problems become even more complex, she says, when there is an underlying or secondary nutritional issue such as type 1 diabetes or coeliac disease in an anorexia patient. These patients need a lot of long-term support in managing their conditions, explains Kilcawley, and having a dietitian on the team is vital in such cases.
Kilcawley has worked as a community dietitian in Galway for the past two years and has completed a number of specialist courses in child and adolescent services run by the Maudsley Trust in Britain which involved counselling techniques, motivation and intervention skills.