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The Royal College of Psychiatrists Improving the lives of people with mental illness

CR168. Junior MARSIPAN: Management of Really Sick Patients under 18 with Anorexia Nervosa

Price: £0.00

Approved: May 2011

Published: Jan 2012

Status: current

Number of pages: 76

Review by: 2016

Download free PDF version

There is also a Summary of Junior MARSIPAN (CR168s) document to download.

The MARSIPAN checklist may also be useful (it is suitable for use with all ages.)


This report is only available online – there are no printed copies available to buy.

Please use the link above to view and download a PDF file of the report.  Please note, in November 2014, the currency period for this report was extended to 2016.

The Junior MARSIPAN working group was formed to develop guidelines for young people with anorexia nervosa to complement the report from the MARSIPAN group (CR162. MARSIPAN: Management of Really Sick Patients with Anorexia Nervosa) which addresses the care of adult in-patients with anorexia nervosa.

The rationale for a separate document is that the definition of very sick patients with anorexia nervosa differs in young people, because serious underweight varies with age and gender; other aspects of risk differ in young people (e.g. blood pressure norms); consent and capacity are addressed within different legal frameworks for young people than adults; there are differences in service organisation for specialist child and adolescent mental health services (CAMHS); and paediatric services have a central role in the care of young people.

The Junior MARSIPAN report provides guidance and recommendations on:

  • Risk assessment, physical examination and associated action.
  • Location of care and transition between services.
  • Compulsory treatment.
  • Paediatric admission and local protocols.
  • Management of re-feeding.
  • Management of compensatory behaviours associated with an eating disorder in a paediatric setting.
  • Management in primary care and paediatric out-patient settings.
  • Discharge from paediatric settings.
  • Management in specialist CAMHS in-patient settings.


Endorsing organisations

Junior MARSIPAN Working Group

Executive summary and recommendations



  • History of the project
  • Procedure followed in producing the report
  • The problem

Issues arising in all settings

  • Risk assessment: how ill is the patient?
  • Location of care: where will the patient be best managed?
  • Transfer between services
  • Compulsory admission and treatment
  • Policies and protocols

Management of children and adolescents with anorexia nervosa in different sectors

  • Management in general practice
  • Management in out-patient paediatric settings
  • Management in in-patient paediatric settings
  • Management in SEDBs
  • Audit and review


A. Calculating the degree of underweight for females: comparison of two methods

B. Comments from general practitioners and parents/carers group

C. Re-feeding syndrome in children and adolescents: literature summary

D. Some cases reported to the Junior MARSIPAN group

E. Protocols for managing very ill young people with anorexia nervosa

F. Example of a care pathway designed to improve speed of referral




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