It will not have escaped any paediatrician that the COVID-19 pandemic has seen a marked rise in presentations of children and young people with restrictive eating disorders. The surge has spilled onto paediatric wards, with young people in distress often admitted for weeks at a time awaiting more specialist care.1 In some centres in the UK, however, admission rates have been lower through closer collaboration between paediatricians and eating disorder teams who offer a different, more pre-emptive approach to the medical management of affected young people and their families. We discuss how paediatricians and the proactive paediatric admission, sanctioned and supported by the eating disorder team, can influence the journey to recovery of a young person with a restrictive eating disorder.

Restrictive eating disorders are an important cause of lifetime morbidity and mortality, with much of the risk attributable to complications from starvation. In addition to the acute risk, the main legacy is the impact on the skeleton, with higher prevalence of osteoporosis in adulthood. Given this, one might imagine that every young person with an eating disorder would have a paediatrician. In fact, though, most cases are managed by outpatient eating disorder teams alone, even when very low weight. Only a minority may meet a paediatrician, usually as part of an unplanned hospital attendance in crisis, where their experience of care is variable. The doctors they meet in the acute setting often feel unequipped to assess their physical risk2 and absence of pathways leads to …