You don’t often think about anorexia in primary schools. For most people, it is something that happens only to teenagers. So it was not surprising when one of our girls began displaying symptoms of anorexia that we found limited information and advice out there to guide us in helping her.

So, throughout our time supporting her, we learned many lessons. I hope sharing our experience below might provide others with an insight into what to expect if they’re ever faced with a similar journey.

Trusting your instinct

It was the start of a new academic year. As the Year 6 children entered the classroom, “A” stood out. There was a marked change in her appearance: she had gone from being a child who was overweight to one who was quite slim - a loss of weight that seemed excessive for a six-week period. Her mother explained that she had been sick during the summer and had been hospitalised.

It wasn’t just her appearance that had changed, though. “A” had become withdrawn and would sit in the classroom like a rabbit in headlights. She would shy away from her once-familiar teachers and avoid talking to people. Her whole demeanour had changed from being a bubbly, outgoing child to one who was cowering and full of anxiety. Instinctively, we knew that there was more to this situation that needed investigating.

One day, “A” refused to eat any lunch. This was the first refusal we had encountered. Soon after that, she started to refuse to sit down for lunch. I called child and adolescent mental health services (Camhs) for advice, and explained the situation; they recommended her for an immediate referral.

Overcoming the taboo

In my role as special educational needs coordinator, one of the most difficult challenges I have faced has been getting parents to agree to a Camhs referral. The term “mental health” has an association that frightens parents. Often, they want to explore every other avenue before agreeing to a referral, which can be a lengthy process, but one that is equally important to eliminate all other possibilities.

The mother of “A” had her daughter referred to hospital for blood and urine tests to rule out infection. The tests came back clear. Finally, she agreed to the referral.

Liaising with professionals

While we were waiting for the Camhs referral to be processed, we took the case to a Team Around the Family meeting to see if there was any advice or support we could access in the meantime. It was recommended that we advised the mother of “A” to return to the GP to get her daughter a full examination and weight check. As her mother spoke limited English, we supported the family by writing a detailed letter of all the symptoms and behaviours her daughter had displayed.

We also opened a Common Assessment Framework (CAF) at this point because it had emerged that there were other instabilities in the household that needed to be addressed. This was an important factor, as anorexia can be used by the individual concerned as a struggle to regain control. We couldn’t just address the eating disorder, we needed to account for all factors that could contribute to her recovery.

Handling hospitalisation

“A” was eventually admitted to a psychiatric hospital, where she spent the next few weeks receiving treatment. During these few weeks we tried to support the family as much as possible. We continued to hold CAF meetings at the school and sent in school work for her to complete. We also attended the hospital for case meetings and to visit the child - sending in cards that her friends had written for her. We had no idea how long she would be in hospital, but knew she would be discharged and would return to school. It was important that “A” still felt that she was part of our school community.

Although hospital was the best place for her treatment, due to her age, this led to other concerns being raised. The hospital was experienced in schooling teenagers, but not primary-aged children; this was affecting her educational progress. But our biggest concern was that she was surrounded by teenagers and some of these children were much more experienced in living with anorexia, so interactions had to be closely monitored to ensure “pro-ana” tips weren’t being passed on.

Returning to school

We received a call from the Camhs home team to say that “A” would be returning to school for the final term. On the one hand, we were over the moon that she was returning to us, but on the other, we were filled with trepidation. What would her support look like? What should we do if she refused to eat? Would she need to be accompanied to the toilet? What would happen in PE? What if we did something to trigger a relapse?

The questions just kept on coming and our anxieties kept building. The Camhs team were fantastic. They talked us through all the plans they were putting in place to help her maintain and increase her weight.

The following are some examples of the strategies we implemented:

* Menus were sent home, and all meals and snacks were chosen in advance (as a school, we had to ensure that whatever had been picked was served because any deviation was seen as an opportunity to refuse food).

* Breaktimes had to be supervised and high-fat snacks given (chocolate or biscuits).

* A 30-minute rest period had to be adhered to after eating.

* She was not to engage in any physical activity, including PE.

* A daily log of the school day, including her eating habits, was kept and shared with her mum and Camhs.

Throughout her time at school, the thing that occurred to me most was how many people had to be involved in her recovery: the mentors and teaching assistants who had to supervise all undirected times; the PE teachers who had to adapt their plans; the dinner staff who had to ensure her meals were exactly as stated; the teaching staff who had to fill in daily logs and offer her additional tuition; the office staff who had to translate to mum the daily feedback; myself, liaising with Camhs frequently to communicate all issues. Everyone had a part to play in her recovery.

Key things learned on this journey

* If there has been a rapid weight loss and the child’s demeanour has changed, call Camhs for advice and make a referral.

* Talk to the family to establish any possible cause for the change. Get them to go to the GP and write letters detailing your concerns. Provide a translator if needed, if you have the capacity to do so.

* Open a CAF (or “early help”) to address other needs in the household and to ensure all professionals are communicated with effectively.

* Allocate a mentor to work with the child and other children to support healthy eating habits. We were advised that it wasn’t unusual for friendship groups to develop anorexic tendencies, so this had to be monitored carefully.

* Ask the Camhs worker lots of questions to get provision and plans right.

* Most importantly, communication is key. Situations can easily be manipulated by the child because of how many people are involved. This issue can be eliminated if everyone is talking to each other and is on the same page.

This article has been seen by the mother of “A”, who gave her permission for it to be published.

Katie Causon is assistant headteacher at a school in Birmingham. She tweets at @KatieCauson

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