A 16-year-old girl who was only 11 years old when first diagnosed with anorexia is now "critically unwell" and in an "emergency situation" in hospital, the High Court has heard.
High Court president Mr Justice Peter Kelly made orders for the girl's detention and treatment in hospital after hearing doctors believe she lacks capacity to understand how seriously ill she is.
The orders, which permit tube feeding, sedation, restraint and resuscitation if necessary, were sought by Donal McGuinness, for the HSE.
They were sought in the context of an application to have the girl made a ward of court and were supported by the girl's parents.
Counsel said the girl has "intractable" anorexia and while she had received treatment previously and improved, she had relapsed and was readmitted three times to hospital last month.
She remains in hospital and her current Body Mass Index is just 11.7, he said.
A doctor involved in the girl's care told the judge the girl is now critically unwell but does not believe she is, had said she feels "fine", and is not fully complying with treatment.
There were also behavioural issues including the girl is refusing bed rest and is "microexercising".
The doctor agreed with the judge that denial of illness is "very prominent" in anorexic conditions.
Her view was that the girl, as a result of anorexia, lacks capacity to understand the seriousness of her condition and the hospital wanted orders permitting her detention and treatment, including tube feeding if necessary.
The girl's parents are very concerned and, while they could consent to the various treatments for her because she is a minor, there was concern about the impact of that on the parent/child relationship, she said.
The girl does not want to be in hospital and does not understand why she needs to be there, the doctor added.
While the girl's blood sugars have stabilised, she is critically unwell and remains at risk, she said.
The doctor also said a bed may become available for the girl in a residential unit here but that had not been confirmed. That unit is in a position since earlier this year to provide tube feeding, she added.
In his ruing, the judge said he was satisfied on the medical evidence the girl's situation has deteriorated.
She is now critically ill and in an emergency situation and clearly needs naso-gastric feeding in trying to help restore her BMI to normal form, he said.
He noted her parents supported the orders sought and acknowledged her lack of capacity to understand her situation.
In anticipation of a minor wardship application to be heard very soon, he would make the detention and treatment orders sought.