Modification of an inpatient medical management protocol for pediatric Avoidant/Restrictive Food Intake Disorder: improving the standard of care

Journal of Eating Disorders

Research

Sharon Clifton¹  Elizabeth Saunders¹  Sara M. Buckelew¹  Siena S. Vendlinski¹  Rachel Kramer²  Sasha Gorrell²  Erin E. Reilly²  Sarah Forsberg²  Lisa Hail²  Amanda E. Downey³  Daniel Le Grange⁴  Arianna S. Thompson⁵ 

[1] Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA;Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., 94143, San Francisco, CA, USA;Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., 94143, San Francisco, CA, USA;Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA;Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., 94143, San Francisco, CA, USA;Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA;School of Medicine, University of California, San Francisco, San Francisco, CA, USA;

关键词: ARFID;    Eating disorders;    Inpatient protocol;    Inpatient treatment;    Adolescents;   

DOI  :  10.1186/s40337-023-00895-9

 received in 2023-05-31, accepted in 2023-09-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundNo guidelines currently exist that represent a standardization of care for Avoidant/Restrictive Food Intake Disorder (ARFID) on an inpatient service. Unique features of this diagnosis (e.g., sensory sensitivity contributing to involuntary emesis) suggest that established protocols that were developed for anorexia nervosa might be less effective for adolescents with ARFID. To inform improved inpatient medical stabilization and care for these patients, we first provide an overview of clinical characteristics for patients with ARFID who presented to a pediatric hospital for inpatient eating disorder care. We use these descriptives to outline the rationale for, and executions of, modifications to an inpatient protocol designed to flexibly meet the needs of this clinical population.MethodsChart review with descriptive statistics were conducted for patients who had received an ARFID diagnosis from March 2019 to March 2023 (N = 32, aged 9–23). We then present a case series (n = 3) of adolescents who either transitioned to a novel adjusted protocol from an original standard of care on the inpatient service, or who received only the standard protocol.ResultsThe sample was aged M(SD) = 15.6 (3.3) years, 53% male, and a majority (69%) presented with the ARFID presentation specific to fear of negative consequences. On average, patients had deviated from their growth curve for just over two years and presented with mean 76% of their estimated body weight. Of those requiring nasogastric tube insertion during admission (n = 8, 25%), average duration of tube placement was 15 days. From within this sample, case series data suggest that the adjusted protocol will continue to have a positive impact on care trajectory among adolescents admitted for ARFID including improved weight gain, reduction of emesis, and improved food intake.ConclusionsFindings demonstrate the likely need to tailor established medical inpatient protocols for those with ARFID given different symptom presentation and maintenance factors compared to patients with anorexia nervosa. Further research is warranted to explore the longer-term impact of protocol changes and to inform standardization of care for this high priority clinical population across care sites.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023