VB Stoody et al. J Pediatr 2023; 260: 113482. Advancements in Inpatient Medical Management of Malnutrition in Children and Adolescents with Restrictive Eating Disorders

This article is a good review detailing the management of restrictive eating disorders, including anorexia nervosa, atypical anorexia nervosa (weight in normal range despite significant loss) and avoidant/restrictive food intake disorder. The tables provide diagnostic criteria, medical complications, and clinical factors supporting admission.

The authors also delve into the topic of refeeding syndrome. Key points:

• “Contrary to prior belief, HCR [high calorie restriction] does not carry a significant risk of RS [refeeding syndrome] when close electrolyte surveillance and supplementations are implemented. Furthermore, LCR is associated with poor inpatient weight gain…and longer hospital admissions.”
• “The evidence in our progress report supports an HCR strategy of initiating inpatient refeeding at 2000-2400 kcal/day…and increasing by 200 kcal/day in patients with an admission BMI of >60% mBMI.”
• The authors recommend daily electrolyte assessment for first 7 days, followed by every other day for duration of admission.
• Daily caloric requirements “often exceed 3000 kcal/day in the initial weeks of refeeding”

My take: While the authors focus on restrictive eating disorders, their approach to refeeding implies consideration in other disorders associated with moderate malnutrition.

Related blog posts:

• Prevalence of Avoidant/Restrictive Food Intake Disorders in Pediatric Neurogastroenterology
• Mel Heyman: Past, Present and Future of ARFID
• Avoidant/Restrictive Food Intake Disorder (ARFID) with Irritable Bowel Syndrome and with Inflammatory Bowel Disease
• Afraid to Eat -Could be “Avoidant Restrictive Food Intake Disorder”

Dog walks into a bar jokes:

A dog walks into the bar, jumps up on the stool and says to the bartender, “Hey barkeep, it’s my birthday today. How ’bout a free drink?” The bartender turns, looks at the dog and nods his head, “Sure pal, toilet’s right down the hall.”

And

A dog walks into a bar. Bartender nods and says, “Hey dog, haven’t seen you in a while, how are things going?” Dog looks at him sadly and replies, “Ruff.”

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