Eating Disorder Pathway Background and Objectives Eating disorders are increasingly prevalent in pediatrics and represent a complex interaction between medical and psychiatric manifestations. The need for a standardized approach is critical, due to the high risk of the condition (eating disorders have the highest mortality of any psychiatric disorder), as well as the high variation in presentations, particularly among children. This standardized pathway was first developed at Connecticut Children’s in 2003 and has undergone multiple revisions since. It rests on the core principle that it is necessary to recognize the physiologic manifestations of restricted eating, as they are a reflection of true medical instability. Once the risk is identified, the pathway outlines a process of resuming adequate nutritional intake while watching for signs and symptoms of refeeding syndrome. It utilizes an incentive-based system, in which gradual increases in caloric intake occur within a restricted and highly structured setting, leading to gradual medical stability. This clinical pathway involves daily multi-disciplinary collaboration, with pediatric hospital medicine, psychiatry, nutrition, and cardiology specialists all playing an integral role in the care. The objectives of this pathway are to: Restart nutrition in safe manner to prevent refeeding syndrome Promote patient weight gain and gradual medical stability in structured manner Provide appropriate treatment for the patient’s medical needs AND begin to address underlying psychiatric causes Algorithm Download Eating Disorder Pathway Algorithm – Updated January 31, 2023 Quality Metrics Percentage of patients with order set usage Average time from admission to order set placement (minutes) Percentage of patients who require nasogastric tube placement Percentage of patients with refeeding syndrome Average number of days to reach Activity Level 3 Average length of stay (days) Number of patients readmitted for eating disorder related causes within 30 days of discharge Educational Module Download Eating Disorder Educational Module – Updated February 28, 2022 Patient Handouts Patient Handout – English – Updated February 28, 2022 Patient Handout – Spanish – Updated February 28, 2022 Key References Golden NH, Katzman DK, Sawyer SM, Ornstein RM, Rome ES, Garber AK, Kreipe RE. Update on the medical management of eating disorders in adolescents. J Adolesc Health. 2015 Apr;56(4):370-5. Society for Adolescent Health and Medicine, Golden NH, Katzman DK, Sawyer SM, Ornstein RM, Rome ES, Garber AK, Kreipe RE. Position Paper of the Society for Adolescent Health and Medicine: medical management of restrictive eating disorders in adolescents and young adults. J Adolesc Health. 2015 Jan;56(1):121-5. Ozier AD, Henry BW, and the American Dietetic Association. Position of the American Dietetic Association: nutrition intervention in the treatment of eating disorders. J Am Diet Assoc, 2001 Aug; 111(8):1236-41. Pathway Contacts Diane Siegel, RD Christine Skurkis, MD Alyssa Bennett, MD Lisa Namerow, MD Disclaimer The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case. View all Clinical Pathways >
