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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 presentation, 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 a system in which gradual increases in caloric intake occur within a highly structured setting. This leads to gradual medical stability while beginning the psychological treatment of food exposure. This clinical pathway involves daily multi-disciplinary collaboration with pediatric hospital medicine, psychiatry, psychology and clinical nutrition all playing an integral role in the care. The objectives of this pathway are to:

  • Restart nutrition in a 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


Download Eating Disorder Pathway Algorithm – Updated August 28, 2023

Quality Metrics

  • % Patients with pathway order set (ARFID/NON-ARFID)
  • AVG time (minutes) from hospital admission to pathway order set (ARFID/NON-ARFID)
  • % Patients who require NG placement (ARFID/NON-ARFID)
  • % Patients with 1 NG tube placement (ARFID/NON-ARFID)
  • % Patients with 2 NG tube placements (ARFID/NON-ARFID)
  • % Patients with > 2 NG tube placements (ARFID/NON-ARFID)
  • % Patients with Hypophosphatemia who receive phosphorus supplement (ARFID/NON-ARFID)
  • AVG time (days) from hospital admission to Order Activity 3 (ARFID/NON-ARFID)
  • # Patients readmitted (ARFID/NON-ARFID)

Educational Module

Download Eating Disorder Educational Module – Updated September 5, 2023

Patient Handouts

Key References

  • Golden NH, Katzman DK, Rome ES, Gaete V, Nagata JM, Ornestein RM, Garber AK, Starr T, Kohn M, Sawyer SM. Position Paper from The Society for Adolescent Health and Medicine. Medical Management of Restrictive Eating Disorders in Adolescents and Young Adults. Journal of Adolescent Health. 2022 71:648-654
  • Hornberger LL, Lane MA. AAP THE COMMITTEE ON ADOLESCENCE. Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics. 2021 Jan;147(1):e2020040279.
  • Garber AK, Chen J, Accurso EC, et. Al. Short-term Outcomes of the Study of Refeeding to Optimize Inpatient Gains for Patients With Anorexia Nervosa. A multicenter Randomized Clinical Trial. JAMA Pediatrics. 2021;175(1):19-27.

Pathway Contacts

  • Diane Siegel, RD
  • Lisa Namerow, MD
  • Christine Skurkis, MD
  • Alyssa Bennett, MD


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.

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