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