Advancements in Inpatient Medical Management of Malnutrition in Children and Adolescents with Restrictive Eating Disorders.

There is an urgent need to identify best practices for hospital treatment of youth with malnutrition secondary to restrictive eating disorders, including anorexia nervosa (AN) and avoidant/restrictive food intake disorder (ARFID). Certain physical health complications of malnutrition, such as bradycardia, hypotension, and hypothermia, often lead to hospitalization. These acute medical complications improve with refeeding or short-term nutritional rehabilitation and will resolve with ongoing recovery. Historically, refeeding was approached with extreme caution, with lower calorie protocols that advanced slowly and required weeks to restore medical stability.(1-3) Prolonged hospitalizations place eating disorders among the top 6 most common and costly pediatric mental health diagnoses.(4) This article reviews the current evidence on refeeding approaches for hospitalized youth with eating disorders. Recent findings suggest that high calorie refeeding (HCR) is a clinically safe method of inpatient management and, more importantly, improves clinical outcomes.