A Systematic Review and Meta-Analysis of Intensive Multidisciplinary Intervention for Pediatric Feeding Disorders: How Standard Is the Standard of Care?

Sharp, William G.; Volkert, Valerie M.; Scahill, Lawrence David; McCracken, Courtney; McElhanon, Barbara O.

doi:10.1016/j.jpeds.2016.10.002

Cited by 248 publications

(226 citation statements)

References 21 publications

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“…Patients often present with one or more of the following eating related symptoms: (1) low appetite and Lack of Interest (LOI) eaters; (2) sensory sensitive eaters; and (3) fear of aversive consequences eaters—all without shape or weight concerns. Currently, there is a limited evidence base for treating this disorder (Sharp et al, ; Sharp, Volkert, Scahill, McCracken, & McElhanon, ). While family‐based treatment (FBT) is effective for other eating disorders in youth, it has not yet been systematically examined for ARFID (Lock, ).…”

Section: Introductionmentioning

confidence: 99%

Applying family‐based treatment (FBT) to three clinical presentations of avoidant/restrictive food intake disorder: Similarities and differences from FBT for anorexia nervosa

Lock

Robinson

Sadeh‐Sharvit

et al. 2018

Intl J Eating Disorders

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Objective This article uses three brief case reports to illustrate how family‐based treatment (FBT) can be used to treat pre‐adolescents with avoidant/restrictive food intake disorder (ARFID). Method We present case material illustrating how FBT can be used in three different clinical presentations of ARFID: (1) low appetite and lack of interest; (2) sensory sensitive eaters; and (3) fear of aversive consequences eaters—all without shape or weight concerns. Results This case material illustrates that the main principles of FBT—agnosticism as to the cause of the illness, externalization, emphasizing the seriousness of ARFID, parental empowerment, behavioral consultation, and practical behavioral focus—are applicable for a range of ARFID clinical presentations. Common challenges in this patient group include (1) promoting urgency; (2) challenging long term behavioral accommodation; (3) lack of parental alignment, parental fatigue, (4) and co‐morbid psychiatric problems in the patients. Strategies to address these problems are described. Conclusion FBT can be adapted for children with ARFID using the main principles of the approach.

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Section: Introductionmentioning

confidence: 99%

Applying family‐based treatment (FBT) to three clinical presentations of avoidant/restrictive food intake disorder: Similarities and differences from FBT for anorexia nervosa

Lock

Robinson

Sadeh‐Sharvit

et al. 2018

Intl J Eating Disorders

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“…From the pediatric feeding disorders' perspective, a notable strength of ARFID is providing a diagnostic home for children with feeding disorders who do not present with weight concerns, such as cases involving food selectivity (described below) or patients where successful medical intervention (e.g., insertion of a feeding tube) results in improved weight status despite ongoing concerns with restricted oral intake. Case in point, many children with feeding disorders present with congenital or acquired medical conditions (e.g., gastroesophageal reflux; food allergy) that promote conditioned food aversion by pairing unpleasant consequences—such as pain, nausea, and/or fatigue—with eating (see Sharp et al, for review). Persistent food avoidance—in the form of frequent, intense and disruptive mealtime behaviors (e.g., intense tantrums, tearful protests)—subsequently precludes contact with food and, thus, meets diagnostic criteria for ARFID.…”

mentioning

confidence: 99%

Avoidant/restrictive food intake disorder: A diagnosis at the intersection of feeding and eating disorders necessitating subtype differentiation

Sharp

Stubbs

2019

Intl J Eating Disorders

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Avoidant/restrictive food intake disorder (ARFID) is a diagnosis that sits squarely at the cross roads of feeding disorders and eating disorders. It is historically tied to feeding disorders as a replacement of the DSM‐IV diagnosis of feeding disorder of infancy or early childhood. The revision process, however, extended the diagnostic umbrella by removing its predecessor's weight loss requirement and age of onset restriction (i.e., 6 years). Implications of this extension include capturing an older cohort of patients with ARFID accessing care at eating disorders clinics, as well as providing a diagnostic home to previously orphaned pediatric subgroups with feeding disorders that lacked a diagnostic home prior to DSM‐5. While recognizing notable strengths of this now 5‐year‐old diagnostic entity, ARFID is largely recognized as a very heterogeneous condition that lacks specificity to best guide clinical and research activities. The current commentary discusses the implications of ARFID as a replacement and extension of the DSM‐IV diagnosis of feeding disorder of infancy or early childhood and provides the rationale and guidance for developing a subtype taxonomy.

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“…There are many preliminary medical guidelines/considerations for inserting feeding tubes, with most relating to the insertion, care, and medical management . Additional clinical guidance concerning successful intervention to remove nasogastric/gastrostomy tubes has recently been requested, yet this cannot be achieved until consensus concerning what constitutes a successful wean has been published . Despite the lack of guidance, several successful treatment strategies have allowed children to transition from their nasogastric/gastrostomy tube to full oral eating.…”

mentioning

confidence: 99%

Definitions and Clinical Guidance on the Enteral Dependence Component of the Avoidant/Restrictive Food Intake Disorder Diagnostic Criteria in Children

Dovey

Wilken

Martin

et al. 2017

J Parenter Enteral Nutr

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The aim of the current article is to offer definitive guidance on weaning children who are reliant on nasogastric/gastrostomy feeding tubes. To date, no internationally recognized definitions or principles for interventions exist, and clinics have been reliant on creating their own unique intervention criteria. To achieve the aim, 2 goals are set out within the current article. The first goal was to definitively define the process of tube weaning. To achieve this, both tube dependency and oral eating also required definitions. It is necessary for these 2 additional definitions to fully understand the process of tube weaning and the transition that the child is making within these clinical interventions. The second goal of this article was to propose a set of minimum measurement criteria within a tube weaning protocol so that different clinical practices and perspectives may be measured accurately. This would then allow outcomes from different clinical services to be compared for efficacy. The culmination of this article is a set of 5 core principles that should govern clinics that adhere to the auspices of evidence‐based practice. These principles, if adopted, will provide the basis of a set of internationally recognized criteria within this field of pediatric gastroenterology.

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A Systematic Review and Meta-Analysis of Intensive Multidisciplinary Intervention for Pediatric Feeding Disorders: How Standard Is the Standard of Care?

Cited by 248 publications

References 21 publications

Applying family‐based treatment (FBT) to three clinical presentations of avoidant/restrictive food intake disorder: Similarities and differences from FBT for anorexia nervosa

Applying family‐based treatment (FBT) to three clinical presentations of avoidant/restrictive food intake disorder: Similarities and differences from FBT for anorexia nervosa

Avoidant/restrictive food intake disorder: A diagnosis at the intersection of feeding and eating disorders necessitating subtype differentiation

Definitions and Clinical Guidance on the Enteral Dependence Component of the Avoidant/Restrictive Food Intake Disorder Diagnostic Criteria in Children

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