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

Abstract

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.

Hospital course of underweight youth with ARFID treated with a meal‐based behavioral protocol in an inpatient‐partial hospitalization program for eating disorders

“…Efforts are needed to educate gastroenterologists and primary care physicians on the effectiveness of meal‐based behavioral strategies for improving GI symptoms and motility in starved patients given the potential negative consequences of prolonged nasogastric/gastrostomy tube feeding including tube dependency, reduced motivation for oral feeding, and mortality (Dovey, Wilken, Martin, & Meyer, ). The diagnosis of ARFID is generally one of exclusion and warrants a comprehensive workup to rule out comorbid medical and psychiatric conditions.…”

“…Many patients with ARFID are likely to meet criteria for functional GI disorders and GI dysmotility, common complications of starvation and of purging behaviors in patients with AN, which improve with nutritional rehabilitation and behavioral treatment (Benini et al, 2004;Boyd, Abraham, & Kellow, 2005;Heruc et al, 2018;Kamal et al, 1991;Waldholtz & Andersen, 1990 Efforts are needed to educate gastroenterologists and primary care physicians on the effectiveness of meal-based behavioral strategies for improving GI symptoms and motility in starved patients given the potential negative consequences of prolonged nasogastric/gastrostomy tube feeding including tube dependency, reduced motivation for oral feeding, and mortality (Dovey, Wilken, Martin, & Meyer, 2017). The diagnosis of ARFID is generally one of exclusion and warrants a comprehensive workup to rule out comorbid medical and psychiatric conditions.…”

Cognitive–behavioral treatment of avoidant/restrictive food intake disorder

“…Of note, at least two studies have reported that patients with ARFID were significantly more likely than those with other eating disorders to require tube feeding during inpatient hospitalization [24,25 *]. Although tube feeding can be a life-saving measure in some cases of acute food refusal, a recent review described potentially iatrogenic effects of tube feeding, including long-term tube dependence and decreased oral intake [26], highlighting the urgent need for future research on effective tube weaning protocols for individuals who require tube feeding.…”

A systematic scoping review of diagnostic validity in avoidant/restrictive food intake disorder

“…Similarly, it has been suggested (Dovey et al, 2017) that children who receive a nasogastric tube are instantly ascribed with a diagnosable psychiatric disorder according to the DSM-5. This is not necessarily the case-again, clinical "common sense" must be applied in all psychiatric diagnostics and in this specific case it also depends on whether or not the use of a nasogastric tube is seen as an unusually advanced intervention in relation to an underlying medical condition.…”