Intensive multidisciplinary feeding intervention for patients with avoidant/restrictive food intake disorder associated with severe food selectivity: An electronic health record review

Abstract

Objective: Expert consensus increasingly recognizes intensive multidisciplinary intervention (IMI) as the standard of care to address chronic and severe feeding problems in pediatric populations. In this study, we examined the clinical presentation, intervention characteristics, and treatment outcomes for young children receiving IMI for avoidant restrictive rood intake disorder (ARFID) involving nutritional insufficiencies associated with severe food selectivity. Method: We followed the Strengthening the Reporting of Observational Studies inEpidemiology statement to conduct this retrospective chart review. The review focused on consecutive patients (birth to age 21 years) admitted to the IMI program over a 5-year period (June 2014 to June 2019). Inclusion criteria required micronutrient insufficiencies (vitamins A, B12, C, D, E; folic acid; calcium; iron; and zinc) and chronic mealtime refusal behavior (e.g., turning head away from food/spoon, pushing or throwing spoon, crying, screaming, and leaving the table) associated with severe food selectivity.Results: Over the 5-year period, 63 of the patients met study entry requirements. Of these, 60 patients (50 boys and 10 girls; mean age = 72 ± 39 months; range = 23-181) completed intervention (95% treatment completion rate). At discharge, dietary diversity improved by 16 new therapeutic foods (range: 8-22), rapid acceptance and swallowing of new foods exceeded clinical benchmarks (80% or > bites), and risk for nutritional inadequacies declined for this patient cohort.Discussion: Results of the current study support the benefits of IMI to increase dietary variety, improve mealtime behaviors, and enhance nutritional intake for children with ARFID presenting with severe food selectivity.

Clinical Outcomes from an Interdisciplinary Outpatient Feeding Treatment Pilot Program

“…Research on interdisciplinary treatment has resulted in improved feeding behaviors of children with pediatric feeding disorders in day treatment programs and inpatient programs, including children with severe feeding difficulties that have resulted in the use of a feeding tube (Seiverling et al, 2020 ; Sharp et al, 2017 ; Volkert et al, 2021 ). Improved outcomes from interdisciplinary treatment programs have included decreases in inappropriate mealtime behaviors, decreases in caregiver stress, and increases in food volume and variety (Greer et al, 2008 ; Seiverling et al, 2020 ; Sharp et al, 2017 ).…”

Using Behavior-Analytic Treatment to Teach Tongue Lateralization Skills to Children With Avoidant/Restrictive Food Intake Disorder

“…Children diagnosed with avoidant/restrictive food intake disorder (ARFID; American Psychiatric Association, 2013; World Health Organization, 2019) display chronic feeding difficulties that lead to a limited volume or variety of food intake and result in weight loss or failure to thrive, nutritional deficiencies, dependence on nutritional supplements, and/or psychosocial dysfunction (Brigham et al, 2018). Often, children develop ARFID as a result of multiple etiologies (i.e., interactions between complex medical histories, skill deficits, and behavioral challenges; Fernand et al, 2018; Piazza et al, 2020), such that a multidisciplinary approach to treatment is commonly pursued (Borne et al, 2020; Volkert et al, 2021).…”

Clinical features of adult patients with avoidant/restrictive food intake disorder presenting for medical stabilization: A descriptive study

“…Since ARFID's identification, several studies have characterized the medical presentations/comorbidities of children/adolescents with ARFID in various clinical settings (Alberts et al, 2020; Aulinas et al, 2020; Becker et al, 2021; Cooney et al, 2018; Eddy et al, 2015; Keery et al, 2019; Lieberman et al, 2019; Middleman et al, 2021; Strandjord et al, 2015; Volkert et al, 2021). However, many are limited in their sample size, and none provide comprehensive descriptions of laboratory findings and medications.…”