Malnutrition, Weight Loss and Eating Disorders — Suspected or Diagnosed Malnutrition — Clinical Pathway: ICU and Inpatient

Malnutrition, Weight Loss and Eating Disorders Clinical Pathway — ICU and Inpatient

Child with Suspected or Diagnosed Malnutrition

This clinical pathway should be used to guide the evaluation and treatment of children > 7 years with suspected or diagnosed malnutrition or weight loss concurrent with disordered eating behaviors.

Possible Medical and Behavioral Causes of Malnutrition

Primary or Secondary Causes of Caloric Restriction
  • Anorexia Nervosa
  • Atypical Anorexia
  • Bulimia Nervosa
  • Avoidant Restrictive Food Intake Disorder (ARFID)
Does Not Meet Criteria for Eating Disorder Diagnosis
  • Unhealthy dieting
  • Restriction
    • Total intake or particular foods/food groups
  • Purging
  • Laxative abuse
  • Excessive exercising without compensating for appropriate caloric intake
  • Inability to gain weight despite medical recommendations
Underlying Medical Conditions Eating and digestion problems
Emotional Disorders
  • Major depressive disorder
  • Anxiety disorders (emetophobia)

Medical and Behavioral Factors to Consider

Many older children and teenagers who may initially lose weight because of a medical problem are at higher risk of developing behavioral signs of an eating disorder. It is also common for a medical problem to develop while a teenager is undernourished. This adds to the complexity of diagnosis and treatment of the medical problems that may be primary or secondary, and may not fully present until the patient progresses with nutritional rehabilitation. Therefore, the Nutritional Rehabilitation Pathway (NRP) and CHOP’s practice standards for the treatment of malnutrition are designed to:

  • Anticipate and offset symptoms of eating disorders, malnutrition, and refeeding, in a safe and caring environment.
  • Promote positive and sustainable eating and coping practices (without treating the potential underlying eating disorder).
  • Engage families in education towards an effective and timely transition to outpatient care or higher level of care if indicated.

Exclusions

  • < 7 years of age
  • Inability to participate in treatment due to cognitive impairment not associated with disordered eating