Drs. Krause and Rhee presented an update on the management of eating disorders and Avoidant Restrictive Food Intake Disorder (ARFID) in the pediatric population. The audience was led through a discussion of current diagnostic criteria for eating disorders and ARFID and a robust discussion of the mindset of patients with these disorders. A series of cases with learning points were discussed and admission criteria and level of care guidelines were reviewed.
Dr. Rhee reviewed common presentations of patients with ARFID and how this population differs from patients with eating disorders such as bulimia and anorexia. She described the medical behavior unit structurally and the multidisciplinary team approach at Rady Children’s Hospital in San Diego. She explained the behavioral and medical management of these unique patients, including common medications used in their treatment program.
- Eating disorders are the second deadliest Diagnostic and Statistical Manual of Mental Disorders diagnosis (from suicide) and early intervention leads to significantly better outcomes.
- Anorexia nervosa is an ego-syntonic illness, meaning patients do not want to give up the behaviors, believing they are acceptable, while bulimia nervosa is an ego-dystonic illness, associated with guilt and shame.
- ARFID commonly presents as selective eating, poor appetite, or food fears such as choking and vomiting.
- Compared to typical eating disorders, patients with ARFID are younger, not as low in weight, more frequently male, have longer durations of illness before diagnosis, and have high rates of comorbid conditions.
- Behavioral management for ARFID requires a multidisciplinary team approach with structure, rewards, and consequences, and a stepwise progression of food exposure with positive reinforcement.
Dr. Schwenk is a pediatric hospitalist at Norton Children’s Hospital in Louisville, Ky. He serves as medical director for inpatient services and is a professor of pediatrics at the University of Louisville.