The Nutritional Management of Anorexia Nervosa in Children and Adolescent Inpatients: The Current Practice of Australian Dietitians

Nutritional rehabilitation in anorexia nervosa (AN) is one of the key steps in overall recovery. However, research on dietetic practice in the management of AN in children and adolescents inpatients is limited. This study aimed to describe the reported practices of Australian dietitians in the nutritional management of AN in this population. A cross-sectional survey was conducted in July-September 2012, using an eight-part questionnaire with single-, multi-, open-ended and Likert scale style questions. Seventeen dietitians from 15 facilities participated in the survey. The results showed that the recommendations for energy intake at the initiation of treatment varied and were dependent on physiological needs of the inpatient. On-going energy requirements were commonly based on individual needs, with interim weight measurements used to determine progress. High-energy supplements andnasogastric feeds were used as an adjunct to food to meet energy needs. The combination of prescribed vitamin and mineral supplements differed between facilities, however multivitamins, thiamin and phosphate were used more frequently than others. Most participants (94%) reported that the current evidence for the nutritional treatment of children and adolescent inpatients with AN was somewhat or insufficient to guide practice. The variation in nutritional management of inpatient children and adolescents with AN, suggested by the results of this study, is congruent with the lack of evidence in the literature. Evaluation of existing protocols and comparative multicenter investigations are needed to inform the development of evidence based guidelines and ensure best practice by dietitians and other practitioners working in this field