Nutritional management of anorexia nervosa in children and adolescent inpatients: The current practice of Australian dietitians

Aim: To describe the reported practices of Australian dietitians in the nutritional management of anorexia nervosa (AN) in children and adolescent inpatients. Methods: A cross-sectional survey of dietitians working in inpatient facilities was conducted in July-September 2012 using an eight-part questionnaire with single-, multi-, open-ended and Likert scale style questions. Results: Seventeen dietitians from 15 facilities participated in the survey. Recommendations for energy intake at the initiation of treatment varied and were dependent on physiological needs of the inpatient. Ongoing energy requirements were commonly based on individual needs, with interim weight measurements used to determine progress. High-energy supplements and nasogastric 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, thiamine 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 insufficient or only somewhat sufficient to guide practice. The need for further research to establish the best practice approach for the treatment of AN was expressed. Conclusion: The nutritional management of inpatient children and adolescents with AN as reported by dietitians varied, congruent with the lack of current evidence in the literature. Evaluation of existing protocols and comparative multicentre investigations are needed to inform the development of evidence-based guidelines and ensure best practice by dietitians and other practitioners working in this field. © 2013 Dietitians Association of Australia.