Table 40.
Inpatient Treatment for ARFID
| Certainty assessment | Impact | Certainty | Importance | ||||||
|---|---|---|---|---|---|---|---|---|---|
| № of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | |||
| Weight Change (assessed with: Pre-post weight in KG), caloric intake, ability to tolerate oral intake | |||||||||
| 4 | Case Reports | very serious a,b | not serious | not serious | not serious | none | Two articles reporting on case studies of 3 boys with ARFID ages 6–8 yrs. treated in an inpatient CBT-based treatment program and 2 studies reporting on a total of 5 children ages 9–13 yrs. treated in a family-based inpatient setting. LOS varied from 16 days to 112 days. All patients gained weight. For studies reporting on absolute weight gain the cases gained 2.7 kg in 60 days, 1.2 kg in 16 days and 0.3 kg in 19 days). At discharge these patients were at 97, 104 and 96%TGW. For the study reporting on change in %TGW, patients weight improved from 83 to 100%TGW (in 38 d), 75.8 to 100%TGW (in 2 months) and 72 to 88%TGW (in 2 months) and 69 to 86.8%TGW (LOS unclear). |
⨁◯◯◯ VERY LOW |
CRITICAL |
| very serious a | not serious | not serious | not serious | none | One study reporting on 3 case studies on boys with ARFID ages 6–8 years treated in an inpatient CBT-based program. LOS varied from 16 to 60 days. Caloric intake in kcal/day rose for all 3 patients (from 1557 to 2208, 740 to 1300, and 1200 to 1500). |
⨁◯◯◯ VERY LOW |
CRITICAL | ||
| very serious b | not serious | not serious | serious c | none | One study reporting on 2 cases of females ages 17 and 13 yrs. and one study describing two 9 yo girls. In the adolescent case reports both patients were severely underweight and due to the onset of vomiting and food refusal after admission NJ tubes were placed. Authors report that the use of an individualized behaviour plan for each patient providing reinforcements for eating was the critical factor in helping patients to tolerate oral intake without vomiting. The case reports involving the 9 yo girls, in both cases the patients were exclusively NGT fed due to a refusal of all oral nutrition, but with the addition of family therapy and mobilization from hospital the patients were able to resume eating orally. |
⨁◯◯◯ VERY LOW |
IMPORTANT | ||
Explanations
aObservational study, no comparison/control
bCase studies only, likely biased reporting on patients with successful outcomes
cResults descriptive only, no quantitative outcomes re frequency of amount of food tolerated
Bibliography:
Case Reports - Pitt 2018 [209], Singer 1992 [208], Spettigue 2018 [53], Rhodes 2009 [210]