Enteral feeding young people with anorexia nervosa under restraint in inpatient settings

Abstract

Background Children and adolescents who require inpatient admission for the treatment of anorexia nervosa often require medical stabilisation – administration of adequate nutrition – which can be lifesaving. In the majority of cases, this can be achieved through oral intake. However, in extreme cases, when a patient refuses to eat and/or drink, nasogastric tube feeding may be required. If there is resistance to this, subject to the appropriate legal framework to ensure valid consent, staff can apply physical interventions (restraint) to ensure the patient and staff's safety during this process. Methods A survey of 134 (99%) of child and adolescent mental health units and eating disorder units was undertaken in the United Kingdom and Ireland to identify current practice and makes recommendations for future guidelines to standardise practice. Results A total of 58 units (43.3%) reported that they were able to facilitate nasogastric tube feeding. Of these, 46 units (79%; 34% of total) reported that they could facilitate this with physical interventions; however, two units had no experience of this. Conclusions Many, but not all, units apply the ‘least restrictive practice’ principle and reduce the number of feeds a day while increasing the volume up to 1000 ml and deliver these feeds quickly via syringe bolus and not enteral pump.