Enteral Nutrition Support and Short-Term Weight Outcomes in Pediatric Avoidant/Restrictive Food Intake Disorder and Anorexia Nervosa During Inpatient Medical Stabilization: A Retrospective Cohort Study

Background/Objective: Avoidant/Restrictive Food Intake Disorder (ARFID) is increasingly recognized among hospitalized pediatric patients with malnutrition; however, optimal nutritional management strategies remain poorly defined. Many programs utilize protocols developed for anorexia nervosa (AN). This study examined patterns of nasogastric tube (NGT) use and weight trajectories in pediatric patients with ARFID and AN/atypical AN (AAN) treated under the same inpatient refeeding protocol. Methods: We conducted a retrospective study of pediatric patients admitted for medical stabilization of malnutrition at a tertiary care children’s hospital (n = 160; ARFID subgroup n = 34). Data included NGT utilization and weight change during hospitalization. Longitudinal change in BMI z-scores during hospitalization was modeled using multivariable analysis. Results: Patients with ARFID were more likely to require NGT than those with AN/AAN (p < 0.001), despite similar BMI z-scores at admission and discharge. Patients with ARFID requiring NGT were younger and had lower BMI z-scores at admission than ARFID patients without NGT (p < 0.05). Conclusions: In this study, pediatric patients with ARFID undergoing inpatient nutrition rehabilitation achieved comparable weight gain during hospitalization to patients with AN/AAN but required higher enteral nutrition support to do so. Among patients with ARFID who required NGT support, anthropometric measures suggested higher baseline nutritional severity and likely confounding by indication. Because NGT use was determined clinically rather than randomly assigned, the observed association between NGT use and higher weight gain should not be interpreted as evidence of a causal treatment effect. Interpretation is also limited by variability in clinical practice and the relatively small ARFID subgroup. This study supports diagnosis-specific considerations during medical stabilization and underscores the need for further ARFID-specific protocols and research.