Restraint for nasogastric tube feeding in young people with anorexia nervosa or atypical anorexia nervosa: a retrospective audit.

Abstract

Background: Medically unstable young people with anorexia nervosa or atypical anorexia nervosa, are admitted to the adolescent medical ward at the reporting institution for nutritional rehabilitation. If meals are refused a nasogastric tube may be needed. At times restraint is used to ensure the required feeds are administered. This is an ethically complex and distressing dilemma for all involved and can result in long-term trauma for young people. The aim of this project was to establish a profile of young people with anorexia nervosa or atypical anorexia nervosa who require restraint for nasogastric tube insertion and/or feeding in the acute care paediatric setting and to understand the extent of restraint events occurring.

Method: We undertook a retrospective audit of inpatients admitted to the adolescent medical ward at a quaternary pediatric hospital in Melbourne, Australia, between 2021 and 2023, for the treatment of anorexia nervosa or atypical anorexia nervosa. Data points were agreed by multidisciplinary stakeholders and were collected from the institution's electronic medical record. Data were analysed using descriptive statistics.

Results: Of the 217 young people admitted, 23 (11%) had documented physical restraint for nasogastric tube feeding. Mental health comorbidities, neurodivergence, and social or behavioural complexity were higher in the young people who required feeding restraint as compared to those that did not. Of note, 15 (65%) of young people who were restrained for feeds had a diagnosis of autism, or a clinical note in their medical record indicating possible autism.

Conclusions: Young people in our institution admitted to the adolescent medical ward with anorexia nervosa or atypical anorexia nervosa who are restrained for feeding have a more complex clinical, social and behavioural profile than those who do not require restraint. Care and treatment tailored to the individual, sensitive to neurodivergence, encourages clinicians to consider the young person they are treating to reduce or prevent restraint and to inform a restraint approach that mitigates iatrogenic harm.