Quality Improvement Project to Implement an Interdisciplinary Nutritional Rehabilitation Protocol for Pediatric Anorexia Nervosa

Introduction: Patients with anorexia nervosa have a mortality rate more than 5 times higher than the general population. Medical stabilization through nutritional rehabilitation is essential, yet institutional practices vary widely. Nasogastric tube (NGT) feeding has been the standard in pediatric inpatient settings, despite evidence suggesting similar outcomes with oral refeeding and potential for psychological trauma. Methods: An interdisciplinary work group representing adolescent medicine, pediatrics, nursing, nutrition, psychiatry, and social work developed a standardized, evidence-based pediatric nutritional rehabilitation protocol. Existing clinical pathways from other institutions were reviewed, and the protocol was adapted for existing resources. Educational modules and a protocol-specific order set were implemented. Pre-implementation and post-implementation data were collected via chart review to evaluate key outcomes, including NGT use, weight gain, refeeding complications, and disposition. Results: A total of 46 patients were included (22 pre-implementation, 24 post-implementation). NGT use decreased from 100% to 16.7% after implementation. No patients developed clinically significant refeeding syndrome. There were no significant differences in average weight gain or length of stay between groups. Discussion: Implementation of a standardized interdisciplinary protocol reduced reliance on NGT feeding without compromising medical outcomes. Oral refeeding proved safe and effective when guided by a consistent, evidence-based approach that integrated behavioral health. Reduced NGT use facilitated psychiatric placement and minimized hospitalization-related trauma. Conclusions: A structured, interdisciplinary nutritional rehabilitation protocol can achieve medical stabilization in pediatric patients with anorexia nervosa while reducing invasive procedures. Standardization of care and emphasis on oral refeeding are important steps toward trauma-informed, evidence-based treatment of eating disorders.