Ethical and Clinical Challenges of Restraint Supported Feeding in Pediatric Eating Disorders With Psychiatric Complexity

Objectives: This paper builds upon previous yet sparse literature about the ethical considerations in using restraint supported feeding in pediatric patients with eating disorders on a medical-surgical unit, particularly those with a co-occurring psychiatric complexity. Methods: Previous literature on the use of restraints in pediatric eating disorders is discussed. An ethical decision-making model by Riss et al. (2025) is expanded when considering a co-occurring complexity such as suicidal ideation. Nuances and considerations informing ethical decision-making are explored. Results: The authors propose three themes in addition to those offered by Riss et al. (2025) to consider when determining ethical permissibility of restraint supported feeds: (a) challenges in decision-making when the clinical picture is dynamic; (b) practical realities of staffing and system resources; and (c) strengths and challenges of interdisciplinary collaboration. Conclusion: Consultation and liaison psychologists will inevitably take care of challenging, complex patients with eating disorders. Ethical decision-making in eating disorder cases with psychiatric complexity can benefit from frameworks that provide guidance yet flexibility for case individualization. This paper provides concrete recommendations that can inform treatment and disposition planning when a patient with an eating disorder may require restraint supported feeding. Implications for Impact Statement Pediatric psychologists often take care of psychiatrically complex patients in inpatient medical-surgical units. When there is a question of using restraints to support feeding for a patient with an eating disorder, psychologists can act as valuable members within an interdisciplinary team tasked with ethical decision-making. This paper provides guidance for such ethical dilemmas.