Home Hospital Nutrition
These instructions are for caregivers of patients who are in the Eating Disorder Assessment and Treatment Program (EDATP) at the Children's Hospital of Philadelphia (CHOP) who are recovering from malnutrition.
Important Information:
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You, as the caregiver, are now in charge of everything to do with your child's food. You will grocery shop, meal plan, prepare and plate the food and supervise all eating occasions. Your child's only job is to eat and rest!
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Plan all eating occasions at least one day ahead of time to be sure you reach your calorie goal.
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Keep a food log and add up the total calories (CalorieKing™ and MyFitnessPal™). Bring the completed food log to your outpatient visit with the registered dietitian (RD).
Instructions for Home Hospital Nutrition program:
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Your child should eat 3 meals and 2 to 3 snacks each day.
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Meals should be 30-minutes long followed by a 60-minute rest period. Snacks should be 15-minutes long followed by a 30-minute rest period.
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During rest periods, your child should not use the bathroom.
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Supervise your child during all eating occasions and rest periods.
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Meals should include foods from all the different food groups (meat, starch, dairy, fruits, vegetables, and fats).
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Avoid diet foods, "health foods," or foods that are advertised as low-calorie, low-fat or low-carbohydrate. Avoid caffeine and chewing gum.
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Include a calorie-containing beverage with all meals and snacks. Water is great in between meals and snacks.
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Add any foods back to their diet that they used to eat and have recently been avoiding.
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Promote food neutrality! Avoid labeling foods as "good, bad, junk or healthy." All foods can be part of a healthy diet.
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For uneaten food, supplement with Boost® or Ensure® nutritional drinks. Give your child 15 minutes to drink the Boost.
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Boost/Ensure = 30 calories per ounce; 1 calorie per mL
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Boost Plus®/Ensure Plus® = 45 calories per ounce; 1.5 calories per mL
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For example, if your child does not eat 240 calories, they will need to drink 8 ounces (240mL) of Boost/Ensure or 6 ounces (180mL) of Boost Plus/Ensure.
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Do not be surprised if your child does not feel hungry or feels bloated. Malnutrition and weight loss disrupt normal hunger and fullness cues. This should improve with time.
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Your child's only interaction with food should be eating it. Redirect discussions about food, weight, calories or exercise. They should not cook, bake, grocery shop, watch food-related shows, read recipes, etc.
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Your child should not have any physical activity until approved by their outpatient team.
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Keep in mind, your child is malnourished and needs a lot of calories to recover. Your child's needs may be different from the rest of the family right now.
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Be mindful of social media usage. Avoid weight loss, diet and exercise-related content.
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While your child might not be ready for social eating events or eating out at restaurants, take-out, frozen food or food prepared by others is fine!
Additional Resources
Books:
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Help Your Teenager Beat an Eating Disorder (James Lock & Daniel Le Grange)
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Feeding Your Anorexic Adolescent (Clare Norton)
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When Your Teen Has an Eating Disorder: Practical Strategies to Help Your Teen Recover from Anorexia, Bulimia, and Binge Eating (Lauren Mulheim)
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Throwing Starfish Across the Sea (Laura Collins Lyster-Mensh & Charlotte Bevan)
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Decoding Anorexia (Carrie Arnold)
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Anorexia and other Eating Disorders: how to help your child eat well and be well: Practical solutions, compassionate communication tools and emotional support for parents of children and teenagers (Eva Musby)
Helpful websites and forums
Reviewed on July 1, 2022, by Kerri Heckert, RD; Angela Luciani, RD; Laura Johnston, RD