Inpatient Nutritional Rehabilitation Pathway (NRP): Monitoring During Meals

Important Information:

Your child is in the hospital because they are malnourished and need nutrition to get healthy. The information below reviews what to expect during your child’s hospital admission.

Meal Plan:

• Food is one of the most important medicines that your child needs to get well. All children on the Nutritional Rehabilitation Pathway (NRP) are prescribed a set amount of nutrition that is determined by a Registered Dietitian (RD) and ordered by a physician. The amount of nutrition increases each day according to the Nutritional Rehabilitation Pathway (NRP) until your child is medically stabilized and showing consistent weight gain.

• The hospital menu is pre-selected and will be delivered by the dietary team prior to each meal. Modifications to the menu are only made for food allergies and religious/cultural dietary constraints. Near the end of your child’s stay, the dietitian will teach you how to plan and choose food with high caloric densities and plan meals to reach calorie goals. Once this has occurred, you will be able to order meals for your child.

• Meals and snacks have set time limits:

  • Meals: 30 minutes

  • Snacks: 15 minutes

• Any unfinished food at the end of the meal and snack times will be replaced with a nutritional supplement, like Boost®, to make sure 100% of nutritional needs are met. Nutritional supplements must be finished within 15 minutes.

• If the supplement is not completed in this time frame, it will be given via nasogastric (NG) tube feeding so they can receive the remaining nutrition. The tube goes in your child’s nose, down their throat and into their stomach.

• After meals and snacks, your child can only engage in restful activity. This promotes digestion and ideally distraction. Restful activity includes any quiet activity that your child can perform while seated in their chair or resting in bed. They are not allowed to engage in any physical activities and cannot go to the bathroom during this time. Restful activity is required for:

  • 60 minutes after meals

  • 30 minutes after snacks

Monitoring Meals:

We require all children who are admitted for malnutrition to be closely observed during and after all meals and snacks. This helps to ensure  that your child is meeting their full nutritional needs. There are 2 ways that meals can be monitored:

1. Our Meals Out of Rooms (MOORS) Program provides supervision by trained Behavioral Health clinicians to make sure that all participants follow meal guidelines. In MOORS, participants will eat all meals, snacks, and Boost® in our meal room and will stay for observation through rest time. Meals will be eaten with other patients who are admitted for malnutrition. Participation in MOORS is expected unless otherwise noted by your child’s healthcare team.

2. If caregivers can stay for all meals, snacks, and rest periods after eating, they may act as the observer in the child’s room. Your child’s treatment team will talk to you about the expectations for being an observer to make sure that you understand and feel comfortable in the role. If caregivers choose to monitor meals, we ask that someone be present for every meal and snack. The care team must approve caregivers to ensure they feel ready and supported. 

Because your child is sick enough to be in the hospital, we provide the structure and support to make sure they are taking the steps towards getting healthy. All guidelines and structures are part of the Nutritional Rehabilitation Pathway (NRP) and are an important part of your child’s treatment. 

Dining Expectations: 

• Your child must sit in a chair during meals and snacks. Eating in bed is not allowed.

• Baggy clothes are not permitted during meals or snacks. This includes hoodie sweatshirts, long sleeves, and boots.

• T-shirts, fitted long sleeves, or short sleeves are the preferred clothing. Your child will be asked to change into a gown if no other options are available due to concerns for hiding food.

• Electronic devices are not permitted during meal and snack periods. This includes cell phones, tablets, computers, TV and other personal electronic devices such as AirPods, smartwatches, headphones, or other items identified by the care team.

• Quiet activities that support coping are recommended after meals and snacks. Books, coloring materials, supportive reminder cards, and other appropriate activities are permitted.

• Your child can talk to other patients while eating. The conversation should remain positive and should not focus on weight, food, calories, stressors, or treatment to decrease the potential of triggering others.

Physical Activity:

• While in the hospital for malnutrition, it is important to limit physical activity to help restore energy. This means the energy obtained from food should match what your child’s body needs. Healing from malnutrition requires energy. Growth and development also depend on proper nutrition. Malnourished, people often have lower stamina and strength, so reducing activity helps prevent injury. If extra movement occurs, additional calories will need to be added to the meal plan.

• On the NRP, physical activity is gradually advanced based on meeting medical goals. Your child’s schedule will include quiet, restful activities after meals. If they are unable to participate in scheduled activities, a different plan will be created to make sure they have a structured period of rest after eating.

• Some children with eating disorders may feel a strong urge to exercise or burn calories. If this happens, they may need one-on-one supervision, continuous heart monitoring, or adjustments to their schedule to support their recovery. 

Reviewed on 3/25 by Daria Campeggio MSN, CPN, RN, and Jeanine Taylor BSN, RN