Nutritional Rehabilitation Protocol (NRP): Behavioral Health Home Hospitalization Plan

It is important that the guidelines outlined below are followed closely for children on the Home Hospitalization Plan. 

Meal Guidelines:

• Caregivers are responsible for grocery shopping, menu planning, preparing all meals and snacks, and supervising all meals and snacks. Diet food, caffeine and chewing gum are not allowed.

• Your child or teen is responsible for completing 100% of meals, snacks, and supplements (if needed). They cannot use weight scales – these should be removed or hidden. They cannot have access to websites, tv shows, movies or social media focused on food, cooking, weight, or shape.

• Follow the time allowed for each eating period:

  • Meals: 30 minutes

  • Snacks: 15 minutes

  • Supplement: 15 minutes

• Physical rest is required following eating. Your child cannot use the bathroom during the rest period unless directly supervised.

  • Meals: 1 hour rest period

  • Snacks: 30 minute rest period

Physical Activity Guidelines:

• Only light activity within the home is permitted.

• No exercise or sports activity is permitted.

• Your child should remain in the common living area during the day.

• Bedroom is for sleeping only.

• Bathroom should be used only before eating.

• Showers only in the morning before eating and cannot be longer than 10 minutes.

• Completing schoolwork is acceptable if it does not interfere with eating.

Behavior Guidelines:

• Caregivers should stay calm during meals and snacks and keep conversations low stress and positive.

• Use encouraging statements, such as “I love you”, “I know you can do this”, “I believe in you”.

• Do not engage in negotiating food and do not talk about calories or weight. Do not comment on food or appearance.

• Encourage mechanical eating when needed.

• Redirect unwanted behavior with brief, matter-of-fact statements, such as “I would like you to stop cutting your food so small”, “Let’s take bigger bites”.

• Provide occasional reminders about timing.

• If your child/teen refuses to eat or engages in eating disorder behaviors (such as exercise, vomiting, hiding food), consider the following possible consequences:

  • Remove physical activity. If your child is not eating, they need to conserve energy.

  • Remove sources of stress, such as their phone, computer, social visits, school, tv, social media.

  • Increase supervision by keeping the bathroom door open when they use it, sleeping in the same room, or removing their alone time.

• Use positive reinforcement to increase wanted behaviors. This may include:

  • Praise

  • Motivating rewards such as visits with friends, screen time

  • Use cause and effect statements, such as “First _________, then _________.”

  • Make sure the size of the reward fits the size of the good behavior!

  • Natural and logical consequences help your child to make better decisions

  • Remember to work together with other caregivers. 

Coping strategies for caregivers to role model:

• Take a break when angry or upset.

• Name feelings out loud (“I feel ___”).

• Communicate your needs (“I need _____”).

• Self-soothe using your senses.

• Ask for help when needed.

• Take care of your own feelings and needs.

• Apologize when you do something wrong.

• Positive affirmations or mantras (“I can do this”).

• Use “I” statements instead of “you” statements.

• Schedule “ME” time.

• Be consistent and reliable.

• Practice gratitude.

• Get fresh air and remember to breathe.

Follow up:

• Follow up with these teams as recommended:

  • Medical provider

  • Behavioral health provider

  • Dietitian

• Return to school requires approval from medical and other treatment provider(s).

Reviewed on 2/25/25 by Jonathon Pletcher, MD