Nutritional Assessment - ARFID

This information sheet can be used to help guide you in conducting a comprehensive nutrition assessment with an individual that has an eating disorder, or that you suspect may have an eating disorder.

NB: Ensure the individual has been assessed and is medically managed by a GP or medical practitioner.

Confidentiality

• Permission to contact other members of treating team, family/carers

• Explain confidentiality & boundaries

Client or Carer Eating Concerns

• Growth and / or nutritional intake

• Food restriction/refusal

• Food volume

• Food range

• Allergies and / or GI related problems

Social & Family History

• Temperament

• Living situation, family / carer support, school, work, family stressors

• Family history of mental health, eating disorders / feeding challenges, learning difficulties

Past Medical & Psychiatric History

• General past medical history (particular focus on food allergy, gastrointestinal, ENT, cardiorespiratory health, neurological disorders, dental issues, or any frequent illness)

• Course of pregnancy, birth, and postnatal period (particular focus on illness/trauma during pregnancy, premature birth, low birthweight, special care nursery or NICU admission)

• Psychiatric history (particular focus on anxiety, autism, ADHD, ID)

• Developmental history

• Current medications

Assessment of Weight / Growth

• Weight, height, and BMI history throughout childhood and adolescence

• Current weight, height, and BMI (percentiles and z-scores for children & adolescents)

• Healthy BMI range or BMI percentiles for children & adolescents

• Premorbid weight

• Highest and lowest weight

• Current trend

• Desired weight

• Body weight and shape within family

• Physical assessment of fat / muscle stores

Biochemical Data, Medical Tests and Procedures

(to be guided by medical professional with input from dietitian)

• Review full blood count, electrolytes (EUC, CMP), liver function, CRP

• Micronutrients as guided by complete nutrition assessment (may include iron studies, B12, folate, Vitamin D, Vitamin A, Vitamin E, Vitamin K, Vitamin C, Vitamin B1, Vitamin B2, zinc)

• Consider coeliac serology

• Review any relevant medical procedures (e.g. swallow studies, ultrasounds, allergy testing, ECG)

Nutrition Related Physical Findings

• Gastrointestinal function (bowels, reflux, vomiting)

• Appetite and taste changes

• Functional capacity

• Oral health/dental

• Rule out ED pathology: vomiting, bingeing, laxative use

• SGA scores / malnutrition status

Assessment of Nutrition Intake

• Diet History

• Current nutrition intake (particular focus on micronutrients, protein, energy, fluid)

• Premorbid nutrition intake

• Accepted foods

• Food & taste preferences

• Food allergies and intolerances

• Food rules

• Hunger & fullness cues

• Oral or enteral supplement use and % of current requirements

Assessment of Feeding History

• Breast/bottle feeding and transition to solids

• History of presenting avoidance / restriction

• Enjoyment of eating

• Negative experiences with eating / mealtimes

• Mealtime environment

• Experience of eating for client and family

• Carers approach to mealtimes

• Sensory preferences for food and mealtimes

• Fear of negative consequences following eating (vomiting, choking, GI discomfort/pain)

• Ability to introduce new foods to diet

• Oral motor skills

• Red flags for eating safety concerns: coughing, choking or gagging with solids/fluid, red watery eyes after drinking

• Efficiency of eating

• Developmental appropriateness of foods consumed

• Previous advice / therapy received for eating challenges

Exercise

• Current pattern of exercise

• Types of exercise

• Incidental activity (walking, standing)

• Duration of exercise per 24 hours

Assessment of the effects of undernutrition

Physical Symptoms

• Fainting, collapse, light headedness, dizziness

• Delayed gastric emptying (causing prolonged fullness)

• Diarrhoea, constipation

• Lack of concentration

• Feeling tired and not sleeping well

• Lethargy and low energy

• Sunken eyes

• Dry lips and tongue

• Hair loss or dry skin

Psychological and Psychosocial Symptoms

• How does eating pattern get in the way of daily activities (e.g. avoiding eating at school, decline invites to social events, being able to travel, avoiding social settings to reduce criticism)

• Ability to engage in social eating experiences

• Changes in mood (irritability, rigidity, low mood)

• Evidence of starvation syndrome (cognitive impairment, personality changes, preoccupation with food)

• Impaired concentration and alertness

• Agitation

• Increased / decreased need for sleep

• Impaired ability to make decisions, rigid and inflexible thinking

Menstrual Disturbances

• Age of menarche or pubertal status (using Tanner Stages)

• Regularity, length, flow

• Absence of menstrual periods

• Date of last menstrual period

• Use of hormonal contraception (pill, IUD)

Effects on Quality of Life

• Effects of feeding / eating disturbance (physically, emotionally, occupationally, socially, cognitively)

• Impact of eating disorder on family or significant other

• Broken sleep, wake up thinking about eating disorder

• Individual’s view on what maintain the eating difficulties

• Individual’s beliefs about what needs to change for them to get better

• Insight into illness

• Motivation to change

Risk Assessment

Managing an individual at risk of suicide and engaging in self-harm requires a skilled health professional to thoughtfully consider the level of risk and determine appropriate interventions to minimise the risk.

Ensure the individual is engaged in a multidisciplinary team, including a psychologist, psychiatrist, social worker or counsellor that is trained in assessing and managing risk.