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Avoidant restrictive food intake disorder (ARFID), a recently described eating disorder categorized under DSM-5, has varied clinical presentations. The primary eating disorders have well-established practice parameters for management. However, there is no evidence-based first line of management for ARFID. There is a significant gap in this evolving construct and clinical practice. We present a case series from a tertiary care center in India, focusing on clinical management. Four adolescents with 3 girls and 1 boy between 12 and 17 years of age were included in the study. Diagnosis and management were delayed in all. Mean body mass index was 15.36 (5.26) kg/m2 at the time of diagnosis. Key drivers were dread of choking, sensory characteristics, and avoidance of unpleasant upper and lower gastrointestinal symptoms. This series supports a culturally cognizant hypothesis, an evidence based, viable management model for ARFID in low- and middle-income countries (LMIC). A combination of family-based treatment (FBT) and cognitive behavior therapy is an effective treatment model for India and other LMICs.

Background: Adolescent sleep deprivation affects their mental health, cardiovascular health, academic performance, and safety while on the road. This study analyzed sleep quality, hygiene, and daytime sleepiness among adolescents attending a tertiary care medical institution in Vellore. Materials and Methods: A school-based self-reported survey was conducted among 257 adolescents using the Adolescent Sleep–Wake Scale, Adolescent Sleep Hygiene Scale, and Epworth Sleepiness Scale. Unpaired t-test was used for continuous variables and Chi-square test for discrete variables for analysis. The correlation between sleep hygiene, sleep quality, and daytime sleepiness was done using Pearson correlation coefficient. Results: The mean age of participants was 14.5 ± 1.08 years. During weekdays, the mean bedtime was 9:39 pm ± 44 min and wake time 6:20 am ± 56 min. During weekends, the mean bedtime was 9:53 pm ± 49 min and wake time 7:03 am ± 88 min. The average duration of nighttime sleep was 8 h 40 min ± 64 min on weekdays and 9 h 10 min ± 81 min during weekends. Twelve percent experienced daytime sleepiness. There was a weak-to-moderate, inverse correlation of daytime sleepiness to sleep quality (r = −0.30) and sleep hygiene (r = −0.23). Mean scores of sleep quality and sleep hygiene were 4.25 and 4.29, respectively. There was a moderate-to-strong (r = 0.63) correlation with low scores in cognitive (mean = 3.72) and sleep stability domains (mean = 3.79). Conclusions: Adolescents in this study population have reasonably good sleep quality and hygiene. Sleep hygiene is closely related to sleep quality.