Does My Child Have ARFID?
Eight year-old Ben had been a picky eater his whole life. His family didn’t know him any other way. In fact, they’d learned to live with Ben’s idiosyncrasies around food…only liking one particular chicken finger from a summertime favorite restaurant, refusing all vegetables, and preferring many sweets and snacks.
Sure, these tendencies weren’t easy to live with–and frankly they sometimes caused quite a bit of drama in the family–but Ben’s parents had learned to skip the vegetables, not bother to offer other types of chicken, and learned to live with meals that included cheese, crackers and strawberries nearly every day.
Did they feel guilty? Of course. But they were doing the best they knew how.
When Ben started to grow more anxious at social events involving food with his peers and his growth started to fail, they started searching for more help. It was then they learned Ben had an extreme form of picky eating called Avoidant Restrictive Food Intake Disorder, or ARFID.
Ben’s parents had never heard of this term. They just thought they were dealing with a picky eater.
But deep down they knew Ben wasn’t your average picky eater.
After all, he was eight years old and still picky. He couldn’t spend the night at a friend’s house because there was nothing for him to eat. He was anxious, tearful, or argumentative at the meal table if his usual dinner wasn’t there.
Picky eating had taken over, leaving Ben’s parents to morph into short-order cooks, masters of bribery, and enforcers of more bites.Parents of picky eaters morph into short-order cooks, masters of bribery and enforcers of more bites. Click To Tweet
What is ARFID?
ARFID is characterized by a persistent disturbance in eating leading to weight loss or growth disturbances, nutrient deficiencies, dependence on supplements, and impaired psychosocial functioning.
The common signs are food refusal, poor eating or feeding skills, underweight or slowed growth, anxiety, and texture sensitivities.
Kids with ARFID typically have an underlying reason for their food refusal, including early negative associations with eating (choking, gagging, vomiting), medical conditions that inhibit eating like food allergy or constipation, co-existing conditions such as autism or ADHD that include texture or other food characteristic sensitivity, or a combination of these.
Kids with ARFID are generally not motivated to lose weight.
In my own practice, I have seen a multitude of reasons for ARFID, from enlarged tonsils and adenoids inhibiting eating to sensitivities around the sensory components of food (flavor, texture, appearance, odor, etc) and even dysfunctional parenting.
Food Parenting May Not Help ARFID
Having a picky eater in the home is challenging enough, but add in years of food refusal and negotiations, and it’s easy to see the role of short-order cook evolve. You may cater to your child’s food preferences and fail to challenge him with new foods. Ultimately, a limited diet of liked or acceptable foods results, possibly compromising your child’s nutritional status.
Alternatively, you may use pressure or force your child to experience new food before she is ready or willing. This can leave a negative association with trying unfamiliar foods and make your child unwilling to eat. Other tactics like bribery further limits your child’s diet, and even encourages unhealthy foods.
Which Kids with Picky Eating Need More Help?
If you’re a parent of a picky eater, there are certain red flags that may indicate more help is needed. I generally tell my clients if picky eating isn’t getting better by the end of the fourth year, it’s time to look deeper and consider professional intervention.
Help may include learning about the techniques around positive food parenting and boosting growth and nutritional status, or it could mean one on one intervention to help your child overcome his sensitivities to food, learn to chew and swallow, or develop coping skills to manage anxiety.
Red Flags that May Signal ARFID
Kids with ARFID are complex and they don’t all present the same signs. I’ve outlined some of the common signs that are seen, but kids can have a variety of signs, demonstrating a variety of them:
A short list of acceptable foods
Eating foods of similar characteristics, such as crunchy in texture, or colorless
Preferences for particular food preparation methods
Avoidance of vegetables, protein sources (meat, beans, etc), fruit
Eliminates foods and never gains them back into the diet
Poor weight gain and growth (child may also be of normal weight and growth)
Nutrient deficiencies (iron, vitamin A, and vitamin C most common)
Skips one or more entire food groups
Becomes emotional or demonstrates stress around unfamiliar foods
Food limitations negatively impact normal social behaviors
A Word on Anxiety and ARFID
Anxiety is an underlying component to ARFID for many kids. In fact, some research has shown that 21% of kids with ARFID also have anxiety, and up to 58% may have an anxiety disorder.
It’s hard to be brave and try new foods when you experience a significant amount of stress at the table, whether it stems from the food itself or from the family dynamic at mealtime.
In the older child, social engagement around food may become a source of angst and is often the trigger for getting more help. What the family has been able to deal with in the home becomes much more limiting to the child’s social life. Equally challenging is the embarrassment the child may feel about his diet and eating around his friends.
Where You Can Get More Help for ARFID
As a new diagnosis, ARFID and its management is still in its infancy. We are learning what is effective and beneficial for the child. Each child will be different in his reasons for ARFID, and therefore, the approach to treat it.
For example, children with sensitivities to the sensory components of food will likely need food desensitization and exposure-based therapy with a feeding specialist. Kids who are anxiety prone will need help with coping skills, food exposure therapy and confidence-building around new food and eating in social situations. Children who have experienced pressure to eat, bribery or even punishment for not eating will benefit from parent-centered positive feeding education, as well as other treatment approaches. And, children who are nutritionally compromised will need nutrition therapy.
Fortunately, there are teams who can treat children with ARFID, as well as single providers who can help.
Resources for Treatment
From books to websites, I’ve outlined a few resources here that can help.
Extreme Picky Eating by Katja Rowell and Jenny McGlothlin
Food Chaining by Cheri Fraker, Mark Fishbein, Sybil Cox, and Laura Walbert
Find a feeding therapist in your area: https://www.feedingmatters.org/find-help-in-your-area
Melanie Potock, Feeding expert: https://mymunchbug.com/picky-eater-advice/
Find a dietitian/nutritionist in your area: http://www.eatright.org/find-an-expert
Do you know someone with ARFID?
Share this article if you know a family who is struggling with a long-term picky eater!
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Written by: Jill Castle, MS, RDN
Published on: March 22, 2017
Updated on: June 12, 2019