Parents, is your child just "a picky eater" or is it something else?

So, your kid won’t eat.  Is it picky eating OR could it be something much more significant?

Turns out, sometimes picky eating can have a much more significant struggle going on behind the scenes.  Many parents get frustrated when their toddler or school age kids come to the table and refuse to eat their fruit/vegetables or their chicken or steak.  “Mom, I can NOT eat foods that are mixed together” or “I just can’t eat foods that have a smooth, mushy texture”.  When these parents take these concerns to their medical providers they are often told.  “Well, they will eat when they are hungry.”  This is not the case for children/adults who struggle with the eating disorder ARFID.  ARFID stands for Avoidant Restrictive Food Intake Disorder and it is a newer diagnosis on the DSM-5, though the eating issue has been around for a long time. 

What sets ARFID apart from picky eating?  There are several criteria that are specific to diagnosing ARFID. With ARFID, restricting food or weight loss is not related to a desire to lose weight or body image concerns.  The food struggle usually has to do with sensory processing disorders (not being able to tolerate certain food smells, textures, combinations), a food trauma incident such as choking, or possibly having an illness related to a food experience.  These clients have difficulty nourishing themselves well because they truly cannot tolerate certain food textures or combinations.  There is often significant anxiety related to eating with their families and social situations.

According to the DSM-5, ARFID is defined and diagnosed as:

  • An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about averse consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:

    • Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).

    • Significant nutritional deficiency.

    • Dependence on enteral feeding or oral nutritional supplements.

    • Marked interference with psychosocial functioning.

  • The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.

  • The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.

  • The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

Who is at risk for ARFID?

  • Children who do not outgrow severe picky eating are much more likely to develop ARFID in later years.

  • Those with autism spectrum disorders are more likely to develop ARFID as are those with ADHD or other intellectual disabilities.

  • It is common for children with anxiety disorders or other psychiatric disorders to develop ARFID.

What are some of the behavioral warning signs that it could be ARFID?

  • Dramatic weight loss

  • GI distress such a constipation, abdominal pain, persistent upset stomach (around meal time that have no known cause)

  • Will only eat certain textures of food

  • Intense fear of choking or vomiting

  • Poor appetite or no interest in food

  • No body image disturbances or fear of weight gain

So what types of treatment are available for ARFID?

In general, the initial focus in treatment is on weight restoration.  Once weight is restored to a healthy place then the treatment emphasis shifts to increasing variety of foods. 

There are several different treatment modalities used.  Some are used exclusively but more often they are used in combination.  Treatment approaches include, food exposure with either an OT or RDN.  Cognitive Behavioral therapy (CBT) addresses the negative thoughts and behaviors behind the food aversions. Food exposure as well as relaxation techniques are utilized as the person learns to practice new thoughts around food experiences.  Dialectical Behavioral Therapy (DBT) empowers patients to manage their emotions in a healthy way. With ARFID, DBT skills help clients to manage distress as the try new foods and re-introduce other food that have been distressing for them in the past.  Group therapy is also beneficial as clients can be in a supportive space to share meals with others and work through sensory issues. As treatment progresses, group therapy might mean meeting to share a meal in a public space or visiting the grocery store together.

The good news is there is help available for ARFID.  If you suspect your child or loved one may have ARIFD our clinical team of therapists and registered dietitians at Focus Integrative Centers are here to help.

Contributed by Lisa Davis, MS, RDN, LDN, Registered Dietitian with Focus Integrative Centers, Knoxville

References: National Eating Disorders Association https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid

 

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