ARFID: A Bigger Problem Than Picky Eating

Chicken nuggets again! Every day, you offer your child a healthy meal or food item, but they will only eat the same thing. As a parent, it is incredibly frustrating and worrisome. Are they getting enough nutrients, and is this just a phase that they will grow out of? Or is it something else?

Children can often be picky eaters, which is also part of normal development. According to some studies, as much as 50 percent of preschool children and 27 percent of old children can have a limited range of food choices and may avoid certain foods because of their taste, texture, or appearance. But when picky eating becomes so restrictive that it results in nutrition deficiencies, significant weight loss, malnutrition, failure to thrive, and development, it can be a more serious nutritional health condition.

ARFID, or Avoidant/Restrictive Food Intake Disorder, is a relatively newly established condition that is considered an eating disorder. ARFID is more than just picky eating. Children with ARFID have difficulty eating enough food and have a lack of interest in food, extreme avoidance of certain foods, or fear of the consequences of eating. It is imperative to mention that people diagnosed with this disease are not picky or struggle with food because they are worried about their body image/size, which happens with other eating disorders.

Picky Eater or ARFID?

While picky eaters may eventually outgrow their restrictive eating habits, ARFID is a more complex and persistent food restriction. Children with ARFID avoid certain textures or colors of food, refuse to eat in social situations, or have a limited number of “safe” foods they will eat. And it may not get better on its own.

To treat ARFID, a registered dietitian constantly assesses the growth and development of the child, as well as their overall nutritional status. The dietitian must carefully examine the child’s macro- and micronutrient intake, investigate any dietary deficiencies, and talk with the child’s family about their feeding history and the family’s eating patterns.

Based on the results of a complete nutritional assessment, the dietitian creates a plan with the family and the child that focuses on a balanced and diverse diet. They also aim to reduce stress and anxiety around meal and snack times, establish healthy relationships with food, and limit distractions while eating.

For example, if the child has an aversion to certain food textures, the dietitian will encourage “safe” foods as part of the plan to maintain proper caloric intake and then slowly introduce new foods. There might be other cases where the patient has no interest in food, and different strategies have to be used, such as structured meal and snack times. In some cases, the dietitian may recommend therapy to address any underlying psychological or anxiety issues that may be contributing to restrictive eating habits.

At the beginning of the treatment, it is vital to avoid switching the “safe” food the child eats to healthier versions. Food changes must be made very slowly, without pressure from family or their social environment. Premature changes or pressure can increase anxiety in already anxious kids.

Since ARFID is relatively new, many other treatments have been suggested, like food chaining or cognitive behavioral therapy, but parental involvement is key. Parental pressure to eat different foods may have consequences, such as children preferring to stay hungry rather than enjoy their “safe” foods, putting their health in danger.

“It is important to note that not all picky eaters have ARFID, and not all individuals with ARFID were picky eaters as children. ARFID can develop at any age and can be caused by a variety of factors, including sensory issues, anxiety, and gastrointestinal problems,” says Sally Dorfzaun, MS, RD, CDN, registered dietician at the Columbia University Irving Medical Center.

What Can You Do?

As a parent or grandparent of a child with ARFID, supporting a child with ARFID can be a challenging experience. Still, with the right resources and approach, it is possible to help your child expand their diet and receive proper nutrition. Here are a few things you can do:

• Please seek professional help: It is essential to consult with a healthcare professional, such as a dietitian or therapist, who specializes in ARFID. They can provide personalized guidance and support for you, the family, and the child. They can also help identify any nutritional deficiencies and create a plan to address them with supplements or fortified foods.
• Create a positive environment: Mealtimes should be a positive experience for your child, free from pressure or negative comments. Avoid forcing your child to eat, as this can increase anxiety and make the situation worse. Instead, provide a variety of safe foods and encourage your child to try new foods at their own pace.
• Offer safe foods: Children with ARFID often have a limited number of foods they feel safe eating. Ensure that these foods are always available and offer them regularly. This can help your child feel more comfortable and reduce anxiety around mealtimes.
• Introduce new foods slowly: Introducing new foods can be daunting for a child with ARFID. Start by introducing small amounts of new foods alongside safe foods. Encourage your child to explore the new food without pressure to eat it. Gradually increase the amount of the new food over time.
• Consider sensory issues: Children with ARFID may have sensory issues with certain textures or smells, contributing to their food aversions. When introducing new foods, consider the sensory aspect of food and be mindful of your child’s preferences, such as crunchy versus mashed.
• Be patient: Feeding a child with ARFID can be a slow process. It is important to be patient and supportive throughout the journey. Celebrate small victories and progress, even if they seem minor.
• Involve your child in meal planning: Making them part of the team can help them feel more involved and in control. It can also help introduce new foods in a non-threatening way.
• Be a role model: Eat a variety of foods and enjoy mealtimes.

Above all, Dorfzaun says, be persistent. “Don’t give up! Feeding a child with ARFID can be a challenging and frustrating experience. However, it is imperative not to give up. With patience, support, and professional help, your child can learn to expand their diet and receive proper nutrition.”

If you or a loved one is struggling with restrictive eating habits, it is important to seek help from a healthcare professional. A registered dietitian can help develop a meal plan that meets the individual’s nutritional needs. In contrast, a therapist can help address any underlying psychological issues contributing to the restrictive eating habits.

“With time and effort, feeding your child can become a more enjoyable and less stressful experience for everyone involved,” says Dorfzaun.