Understanding Avoidant/Restrictive Food Intake Disorder (ARFID)
Mealtimes with children often conjure up images of chaotic scenes: food flung across the table, protests against broccoli, and tears over spilled milk. For many parents, these battles over food can be a source of immense stress and frustration. From navigating picky eating habits to managing tantrums at the dinner table, mealtime struggles can turn a time of nourishment and family bonding into a battleground.
Parents often report feeling overwhelmed by all the advice from parent blogs, podcasts, and health professionals. They then feel more confused about conflicting advice, such as using reward charts, being encouraged to stand their ground while their child is threatening starvation, or being told that they will grow out of it eventually. The parents we work with at Quirky Kid describe cycling through a range of strategies only to endure countless tearful meals or another night of chicken nuggets.
Whilst a stage of reluctance to try unfamiliar foods is common during early childhood (2-6 years of age) (Åoboå & Januszewicz, 2019), typically, this developmental phase will resolve through exploring and developing food preferences and learning about new sensations. For some children, this period of time may be paired with negative experiences or biological predispositions, resulting in the persistence of extreme fussy eating.
This is where the condition known as Avoidant/Restrictive Food Intake Disorder (ARFID) comes into play. ARFID is a unique and often overlooked eating disorder that goes beyond the typical picky eating phase, causing significant distress and impairment in a child’s daily life.
What is ARFID?
Unlike more widely recognized eating disorders such as anorexia nervosa or bulimia nervosa, ARFID manifests uniquely, characterized by a persistent rejection of certain foods or food groups, leading to significant nutritional deficiencies and impairments in daily routines. For individuals living with ARFID, mealtimes are not simply about taste preferences or picky eating habits – they represent a battleground of anxiety, fear, and distress.
Foods that may seem innocuous to others can evoke intense feelings of discomfort or even panic for those with ARFID, making every meal a daunting challenge. While it often emerges in childhood, it can also be triggered by a traumatic experience at any time across the lifespan. It can be identified as a chronic limited diet that may be restricted in either variety or volume. For a diagnosis, it is accompanied by either significant weight loss, nutritional deficiencies (or dependence on supplements), or impairment in psychological or social functioning.
Individuals experiencing ARFID often feel anxiety, fear, or disgust related to food. This can result in developing strategies to cope with these unpleasant feelings, known as avoidance behaviors. This might look like refusing to eat in public, feeling anxious about attending social-eating events, or limiting the amounts of food or types they eat. Due to this, individuals may develop a range of “safe” foods. These are foods that they consistently feel comfortable about eating and are usually limited to a certain texture, color, brand, or food group.
The Impact of ARFID on Families
The restricted routines around food can also take a toll on the families of those diagnosed with ARFID. Parents will describe the constant stress of needing to plan ahead to ensure that they always know what food will be available. This might involve avoiding certain events or packing their own food to take to parties. It can be debilitating for the individual and their family, as they are unable to share meals, attend social events, or eat at restaurants due to the stress and fights about food.
It is predicted that ARFID occurs in 1 out of 300 people in Australia (Hay et al., 2017). It is different from other eating disorders, as concerns are not focused on weight and shape but rather related to the experience of food itself. It is typically associated with one of the following:
- Sensory Sensitivity: Individuals with ARFID may have heightened sensory sensitivities related to taste, texture, smell, or appearance of food and may feel disgusted or stressed by the sensory experiences of eating.
- Fear of Aversive Consequences: They may fear that eating certain foods will lead to negative outcomes, such as choking, vomiting, or other unpleasant experiences.
- Lack of Interest or Enjoyment: Some individuals with ARFID simply do not find eating or certain foods enjoyable and may have a limited interest in food or feeding.
To comprehend the physiological and psychological response of an individual with ARFID, imagine being offered your biggest fear (e.g., spiders or something revolting like vomit) on a plate for breakfast, lunch, and dinner, repeatedly and being pressured to consume them on the promise that you “will like it.” Many individuals with ARFID describe this distressing experience as how they feel when presented with food.
Addressing ARFID: Practical Strategies and Support
It can be overwhelming managing mealtimes with a family member with ARFID. It is important to remember that this disorder needs support and understanding, not pressure or punishment (Powell, et al., 2011). There is an underlying biological predisposition or a history of stressful experiences underlying the disorder and its associated behaviors. Those experiencing ARFID endure extreme distress and are often confused by their own reactions to food.
ARFID can have serious physical and psychological consequences if left untreated. For instance, children with ARFID may not receive adequate nutrients, leading to deficiencies. Additionally, they can develop intense distress around eating, impacting their social lives or self-esteem. It is important to access appropriate intervention, which may include nutritional counseling, family support, and therapy, to support individuals in developing a healthier relationship with food.
Seeking Professional Help
If you suspect a child may be experiencing ARFID, seek professional help from a healthcare provider, such as a Pediatrician or mental health specialist, who can assess and provide appropriate treatment options. Quality interventions involve a thorough assessment to identify the needs of your child, followed by individualized treatment plans. It is crucial that this includes both one-on-one support for children to build confidence in managing new foods and a parent support component.
Parent support prepares families with education and skills to provide a supportive and calm mealtime environment with appropriate opportunities for success. Experienced therapists will aim to support your child in addressing both the physical and psychological aspects of the disorder.
Engaging with Supportive Resources
There are a range of experts and resources that can provide the following support:
Nutritional Counseling: Work with an Accredited Practicing Dietitian who specializes in pediatric feeding disorders and understands ARFID. They can help your family develop a structured and individualized meal plan, starting with the foods your child already accepts and then moving towards nutritional adequacy. Dietitians can also discuss specific supplements to fill gaps while your child explores new foods and provide education and support to parents and caregivers regarding mealtime strategies and food exposure techniques.
Family-Centered Therapy: Engage in therapy sessions that involve the child, parents, and other family members. This approach helps address the psychological and social aspects of ARFID, providing guidance on creating a supportive mealtime environment and implementing effective strategies to help the child gradually expand their food repertoire.
Occupational Therapy: An occupational therapist can assess the child’s sensory processing and related behaviors, developing a tailored treatment plan to address any underlying sensory challenges that may be contributing to the ARFID.
Support Groups: Connect with other families navigating ARFID through local or online support groups. Sharing experiences, strategies, and resources can provide invaluable peer-to-peer support and a sense of community.
It’s important to note that treatment approaches may vary based on each child’s individual needs and specific circumstances. A comprehensive evaluation by a healthcare professional experienced in treating ARFID is essential to develop an individualized treatment plan. This plan should consider the child’s medical history, nutritional status, psychological factors, and any underlying conditions or comorbidities.
ARFID treatment can be gradual and long-term, requiring patience, consistency, and ongoing support. It is essential to watch the child’s growth and nutritional well-being, making gentle adjustments to the treatment plan as their unique progress unfolds. In this nurturing journey, every small step forward is a victory; together, we build a brighter, healthier future.
Conclusion
Navigating the challenges of ARFID can be a daunting task for families, but with the right support and understanding, it is possible to help children and adults develop a healthier relationship with food. By seeking professional guidance, engaging in family-centered therapy, and fostering a supportive mealtime environment, individuals with ARFID can overcome their fears and restrictions, ultimately improving their physical and mental well-being.
Remember, ARFID is a complex condition that requires patience, empathy, and a personalized approach. With the right resources and a team of dedicated professionals, families can navigate this journey and empower their loved ones to thrive. Stay informed, seek support, and celebrate every small victory along the way.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787
Hay, P., Mitchison, D., Collado, A. E. L., González-Chica, D. A., Stocks, N., & Touyz, S. (2017). Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population. Journal of eating disorders, 5(1), 1-10.
Łoboş, P., & Januszewicz, P. (2019). Food neophobia in children. Pediatric Endocrinology Diabetes and Metabolism, 25(3), 150-154.
Powell, F. C., Farrow, C. V., & Meyer, C. (2011). Food avoidance in children. The influence of maternal feeding practices and behaviours. Appetite, 57(3), 683-692.
