Is My Kid a Picky Eater Or Is It The Eating Disorder ARFID?
Let’s face it: almost every kid goes through a phase of being a picky eater, where getting them to eat something other than their favorite crackers and chicken nuggets can be a real struggle.
But what if you’re suspecting it’s more than just a phase? Or if it’s starting to impact them outside of meal time? Maybe it’s stopping them from going to birthday parties or playdates, or it’s causing massive arguments in your house at dinnertime.
Having a child who is a picky eater is developmentally expected, but when your kid’s eating habits are highly restrictive and start to impact other parts of their life, they might have Avoidant/Restrictive Food Intake Disorder, or ARFID.
We sat down with some experts to talk about what parents need to know about ARFID and how it might be treated.
What distinguishes ARFID from a picky eater?
Dr. Sarah Parker, director and co-founder of the Reeds Center, describes ARFID as a condition where “a person has an extremely limited range of foods that they can tolerate or eat” to the point that they’re “experiencing a good deal of suffering or some level of impairment, like it’s getting in the way of important activities.”
This impact on important activities is what distinguishes ARFID from picky eating. A child with ARFID might fall off their growth curve or suffer from nutritional deficits, for example.
The impacts of ARFID expand beyond physical health.
“We’re seeing a lot of psychosocial functioning impairments,” says Amanda Smith, director of ARFID programming at Monte Nido Walden. “Like, they’re not going to sleepovers, they can’t do class parties, they can’t do doughnuts with parents at school.”
What causes ARFID?
There are three different ways that ARFID typically presents itself that causes restrictions on food intake.
Sensory Difficulties
When ARFID presents through sensory difficulties, the taste, texture or smell of some foods can elicit strong feelings of disgust.
“There’s a heightened sensitivity, which leads to a very selective approach to which are acceptable,” says Melissa Gerson, founder and director of Columbus Park.
Fear of Adverse Consequences
As opposed to a sensory difficulty, ARFID stemming from a fear of adverse consequences is more of an anxiety or fear process.
“So many people with ARFID have anxiety about how food is going to affect them,” Parker says. “Or there’s going to be some kind of negative outcome if they eat a particular food.”
These fears related to food can be varied.
“They can be afraid that if they eat, they might choke on the food, or that it might make them sick or vomit,” Gerson says. “That can come on suddenly, or it can kind of build up over time.”
Lack of Interest
People with this type of presentation demonstrate a lack of interest in food and eating.
“It’s a chore,” Smith says. “Too much thought has to go into it, and they would just rather not.”
What’s also worth noting is that regardless of how ARFID presents, it’s not triggered by or related to body image or weight. While ARFID is classified as an eating disorder, this is what distinguishes it from eating disorders like anorexia or bulimia.
When Should Look Into Seeking an ARFID Diagnosis For Their Kid? What Does Treatment for ARFID Look Like?
Parents know their kids best, and the experts we spoke to said to reach out to their pediatrician if they notice their children’s restrictive eating habits are impacting things like their weight or ability to get important nutrients.
Another reason to seek out a diagnosis is noticeable interference with social functioning.
“If your kid has a hard time going to camp, or going to school, or eating with friends,” Gerson says. “That’s impacting their social life and their social connections, so that would be a really good reason to begin to explore.”
Conflicts within the family surrounding food are another thing to look out for.
“If a kid is refusing to eat food and it’s turning into an emotional issue in the family, it seems like that’s a useful time to kind of make an appointment with a pediatrician to find out more about what’s happening,” Parker says.
When it comes to treatment for ARFID, Smith says it typically involves a “multidisciplinary approach to try and really tailor to an adolescent or child’s needs.” From there, treatment might include weight restoration, if it’s needed, and then working to break through blocks eating certain foods before trying to expose the child to new foods and work on building their variety.
Treatment will also vary based on how the child is presenting ARFID. For example, exposure work might be prioritized if a child’s food avoidance is being driven by fear, while a child with sensory issues might be introduced to smaller changes to increase their tolerance and variety of foods they can eat.
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