What is ARFID and How Do You Know If Your Child Has It?
When it comes to eating disorders, we often think of conditions like anorexia or bulimia. There is another disorder that is less well-known, yet just as impactful: Avoidant/Restrictive Food Intake Disorder, or ARFID. This condition can be particularly concerning when it affects children, as it can interfere with their growth, development, and overall well-being.
What is ARFID?
ARFID is an eating disorder characterized by an extreme avoidance or restriction of food. Unlike eating disorders like anorexia or bulimia, ARFID isn’t driven by a desire to lose weight or change the body size or shape. Instead, those with ARFID may avoid certain foods or food groups due to sensory sensitivities, fear of choking or vomiting, or a lack of interest in eating.
ARFID can begin in childhood and persist into adolescence and adulthood, though it often goes undiagnosed because its symptoms can be mistaken for picky eating. Children with ARFID might not eat a sufficient variety or amount of food, leading to malnutrition, weight loss, or stunted growth. The disorder can be challenging to manage, as the child may experience significant distress around eating or mealtime, leading to a tense and frustrating dynamic for both parents and children.
Signs and Symptoms of ARFID
Knowing how to recognize ARFID in your child is the first step toward seeking help. While some level of picky eating is normal, particularly in young children, ARFID is more extreme and persistent. Here are some signs and symptoms to look out for:
Limited Food Preferences
Children with ARFID may develop a very restricted range of foods they are willing to eat, and the foods they accept are often very bland or easy to chew. These kids may have strong preferences for certain textures, flavors, or colors, and refuse to eat foods that don't meet these criteria. For example, they might only eat foods that are white or beige (like bread, rice, and crackers) while refusing vegetables, fruits, or proteins.
Avoidance of Specific Textures or Smells
Many children with ARFID are particularly sensitive to the texture, smell, or appearance of certain foods. They might gag or become distressed when exposed to these foods, making mealtimes difficult. Some children might avoid foods that are sticky, slimy, crunchy, or have a strong odor, making their diet even more limited.
Fear of Eating
Some children with ARFID have an intense fear of choking, vomiting, or gagging, which leads them to avoid certain foods or eating altogether. They may also be fearful of the sensation of food in their mouth or the texture as it changes during chewing.
Social Avoidance
Children with ARFID may be uncomfortable eating in social settings, such as at school, birthday parties, or family gatherings. They may refuse to eat food offered by others, or they may isolate themselves to avoid being pressured to eat.
Emotional Distress Around Food
Mealtimes can become a source of tension and anxiety. Children with ARFID may cry or become irritable when it’s time to eat. They may also avoid food-related activities altogether, such as helping in the kitchen or sitting at the table with family during mealtime.
How Do You Know If Your Child Has ARFID?
It can be difficult for parents to distinguish between typical picky eating and a more serious issue like ARFID. However, if your child’s eating habits are causing significant distress, impacting their health, or interfering with their social and emotional development, it’s important to seek help. Here are some questions to consider:
Has your child been consistently avoiding certain foods or food groups for more than 6 months?
Do they have an intense fear or anxiety about eating certain foods, or do they experience distress during mealtimes?
Is their food avoidance affecting their ability to engage in social activities, like family meals, parties, or school lunches?
If you’re noticing any of these signs, it may be time to consult with a dietitian or a mental health professional specializing in eating disorders.
Treatment Options for ARFID
The treatment of ARFID is multifaceted and often requires a team approach, including pediatricians, dietitians, therapists, and other specialists. Treatment plans are tailored to each child based on their specific symptoms and needs.
This approach involves nutrition counseling. A registered dietitian will play a key role in addressing any nutritional deficiencies that may have resulted from food avoidance. They will work with the child and their family to create a meal plan that provides balanced nutrition, gradually introducing new foods into the child’s diet.
Different therapeutic modalities are also employed to treat ARFID. CBT is a form of psychotherapy that focuses on changing negative thought patterns and behaviors. In the case of ARFID, CBT can help the child address fears related to food, reduce anxiety around eating, and challenge any negative beliefs they may have about food or mealtimes.
Family-based therapy is an approach that involves working with the entire family to improve communication, reduce mealtime conflicts, and help parents support their children in overcoming food aversions. Family-based therapy is particularly helpful in creating a supportive environment that fosters positive eating habits.
In some cases, a pediatrician may prescribe supplements or medical interventions to address nutritional deficiencies or physical symptoms caused by ARFID. This can include supplements for vitamins and minerals or medications to manage anxiety that may accompany eating disorders.
One of the most effective tools used in the treatment of ARFID, especially for children with strong food aversions, is exposure therapy. Exposure therapy is a psychological treatment that helps individuals confront their fears in a gradual, controlled way. For children with ARFID, exposure therapy typically involves identifying food fears and incorporating gradual exposure.
Exposure begins with less anxiety-provoking foods or food-related activities. For example, the child might start by simply looking at a food they’ve been avoiding, then move on to touching it, and eventually progress to tasting it. The process is slow and steady to prevent overwhelming the child and to allow them to build tolerance.
Exposure therapy is often paired with techniques to create positive associations with food. This might include making mealtimes more enjoyable, creating a calming environment, or reinforcing the child for trying new foods, even in small amounts.
ARFID is a serious eating disorder that can have significant impacts on a child’s physical, emotional, and social development. Recognizing the signs early on and seeking appropriate treatment can make a significant difference in helping your child develop a healthy relationship with food.
If you suspect your child may have ARFID, it’s important to consult with healthcare professionals who specialize in eating disorders for an accurate diagnosis and to develop a treatment plan tailored to your child’s needs. With the right support and interventions, children with ARFID can learn to expand their diets, reduce anxiety around food, and thrive.
Are you or your child in need of support?
At Lift Wellness Group, we offer distinct levels of care that are designed to treat eating disorders, including ARFID. Our team of compassionate and highly trained clinicians and staff are here to support you in your recovery.
Outpatient Services: Working with a Lift therapist or dietitian will provide individualized care as you navigate mental health, disordered eating, or eating disorder recovery.
Our Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP) are highly structured and comprehensive programs that focus on holistic healing and recovery from mental health and eating disorders.
Our admissions team is here to lend a listening ear and find a program that is the best match for you. Connect with us today at (203) 908-5603.
Written by Allison Cooke, Certified Intuitive Eating Counselor and MSW Student