ARFID: When Picky Eating Becomes an Eating Disorder

Have you ever wondered if your child’s picky eating is normal, or if maybe you should be concerned about their fussy eating habits? While the majority of toddlers and young children go through some type of picky eating experience as part of typical childhood development, there is a line between where “normal” picky eating ends and an eating disorder you’ve probably never heard of begins. It’s called ARFID.

What is ARFID?

ARFID – otherwise known as Avoidant Restrictive Food Intake Disorder – is an eating disorder involving an extreme avoidance or low intake of food. This can result in poor growth and poor nutrition. While the exact cause is not known, many experts believe that a combination of psychological, genetic, and triggering events can lead to the condition.

ARFID tends to affect young children and adolescents and unlike other eating disorders, it tends to affect boys more often than girls. Also, unlike most eating disorders, those with ARFID are not focused on weight loss or body image.

Beyond Picky Eating

According to the National Eating Disorder Association, ARFID and picky eating have some distinct differences. “While picky eating and ARFID may have certain similarities, ARFID is differentiated by the level of physical and mental distress that eating causes. Someone with ARFID may have difficulty chewing or swallowing, and can even gag or choke in response to eating something that gives them high levels of anxiety. The anxiety can also cause them to avoid any social eating situation, such as a school lunch or birthday party.

Foods may be avoided based on physical characteristics such as texture, smell, and appearance, or based on past negative experiences like choking or vomiting. ARFID is a new addition to the DSM-5, the official list of psychiatric diagnoses. Before this addition, it was classified under feeding disorder of infancy or early childhood, or eating disorder not otherwise specified.”

Stanford Medicine Children’s Health (SMCH) adds: “Those with ARFID severely restrict how much food they eat. They may not eat food items with a particular color, aroma, texture, or even brand name. Instead, they may only eat foods with a certain consistency. ARFID red flags include low interest in food, fears of choking or vomiting, feeling full around mealtimes, and reluctance to eat with other people in social settings. Teens and adults with ARFID may also rely on supplements instead of food.”

What problems can happen with ARFID?

ARFID may lead to health problems as a result of poor nutrition. Kids with the disorder may:

• Not get enough vitamins, minerals, and protein
• Need tube feeding and nutritional supplementation
• Grow poorly
• Experience delayed puberty
• Become overweight or obese OR become severely underweight

The lack of nutrition associated with ARFID can lead to physical issues such as:

• Stomach cramps and digestive upset
• Dizziness and fainting as a result of low blood pressure
• Slow pulse, rapid heartbeat
• Dehydration
• Problems with sleep, fatigue
• Trouble concentrating
• Intolerance to cold, dry skin
• Weakened bones and muscles
• Irregular or absent menstrual periods (amenorrhea)
• Constipation

How is ARFID diagnosed?

If you’re worried about your child, a trip to the doctor is in order. The doctor will do an exam and ask about your child’s medical history, eating and exercise habits, and emotional issues. They’ll also look for significant weight loss, nutritional deficiencies, and poor appetite, lack of interest in food, or food avoidance. This evaluation may require blood or urine tests.

It’s important to speak with your doctor as soon as possible if you think your child may have ARFID, as dealing with the condition early on is the best way to successfully treat it.

Treatment for ARFID

There are many treatment options available to. SMCH notes that treatments may include cognitive behavioral therapy, medicines to boost appetite and reduce anxiety, care in a hospital, and outpatient eating disorder programs. They add that families of people with ARFID often work to help support and encourage their loved one’s healthy eating habits and reduce stress, so that mealtime is a “safe space” for enjoying food and family. Family Based Treatment (FBT) is the most effective treatment for children and adolescents with eating disorders.

While there are some distinct differences between ARFID and picky eating, the line can often be blurred. If you have concerns that your child’s picky eating isn’t typical or may have crossed the line into problem territory, an appointment with your family doctor can help determine if there’s anything worth worrying about. If left untreated, ARFID can develop into anorexia nervosa or bulimia nervosa later in adolescence or adulthood. The National Eating Disorder Information Centre has a short screener for concerned parents and caregivers.