Does My Child Have ARFID?
Photo credit: Dr. Tracy Ballardo
[Image Description: This is an image of a plate with wooden alphabet blocks that spell out “ARFID”. A crossed spoon and fork are placed under the blocks.]
Does My Child Have ARFID?
What is ARFID?
It can feel quite scary and helpless to watch your child have a lack of interest in food, struggle with eating certain types of food, or to expand variety in their food intake. Many families do not realize that there is a difference between their child being a “picky eater” and struggling with a serious eating disorder.
Avoidant/Restrictive Food Intake Disorder, or ARFID, is a serious eating disorder that can often times be mistaken as “picky eating”. Sometimes it is also mistaken as a person restricting food with a desire to change the shape, size, or weight of their body. As some of these characteristics are present in other eating disorders like Anorexia Nervosa, ARFID is different in that there is no desire to change one’s outward appearance that motivates food restriction (Diagnostic and Statistical Manual of Mental Disorders 5th ed.; DSM-5; American Psychiatric Association, 2013; Kennedy et al., 2022).
ARFID is an eating disorder that was introduced to the Diagnostic and Statistical Manual of Mental Disorders 5th Ed. in 2013 (DSM-5; American Psychiatric Association, 2013). A current study found adolescents with ARFID to have a similar prevalence rate as Anorexia Nervosa and Binge Eating Disorder (Van Buuren et al., 2023). ARFID is characterized by challenges with feeding that often begin in infancy or early childhood and can often continue into adulthood for many individuals (DSM-5; American Psychiatric Association, 2013; Kennedy et al., 2022).
This often includes sensory challenges, such as having high levels of sensitivity to the appearance, color, smell, texture, temperature, or taste of food. Psychological factors, such as having a history of trauma, can lead to fears of vomiting or choking on food (DSM-5; American Psychiatric Association, 2013).
So it’s more than “picky eating”?
If you frequently struggle to find something for your child to eat outside of the home, such as at school, on vacation, or on a play date, this may be one warning sign of an eating disorder. ARFID is more than “picky eating” and can often lead to serious medical complications, such as failure to meet developmental growth milestones due to a significant weight loss or nutritional deficiency in childhood and adolescence.
*Note. It is strongly recommended that you seek immediate medical attention for your child if you believe that any symptoms of malnutrition are present, such as irregular menstruation, fainting, fatigue, lethargy, and/or significant weight loss.
So how is it different than being a “picky eater”? If you find yourself saying “yes” to most of these questions about your child, it could be helpful to speak with your pediatrician to screen for an eating disorder and receive referrals for therapy.
10 Questions for Parents to Consider:
1. Do you ever notice that your child appears anxious around food, such as at the dining table or at a grocery store?
2. Do you and/or your child experience anxiety if your child’s preferred foods are not available?
3. Does your child usually struggle to enjoy eating more than a few entrée options off of a menu?
4. Do you have a difficult time increasing variety in your child’s food intake?
5. Does your child struggle with changes to meal routines?
6. Do you often find yourself justifying what or how/the amount your child is eating to others?
7. Do family dinners typically take longer than 30 minutes due to your child’s lack of interest in food or difficulty with eating?
8. Do you find yourself worrying about what your child is going to eat when you are away from them, such as when
they’re at school or at a sleepover with friends?
9. Does your child seem less interested in food compared to peers?
10. Does meal planning or completion ever interfere with tending to daily functioning, such as getting to school on time or eating outside of the home?
Eating Disorder Treatment for My Child:
ARFID is not chosen by those who suffer with the condition. It is also not an outcome of poor parenting. Therefore, it is not encouraged that families “will” their child to eat. Eating disorders, like ARFID, are often accompanied by medical complications and psychological conditions, such as OCD, anxiety, or autism (Kennedy et al., 2022).
Professional, evidenced-based treatment is available and ARFID is treatable (Coglan & Otasowie, 2019). Therapy can benefit by supporting an individual with an eating disorder, provide parenting support and skills, and reduce the likelihood that ARFID persists into adulthood through individual and family therapy. Dr. Ballardo helps clients with eating disorders build adaptive skills, increase self-esteem, and reduce rigidity around food. If you are interested in increasing your child’s independence with food, contact Dr. Ballardo for a free consultation today.
*Note. It is strongly recommended that you seek immediate medical attention for your child if you believe that any symptoms of malnutrition are present, such as irregular menstruation, fainting, fatigue, lethargy, and/or significant weight loss.
About the author: Dr. Tracy Ballardo is a licensed psychologist who specializes in treating eating disorders across the lifespan. Dr. Ballardo has a passion for working with youth and serves children, adolescents, families, and adult clients with various types of eating disorders and co-occurring issues. Dr. B also actively consults with treatment teams that typically consist of pediatricians and other medical doctors, psychiatrists, registered dietitians and outpatient eating disorder treatment centers.
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Coglan, L., & Otasowie, J. (2019). Avoidant/restrictive food intake disorder: What do we know so far? BJPsych Advances, 25(2), 90-98. doi:10.1192/bja.2018.48
Kennedy, H.L., Dinkler, L., Kennedy, M.A. et al. How genetic analysis may contribute to the understanding of avoidant/restrictive food intake disorder (ARFID). J Eat Disord 10, 53 (2022). https://doi.org/10.1186/s40337-022-00578-x
Van Buuren, L., Fleming, C.A.K., Hay, P. et al. The prevalence and burden of avoidant/restrictive food intake disorder (ARFID) in a general adolescent population. J Eat Disord 11, 104
(2023). https://doi.org/10.1186/s40337-023-00831-x