Most parents can attest to the struggle of getting their kids to embrace new flavours and textures. Picky eating is a common concern, but what if you’ve consistently introduced different foods to your child, and nothing seems to change?
The above might be a sign of a more complex issue known as Avoidant/Restrictive Food Intake Disorder (ARFID), an eating disorder that we’ll explore today, which can significantly impact a child’s health and development.
Furthermore, children with certain pre-existing conditions may be more susceptible to ARFID. These conditions include:
What is ARFID?
ARFID is a relatively new and complex eating disorder that involves a persistent inability to meet appropriate nutritional needs. It’s characterised by highly selective eating habits, disturbed feeding patterns or both, which are distinct from other eating disorders like anorexia or bulimia (as it does not necessarily involve concerns about body weight or shape). Let’s explore the three subtypes of ARFID in greater detail:Lack of Interest in Eating or Food
Children suffering from this type of ARFID may exhibit a disinterest or apathy towards food and eating in general. The child might not feel hungry often, and they may feel full very quickly after starting to eat. Their lack of interest in food can lead to significant nutritional and psychological deficits, such as health issues like anaemia, bone density problems, and developmental delays.Sensory Avoidance
This subtype is characterised by food avoidance due to its sensory properties. Children with sensory-based ARFID are particularly sensitive to foods’ taste, texture, smell, or temperature. This avoidance isn’t just a matter of dislike. It is typically intense enough to disrupt normal eating patterns, and their heightened sensitivity can make certain textures (e.g., slimy, crunchy), tastes (e.g., bitter, very sweet), or even colours particularly overwhelming or unappealing.Fear of Aversive Consequences
Children with this type of ARFID are afraid of eating due to fear of aversive consequences. They might fear choking, vomiting, or experiencing allergic reactions or other physical symptoms such as nausea. The fear in children with ARFID can be particularly overwhelming when it intersects with food neophobia (fear of new foods). This reluctance often leads them to stick with known “safe” foods, which they believe could minimise the risk of consuming something harmful. In this case, their fears may extend beyond new foods. For instance, if a child who previously ate tomatoes without issue becomes ill after consuming them, they might then associate all red foods with danger. This experience could lead them to avoid tomatoes and similar foods in the future.What is the Difference Between ARFID and Picky Eating?
While many children, especially between the ages of 2 and 6, may be wary of greens or certain textures, it’s important to understand that such pickiness in food is often a normal part of their development. However, ARFID is a more serious condition with a stronger emotional or anxiety-based component. This can negatively impact a child’s physical and mental health in several ways. For example, children with ARFID may avoid entire food groups, leading to nutritional deficiencies, growth delays, and a weakened immune system. Additionally, the anxiety surrounding food can cause them significant emotional distress and interfere with social interactions.Symptoms of ARFID in Children
- Sensory Sensitivity: Displays sensitivity to food texture and traits. A 2022 study found this to be a common symptom of ARFID, affecting up to 63% of children with the disorder.Children with sensory sensitivity to food often find certain textures, tastes, or colours particularly challenging, significantly limiting their willingness to eat those foods. This can result in a very restricted diet, often limited to foods with neutral taste and non-challenging textures.
- Physical Symptoms: Parents may notice a significant decrease in children’s weight. This is primarily due to the extremely limited diet that can result in significant deficiencies.Many ARFID children also experience gastrointestinal complaints, including frequent stomach pains and constipation, which can arise both as a direct consequence of their unusual eating patterns and as part of the physiological stress associated with eating.
- Mental / Emotional Symptoms: Children with ARFID may experience intense fear of choking or vomiting. This fear significantly influences their eating behaviour, as it can prevent them from trying new foods or even continuing to eat foods that were previously acceptable. It can lead to a vicious cycle where the fear of eating reinforces the restrictive eating habits, further complicating their relationship with food.
Causes and Risk Factors of ARFID vs Picky Eating
The emergence of ARFID is not likely without cause. Studies suggest potential contributing factors, such as biological, psychosocial, and environmental influences. Picky eating, on the other hand, is known to be influenced by early feeding difficulties (such as late introduction of textures or pressure to eat). However, unlike picky eating behaviour that may gradually improve, ARFID conditions can worsen if no intervention is provided. Here’s an overview of their differences:| Picky Eating | ARFID | |
|---|---|---|
| Severity of restrictions | Mild to moderate | Severe |
| Impact on health | Usually minimal | Can be significant |
| Motivation | Mild sensory preferences or dislike | Fear, anxiety, lack of interest |
| Course over time | May improves | May worsen |
- Autism Spectrum Disorder (ASD): Sensory sensitivities and difficulties with social interaction in ASD can contribute to ARFID.
- Attention Deficit Hyperactivity Disorder (ADHD): For children with ADHD, focus difficulties and impulsivity can make mealtimes challenging as their executive functioning skills (crucial for planning and routine) may be impacted, potentially contributing to the development of ARFID.
- Severe Picky Eating: Picky eating that persists and becomes increasingly restrictive over time may be a precursor to ARFID.
What are the Available ARFID Interventions?
ARFID intervention often involves a multidisciplinary approach, incorporating nutrition counselling, psychological support, and most importantly, feeding therapy. Feeding therapy plays a pivotal role in the intervention of ARFID. It addresses challenges like:
- Extreme food selectivity.
- Sensory aversions to textures or smells.
- Oral motor skills are necessary for adequate chewing and swallowing.
There are two main approaches to feeding therapy for children in Singapore: Group and individual feeding therapy sessions. Group sessions foster children’s social interaction and sensory exploration through peer modelling and activities, promoting new food exploration and positive mealtime behaviours (e.g., social skills and openness to textures/tastes), whereas individualised sessions address their specific needs, as well as improving their eating skills and managing anxieties.
Overcoming ARFID Challenges: Enhance Your Child’s Relationship with Food
Even though ARFID can be complex, early intervention with the right tools and support can make a difference. Services such as child behaviour therapy in Singapore can help children establish positive and healthy connections with food, which is crucial for their overall development and future well-being. Remember, every meal is a step toward recovery and understanding!