ARFID (avoidant/restrictive food intake disorder) in children is a diagnosis that has been in the DSM V since it was published in 2013. It is a type of extreme picky eating. Read more about it here.
ARFID vs picky eating
For diagnostic purposes, ARFID falls under the banner of an eating disorder, whereas picky eating is a feeding disorder.
In my opinion, when parents are given an ARFID diagnosis, it is communicated that all hope is lost.
Their child is pathologically unable to eat unfamiliar foods.
I challenge this based on my experience in clinic and my research.
What are the 3 types of ARFID in children
ARFID in children can be broken down into 3 different types.
- dietary restriction secondary to sensory sensitivity (21%)
- fear of aversive consequences while eating (9%)
- lack of interest in eating secondary to poor appetite (58%)
A child can fit into more than one type of ARFID.
Let’s talk about each of these types of ARFID
Dietary restriction secondary to sensory sensitivity
ARFID in children is in the DSM V as a mental health disorder. The other relevant diagnosis is Paediatric Feeding Disorder. This results from a child’s skill development deficit (i.e they never learnt to eat/chew/swallow), medical, nutritional and psychosocial issues. Having a sensory sensitivity to food is really a type of feeding disorder, not eating disorder. Sensory issues can be improved generally by working with an occupational therapist. Specifically for food restriction, a systematic desensitisation approach to feeding therapy works really well. Not only that, but sensory regulation can be improved with zinc supplementation.
Lack of interest in eating secondary to poor appetite
Where to start with this one! There are so many reasons why a child may have a poor appetite. This first one is constipation. A child with a gut full of poo will not have a robust appetite.
This can mean a fear of vomiting or choking. When I hear a child is afraid to eat for these reasons, my first thought is PANS/PANDAS. But I also think of Eosinophilic oesophagitis (EOE), or chewing and swallowing issues. Treating these underlying conditions can stop your child being afraid of vomiting or choking.
Fear of aversive consequences while eating
Zinc deficiency (common in fussy eaters due to the lack of animal protein and zinc containing foods) will suppress appetite. Iron deficiency is a potential factor, and also common in fussy eater. It is a vicious cycle – kids restrict their appetite, become nutrient poor and lose their desire to eat.
Children on ADHD medication will have a poor appetite. That is a well know side affect.
And finally, everyone’s favourite. Worms. A chronic worm infestation can decrease appetite.
ARFID treatment
Treating ARFID as, well, ARFID, means your child will be treated from the perspective of having an eating disorder.
Treating ARFID from a root cause approach, and as a feeding disorder appears from a holistic perpsective to be more appropriate.
ARFID treatment at home should start with the basics, like family mealtimes, however seeking professional help is critical.
The bottom line
If your child has been diagnosed with ARFID, consider what the underlying root causes might be and work with the team at The Paediatric Naturopath to address these issues.
