ARFID in children (avoidant / restrictive food intake disorder) 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 diagnosis purposes, ARFID falls under an eating disorder, whereas picky eating falls under 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.
Lets 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 is a diagnosis due to a child’s skill development deficit (i.e they never learnt to eat/ chew /swallow), medical, nutritional and psychosocial issue. 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 to food restriction, a systematic desensitisation approach to feeding therapy works really well. Not only that, but sensory regulation can be improved with zinc supplementation.
Fear of aversive consequences while eating
This can mean a fear of vomiting or choking. When I hear a child is afraid to ear for these reasons, my first thought is PANS/PANDAS. But I also think of thing like Eosinophilic oesophagitis (EOE), or chewing and swallowing issues. Treating these underlying conditions can stop your child being afraid of vomiting or choking.
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 on is constipation. A child with a gut full of poo will not have a robust appetite.
Zinc deficiency (common in fussy eaters due to the lack of animal protein and zinc containing foods) will suppress appetite. Iron deficiency is also a potential factor, and also common in fussy eater. It is a vicious cycle – kids restrict their appetite, get deficient in nutrients 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.
Treating ARFID as, well, ARFID, means your child will be treated from the perpective 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
So if an ARFID diagnosis is being considered for your child, consider what the underlying root causes might be and work with the team at The Paediatric Naturopath to address these issues.