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Avoidant/Restrictive Food Intake Disorder (ARFID): Is My Child Just a “Picky Eater”?

Many parents negotiate with their children to eat the vegetables or meat on their plate. The reality is that many children are “picky eaters,” and it is a part of typical neural development (Silvers et al., 2023). Innate food preferences once protected human beings from ingesting poisonous or spoiled food. Today, the ‘yuck’ sensation we feel after opening the fridge to find last week’s leftovers continues to protect us against potentially hazardous foods.


However, unlike typical “picky eaters,” children with Avoidant/Restrictive Food Intake Disorder (ARFID) are considered extremely selective about what they eat, limiting their intake to only a few types of food, thereby restricting their intake of nutrients. These children often fear new foods, including their textures, smells, and tastes, or they may fear specific food-related experiences such as throwing up or choking (Thomas & Eddy, 2019). They may have also lost a significant amount of weight or rely on supplemental feeding (Silvers et al., 2023).


How many foods is too few? 

Each type of food serves an important and necessary purpose. Carbohydrates, for instance, serve as our preferred energy source, while micronutrients found in vegetables are crucial for immune functioning. According to Canada’s Food Guide (2023) eating a variety of nutritious foods is vital for growth and development. Young children especially require foods that are rich in iron (such as nuts, eggs, and dark green vegetables) and calcium (such as tofu, soybeans, and leafy greens). Therefore, it is important that your child consumes a variety of food types to support their development. 


What is the difference between ARFID and Anorexia? 

There is an important distinction between ARFID and Anorexia. Specifically, children who meet the clinical diagnostic criteria for Anorexia exhibit a preoccupation with weight or body shape. In contrast, children with ARFID do not have this preoccupation with weight or their bodies appearance (Białek-Dratwa et al., 2022). Instead, children with ARFID experience fear or disinterest in trying new foods due to sensations such as smell, taste, or texture, or they may fear specific food-related experiences. 


How can a child develop ARFID?  

Children with ARFID typically develop the condition due to "safety behaviors," which are intended to prevent frightening experiences from occurring, such as avoiding novel foods. However, avoidance does not effectively eliminate fear; instead, the more the child avoids certain foods, the more intimidating they become. If these avoidance patterns occur over a long period of time, it can make new foods seem even less appealing (Thomas & Eddy, 2019).  


Think back to your first few swimming lessons. They were probably daunting! If you hadn't learned to swim, these activities might still seem intimidating today and may have possibly led to strong aversions toward bodies of water. However, with practice, many people learn to enjoy swimming. Similarly, exposure to new foods helps reduce anxiety!


How can I support my child at home? 

 Do NOT force-feed: It's crucial to understand that children with ARFID already have a fear of food. In treatment, the goal is for them to develop a positive relationship with food. Therefore, forcing your child to eat will only increase their fear during mealtimes.

 Practice at home with novel foods because exposure reduces anxiety! Introduce a small portion of a new food alongside a larger portion of a preferred food or utilize preferred condiments. Does your child enjoy ketchup? Try serving it with the novel food!

 Do NOT trick your child: Building trust with your child is essential. When you trick them into eating foods they fear, you risk inadvertently breaking that trust. It's important for your child to see that you're on their side in overcoming this challenge.





References

Białek-Dratwa, A., Szymańska, D., Grajek, M., Krupa-Kotara, K., Szczepańska, E., & Kowalski, O. (2022). ARFID—strategies for dietary management in children. Nutrients, 14(9), 1739. https://doi.org/10.3390/nu14091739 

Health Canada. (2023). Canada's food guide: 2023. Government of Canada. Retrieved from https://www.canada.ca/en/health-canada/services/canada-food-guide.html

Silvers, E., & Erlich, K. (2023). Picky eating or something more? differentiating arfid from typical childhood development. The Nurse Practitioner48(12), 16–20. https://doi.org/10.1097/01.npr.0000000000000119

Thomas, J. J., & Eddy, K. (2019). Cognitive-behavioral therapy for avoidant/Restrictive food intake disorder: Children, adolescents, & adults. Cambridge University Press. 




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