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How to Support a Child in Recovery From ARFID
Avoidant/restrictive food intake disorder (ARFID) is a type of feeding disorder in which food consumption is limited based on several potential factors, including smell, texture, taste, appearance, or a negative association with the food itself [1]. In the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), diagnostic criteria has been broadened to include adults, though this feeding issue is more prevalently observed in children and adolescents [2].
Understanding ARFID in Children
Many children commonly experience phases of picky eating while developing, with anywhere between 13 to 22 percent of children between ages three to 11 reported as picky eaters [3].
While many children will typically grow out of selective eating habits, 18 to 40 percent of rigidity concerning food persists into adolescence [4].
How is it possible for parents to discern if their child is consuming adequate nutrition, even with selective eating? Interestingly, research has shown that children with selective eating are not usually underweight, though they are often lacking in micronutrients essential for functioning.
Many children with selective eating also have other sensory concerns that influence their limited acceptability for foods and/or failure to grow as expected during childhood/adolescence. Some of these factors may be related to smell, color, texture of food, and/or taste.
Unlike anorexia nervosa, children with ARFID may present as malnourished and ill due to limited acceptability of food but without concern about shape or weight. In the most severe cases of ARFID, patients may experience nutritional deficiencies or may require feeding interventions, such as tube feeding or oral supplements.
A child with ARFID may present with many symptoms similar to anorexia nervosa and can be easily mistaken with such; however, these individuals are not concerned with weight or shape.
Supporting a Child With ARFID
If you have a child that has struggled with ARFID, you may be overwhelmed with this diagnosis, both in acceptance and treatment of this feeding disorder. Some of the specific behaviors related to ARFID that you may be dealing with include decreased appetite, food avoidance, emetophobia (fear of vomiting), and abdominal pain.
Having a child that experiences recurring episodes of these feeding behaviors can make it challenging for a family to function normally.
Some children may present with food refusal due to specific fears related to food, including vomiting, poisoning, defecation, or contamination.
This may make several aspects of family functions difficult, including going out to eat, traveling, even attending school or other social functions regularly.
The challenges of serving as a caregiver are especially demanding, often wearing on the both the child and the entire family unit.
Perhaps one of the most needed and powerful assets to caregivers during treatment for ARFID includes collaborating closely with a team of specialists who can help throughout the recovery process.
Because ARFID and other related feeding/eating disorders are complex issues that involve multiple factors, having a multidisciplinary approach can serve in the best interest of both the child and the caregivers involved.
Successful Treatment Interventions
Many different therapeutic interventions will be needed to support optimal recovery and healing from ARFID.
Ideally, treatment should support the specific and individual needs for the child while involving the family however possible. Being incorporated into the learning process for meal planning, anxiety management, and more will be essential for family members in knowing how to appropriately support their child.
Even if a child is in a treatment facility receiving care for ARFID, family members should still be incorporated in aspects of treatment, as appropriate.
Learning skills from clinicians and understanding potential triggers and stressors that your child may face in their recovery can make it easier to understand how to support them through difficult situations.
As parents, you want nothing more than for your child to thrive in life, and ARFID can taint these hopes and aspirations. However, connecting with specialized treatment can be life-saving for your child and instrumental for you in having the resources needed to know how to best support your child.
About the Author: Crystal is a Masters-level Registered Dietitian Nutritionist (RDN) with a specialty focus in eating disorders, maternal/child health and wellness, and intuitive eating. Combining clinical experience with a love of social media and writing, where her passion to help others find recovery and healing is integrated into each part of her work.
As a Certified Intuitive Eating Counselor, Crystal has dedicated her career to helping others establish a healthy relationship with food and body through her work and nutrition private practice.
References:
[1] Fisher, Martin M.; Rosen, David S.; Ornstein, Rollyn M.; Mammel, Kathleen A.; Katzman, Debra K.; Rome, Ellen S.; Callahan, S. Todd; Malizio, Joan; Kearney, Sarah (2014-07-01). “Characteristics of Avoidant/Restrictive Food Intake Disorder in Children and Adolescents: A “New Disorder” in DSM-5″. Journal of Adolescent Health. 55 (1): 49–52. doi:10.1016/j.jadohealth.2013.11.013.[2]: American Psychiatric Association. (2013). Highlights of Changes from DSM-IV-TR to DSM-5. Retrieved May 14, 2014, from http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf
[3]: Chatoor I. Feeding disorders in infants and toddlers: diagnosis and treatment. Child Adolesc Psychiatr Clin N Am. 2002;11(2):163–183. doi: 10.1016/S1056-4993(01)00002-5.
[4]: Mascola AJ, Bryson SW, Agras WS. Picky eating during childhood: a longitudinal study to age 11 years. Eat Behav. 2010;11(4):253–257. doi: 10.1016/j.eatbeh.2010.05.006.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on May 5, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on May 3, 2017.
Published on EatingDisorderHope.com
Baxter Ekern is the President of Eating Disorder Hope. He is responsible for the management and operations of Eating Disorder Hope. Baxter has been lending his services to Eating Disorder Hope for several years but came on board as the full-time president in November 2016.
