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Parenting a Child with ARFID: Warning Signs & Treatment
Contributor: Margaret Geraci, RD, LDN, Director of Nutrition Services, Timberline Knolls
Countless parents may struggle with mealtime battles when it comes to child feeding. Whether it be picky eating, behavioral issues at the dinner table, or simply knowing whether a child is consuming adequate nutrition, feeding children can trigger a host of doubts and questions.
For children that struggle with avoidant/restrictive food intake disorder (ARFID), the challenges and difficulties around child feeding can become overwhelming. Understanding the basis of this feeding disorder, warning signs, and treatment options can support parents and caregivers who are raising a child with ARFID.
Understanding ARFID
On the surface, ARFID may appear to be picky or selective eating, but there are many more factors involved than meet the eye.
In the most recent version of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), the diagnostic criteria for ARFID was defined as [1]:
- A disturbance in feeding or eating behaviors as manifested by persistent failure to meet appropriate nutritional/energy needs
- Feeding disturbances cannot be explained by lack of food or cultural practice
- Feeding disturbance is not attributed to a co-occurring medical condition or other mental health disorder
- No evidence of body image/weight disturbances
- Feeding disturbances do not occur exclusively during the course of other eating disorders, like anorexia or bulimia nervosa
Children who struggle with ARFID may display a variety of feeding disturbances, including aversion to certain flavors, avoidance of foods with particular colors or textures, expressing fear of eating due to concerns about choking or vomiting, eating very small portion sizes, lack of appetite, and/or difficulty with digestion.
A child dealing with ARFID may not necessarily suffer significant weight loss, but may slow and/or stop expected growth due to nutritional inadequacies, which is equally concerning.
While ARFID can be diagnosed in adults and children, it is the second most common eating disorder among children twelve years old and younger [2].
Warning Signs of ARFID
In many situations, ARFID may initially begin as picky eating, or the consumption of a limited number of preferred foods; however, the food choices of a person with ARFID will become more selective and rigid over time. A child with ARFID may also express fears of eating certain foods or will refuse to eat meals and snacks altogether.
Eating in front of others can also be a stressor for a child with ARFID, with an observable reluctance toward eating in social situations, including at school or in restaurants. While it is common for children to go through phases of picky eating or selectivity with certain foods, a child with ARFID will engage in feeding behaviors that worsen over time, severely narrowing their range of acceptable foods.
Those with ARFID may be at risk for several health consequences as a result of their feeding behaviors, which can be distressing for both the child and the entire family. It is not uncommon for other mental health disorders to co-occur with ARFID, such as anxiety disorders, which can make the illness even more complex.
For parents or caregivers who are navigating these waters, it is important to know that you are not alone and several resources are available to support you and your family.
Seeking Out Professional Treatment
If you suspect that your child or loved one may be suffering with ARFID, it is crucial to seek out a professional assessment with a qualified professional. This is a necessary first step toward determining an individualized care plan that will meet the unique needs your child has when it comes to their physical, emotional, and mental well-being.
Various forms of treatment may be applicable, depending on the needs of your child. In some cases, if a child is medically unstable, more acute treatment may need to be provided within a hospital or residential care setting. If your child with ARFID has reached medical and psychiatric stability, intensive outpatient or outpatient care may be suitable for meeting their treatment needs.
Treatment approaches for ARFID can include a combination of medical nutrition therapy, behavioral interventions, psychotherapy, family-based treatment, and medication management. Families play an important role in helping a child to recover from ARFID and are in no way to blame for this complex feeding disorder.
While evidenced-based treatments are still being developed for ARFID, it is essential to connect to specialized treatments that can reduce the morbidities connected with this illness [3].
About the Author: Margaret Geraci, RD, LDN, is Director of Nutrition Services at Timberline Knolls Residential Treatment Center.
As Director of Nutrition Services, Maggie‘s job entails many duties. She oversees the dietitians and diet technicians, carries a caseload of adolescents, supervises the menu and meal planning stages and develops nutrition-related protocols. She also implements current nutrition recommendations, participates in community outreach and trains dietitians.
Prior to joining Timberline Knolls, Maggie was the Nutrition Manager at Revolution in Chicago. She started with Timberline Knolls as a diet technician and progressed to a Registered Dietitian.
Maggie attended Eastern Illinois University for her undergraduate degree in Dietetics and Nutrition and then completed her dietetic internship at Ingalls Memorial Hospital.
She is a member of the Academy of Nutrition and Dietetics, Behavioral Health DPG and South Suburban Academy of Nutrition and Dietetics.
References:
[1]: American Psychiatric Association, “Diagnostic and Statistical Manual of Mental Disorders (DSM-5) https://www.psychiatry.org/psychiatrists/practice/dsm Accessed 15 June 2017[2]: National Eating Disorder Association, “Avoidant-Restrictive Food Intake Disorder”, https://www.nationaleatingdisorders.org/avoidant-restrictive-food-intake-disorder-arfid Accessed 15 June 2017
[3]: Norris, M. L., Spettigue, W. J., & Katzman, D. K. (2016). Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatric Disease and Treatment, 12, 213–218. http://doi.org/10.2147/NDT.S82538
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 July 1, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on July 1, 2017
Published on EatingDisorderHope.com
