Just Fussy with Food? Or Could It Be ARFID?
ARFID is a problem with eating causing a child, teen or adult to be unable to meet their nutritional requirements.
Most parents will experience conflict over food with their children at some point or another; from difficulties feeding either with the breast or the bottle in infancy, to finicky toddlers, fussy children and picky teens. Food is a notorious battleground and often vegetables are the main catalysts for some of the strongest clashes. Seemingly illogical and unfathomable, statements from children decrying certain foods based on their colour, their texture or even their proximity to other foods will try the patience of even the patron saint of parents. These are the parents who are just trying to ensure the best possible nutritional health of their children to enable them to grow and to develop.
It can be hard to know what is causing this fussiness. Is it the food itself? Is it the process of eating? Is it the power that children can wield over their parents’ reactions or is it something more serious than being ‘a bit picky’?
Presuming that there are no issues with feeding in infancy, picky eating can surface around the age of one. This is a time when many children begin to feed themselves and exert some control over their lives. They begin to select what and how much they eat. This period in their lives also coincides with a reduction in their speed of growth as well as huge developments in skills such as walking and talking. Amongst all this distraction and change, they can crave consistency, even if that comes in a small selection of foods.
Ellyn Satter, a researcher and practitioner in paediatric feeding, provides an excellent perspective on the different roles that both parents and children have around food and mealtimes:
Parents are responsible for providing healthy food at meal and snack times. Children are responsible for what and how much they eat. This helps children learn what it feels like to be hungry and then full — and how to make healthy choices based on this awareness, i.e. eating when hungry and stopping when full.
But as children get older, what should the warning signs be of something more serious? Something like ARFID (Avoidant Restrictive Food Intake Disorder)? Put simply, ARFID is a problem with eating which causes a child, teen or adult to be unable to meet their nutritional requirements. This means that they may lose weight or not grow as expected and therefore rely on nutritional supplements. The problems leading to this may be varied, from a child who consistently lacks appetite and is an extremely slow eater, to a child who has had a traumatic experience of choking and subsequently appears unable to eat solid foods. So strong is this psychological barrier that the child may be severely anxious and visibly retch or gag, if they try or are forced to speed up or try other foods. Other examples of ARFID sufferers are those who cannot tolerate certain colours of food or textures or those who have difficulty in digesting certain foods. Times which can be particularly problematic can be school lunchtimes which do not allow the child enough time to eat sufficiently or social occasions where the required food may not be available coupled with the distraction of social interaction.
Children often go through a variety of patterns with their eating and for some months stop eating a type of food that they used to love before. Many of these resolve themselves in a few months without the need for intervention. If however, symptoms worsen then this could be a warning sign. It is also worth making sure that there isn’t a physical issue with food or digestion which could further explain the symptoms.
Whilst parents of teens may be on the lookout for signs of more well known eating disorders such as anorexia or bulimia, ARFID sufferers tend not to link food to body image. However, sufferers of ARFID in childhood can go on to develop anorexia or bulimia which is another good reason to seek out treatment as soon as possible. Anxiety and depression are also not uncommon alongside this disorder.
How can parents and carers seek treatment?
It is important to see this condition as a phobia, as a fear of food. No amount of cajoling or punishing is going to work and can even serve to heighten the anxiety surrounding the process of eating. Fortunately, awareness of ARFID is increasing and some good treatments are available such as exposure therapy and specific types of hypnosis. Most treatments centre on tackling the phobia (and possible the co occurring anxiety and depression or even OCD) along with retraining the palate and certain practitioners have incredibly high success rates. Help is at hand for those who feel at their wit’s end!
Have you experiences of ARFID? What worked for you?