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Avoidant/Restrictive Food Intake Disorder (ARFID). Tips for Parents


Avoidant/restrictive food intake disorder (ARFID) is an eating disorder that starts early in life. Unlike other eating disorders, ARFID does not cause body image issues or fear of gaining weight. It is all about disinterest in eating and/or fear and anxiety related to food.

A child with ARFID is an extremely picky eater and is not interested in eating. The smell, texture, appearance, taste, or even the color of the food repulses him. In some cases, the fear of pain or choking is the reason why the child may avoid eating.

Parents should seek professional advice if they suspect ARFID or other eating disorders. Eating a limited number of foods leads to malnutrition, poor growth, and delayed puberty.

Depending on the foods avoided and nutrient deficiencies, this condition can cause fatigue, dizziness, stomach cramps, slow heart rate, hair loss, fragile bones, anemia, and abnormal menstruation in girls.

ARFID can also lead to serious complications including extreme weight loss and malnutrition, which require hospitalization.

Furthermore, this condition is often associated with anxiety, obsessive-compulsive disorder, ADHD, and autism spectrum disorder.

There are support groups and organizations like the National Alliance for Eating Disorders that provide free support for children with ARFID and their family members.

But what else can you do as a parent to help your child with ARFID?

  1. Educate yourself. Set aside time every day or week to learn more about ARFID. Subscribe to podcasts on this topic or read a book (click here to find helpful books about ARFID available on Amazon). When reading blogs, it’s important to get reliable information. Focus on articles written by healthcare providers or parents of children with ARFID. Also, keep an eye on the latest research. For instance, the Eating Disorders Clinical and Research Program team developed a new cognitive-behavioral therapy specific for ARFID (CBT-AR) to treat those ages 10 and older at the Massachusetts General Hospital. The substantial results are yet to be discovered, but “preliminary results are promising”.
  2. Be a role model. If you eat a healthy diet with various foods, it will be easier for your child to follow your eating habits.
  3. Set a routine. Eat the main meals at regular times to create healthy eating habits, and also to improve digestion. Eating randomly can increase food-related stress.
  4. Create a stress-free environment at the table. Maintain a pleasant atmosphere, and avoid talking about problems that may have happened during the day. Also keep the phone and tablets away, and avoid watching TV during meals.
  5. Let your child explore his options. Encourage your child to go grocery shopping with you. Allow him to try new foods and explore new dishes, without forcing him to eat. According to the American Heart Association, research shows that it may take 11 tries for a child to decide they like a new food because they are cautious with new things. Young children may want to play with a vegetable or fruit before eating.
  6. Offer one bite at a time. Just one bite. Introduce new foods in small amounts and increase the amount over time. Repeated exposure to a food increases familiarity and the child will learn to tolerate it. Just make sure not to force one food type. Rather, introduce a variety of new foods.
  7. Offer “smart snacks”. Offer fruits and vegetables when the child is hungry as snacks. These are better than chips, cookies, or other processed foods.
  8. Reward positive eating behaviors. Set realistic expectations and involve the child in choosing the reward. Provide positive feedback and stay consistent throughout the process.
  9. Have your child around during meal prep. Allow him to get involved in cooking and ask what else you could add to the dish to make it tastier.
  10. Talk to the teachers. Discuss the accepted and preferred foods, and monitor the food intake at school. If needed, make arrangements for your child to eat lunch in a quiet location.
  11. Help your child manage stress. ARFID is often associated with excess stress, anxiety, OCD, ADHD, and autism. Mindfulness meditation can be used even at a young age. Yoga, music, art, and dance have all relaxing, anti-stress effects. There are some apps that are great options for children who feel distressed at mealtimes.
  12. Don’t neglect your well-being. Parents also need quality time to recharge. Follow a balanced diet, get enough rest, stay active, and find ways to manage stress. Know that there will be highs and lows, but overall, your child with ARFID can have this condition treated with success.

Avoidant-restrictive Food Intake Disorder Diet

There is no official ARFID Diet. The condition is treated by a team of healthcare professionals, including a dietician who will create a personalized plan.

The principles of the Mediterranean diet can be used as a guideline. It emphasizes wholesome foods, with plenty of vegetables and fruits. Whole grains, legumes, poultry, fish, seafood, olive oil, nuts, seeds, herbs, and spices are all part of the diet.

The goal is to eat a variety of foods from all food groups that provide all macronutrients - proteins, fats, carbohydrates, as well as micronutrients like vitamins and minerals.

Protein shakes, multivitamins, and mineral supplements are also a great addition to the diet.

What is not helpful

Parents sometimes use new strategies, thinking that may help their children. But some techniques prove counterproductive. These include:

  • Trying to trick children into eating certain foods.
  • Withholding the foods that are preferred in favor of healthy foods.
  • Withholding all foods and leaving the child hungry.
  • Pressuring the child to eat certain foods.

Seeking medical help is important, especially if your child has unexplained weight loss, shows signs of malnutrition, nutrient deficiencies, or experiences stress, anxiety, and other emotional troubles.

References:

Brigham, Kathryn S., Manzo, Laurie D. et al. (June 2018) Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534269/

American Heart Association (April 2015). 5 Tips to Deal with Picky Eaters (Both Kids & Adults). https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/5-tips-to-deal-with-picky-eaters-both-kids-and-adults

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