What Is ARFID?

Published on

30 October 2024

Avoidant/Restrictive Food Intake Disorder (ARFID) is a relatively new eating disorder, recognised for its unique characteristics that distinguish it from other feeding issues. ARFID is not about a child being fussy or having a simple preference for certain foods; it is a serious condition that impacts a child’s ability to consume enough nutrients to grow and develop properly. This disorder can lead to significant nutritional deficiencies, weight loss, or a failure to achieve expected weight gain.

Having a child with ARFID can indeed be challenging and overwhelming for any parent. The complexities of ensuring your child gets adequate nutrition while managing their aversions can be daunting. We understand your emotional and practical difficulties, but rest assured that we are here to help guide you through this journey.

Defining ARFID

ARFID, short for Avoidant/Restrictive Food Intake Disorder, is an eating disorder characterised by a persistent refusal to eat certain foods, leading to nutritional deficiencies, weight loss, or failure to grow appropriately.

Unlike other eating disorders, ARFID is not driven by body image concerns but rather by an aversion to food based on its sensory characteristics, fear of choking, or past negative experiences with eating. This disorder can manifest in various ways, including avoiding foods with specific textures, colours, or smells, and having a very limited range of acceptable foods.

Different Types of ARFID

ARFID can manifest in various ways, and understanding these different types is essential for effective management and treatment. ARFID can be categorised into five primary types:

Sensory-Based Avoidance: This type involves an aversion to the sensory properties of food, such as texture, smell, taste, or appearance. Children of this type may reject foods that are too crunchy, mushy, or unusually coloured. The sensory sensitivities can be so strong that they significantly limit the range of foods the child is willing to eat.
Fear-Based Avoidance: This type is driven by a fear of adverse consequences related to eating, such as choking, vomiting, or having an allergic reaction. The fear can stem from a past negative experience or anxiety about potential risks. Children with this type may develop intense anxiety around mealtimes and avoid eating certain foods or even entire food groups.
Limited Interest in Eating: Children of this type show little interest in food or eating. They might have a very low appetite and often need to be reminded or encouraged to eat. This lack of interest can lead to inadequate nutritional intake and growth issues. These children may eat very slowly and become full quickly.
Selective Eating: This involves a highly selective eating pattern where the child eats only a very narrow range of foods. The selectivity can be so extreme that it affects the child’s nutritional health and growth. Unlike typical picky eating, selective eating in ARFID is persistent and severe, often requiring intervention to expand the child’s diet.
Lack of Hunger: Some children with ARFID may not feel hunger signals appropriately. This can lead to irregular eating patterns and a lack of interest in food. These children may eat infrequently and often fail to consume enough calories and nutrients, affecting their overall health and development.

Understanding these types helps in tailoring specific interventions to address the unique challenges each child faces with ARFID.

What Are The Primary Indicators of ARFID?

ARFID is often misunderstood as mere fussiness or pickiness about food. However, the distinction lies in the severity and impact on the child’s health and daily functioning. Here are the primary indicators of ARFID, according to the National Eating Disorders Collaboration (NEDC):

Eating Disturbance: Individuals with ARFID exhibit a persistent disturbance in eating patterns, leading to the avoidance or restriction of food. This can be due to:
- Lack of Interest in Eating: Little to no interest in food or eating.
- Sensory Avoidance: Avoidance based on sensory characteristics like texture, smell, sight, or taste.
- Fear of Aversive Consequences: Fear or anxiety about the potential negative consequences of eating, such as choking, vomiting, or allergic reactions.
Complications from Restricted Intake: The restricted intake of food results in one or more of the following complications:
- Significant Weight Loss: Noticeable weight loss or, in children, failure to achieve expected weight gain or growth.
- Nutritional Deficiency: Significant nutritional deficiency due to limited food variety or insufficient intake of essential nutrients.
- Dependence on Nutritional Supplements: Reliance on feeding supplements or tube feeding to meet nutritional needs.
- Impaired Psychosocial Functioning: Marked interference with psychosocial functioning, affecting daily activities such as eating with others, participating in social events, or performing at school or work.
Differences from Picky Eating: Unlike typical picky eating, ARFID is associated with more severe and persistent eating disturbances that significantly impact the individual’s physical health and psychosocial functioning. Unlike ARFID, picky eating generally does not result in nutritional deficiencies or significant weight loss.
Not Linked to Body Image Concerns: Unlike other eating disorders, ARFID is not driven by concerns about body weight or shape. The avoidance or restriction of food is not related to a desire to lose weight or alter body appearance.

Recognising these indicators early is crucial to seeking appropriate intervention and support. If you suspect your child may have ARFID, consult a healthcare professional for a comprehensive assessment and guidance on the next steps.

Diagnostic Criteria of ARFID and How To Get a Diagnosis

Diagnosing ARFID involves a comprehensive evaluation by healthcare professionals, focusing on the child’s eating behaviours, nutritional status, and psychological well-being.

The process is meticulous and involves several steps to ensure an accurate diagnosis. Here’s an in-depth look at the diagnostic criteria and the steps parents need to take to get a diagnosis in Australia.

Diagnostic Criteria of ARFID

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic criteria for ARFID include:

Persistent Failure to Meet Appropriate Nutritional and/or Energy Needs: This can manifest as significant weight loss, nutritional deficiencies, dependence on nutritional supplements or tube feeding, or marked interference with psychosocial functioning.
The Disturbance is Not Better Explained by a Lack of Available Food or by a Culturally Sanctioned Practice: The eating behaviour cannot be attributed to economic or cultural reasons.
The Eating Disturbance Does Not Occur Exclusively During the Course of Anorexia Nervosa or Bulimia Nervosa, and There is No Evidence of a Disturbance in the Way One’s Body Weight or Shape is Experienced: Unlike other eating disorders, ARFID is not associated with concerns about body image or fear of gaining weight.
The Eating Disturbance is Not Attributable to a Concurrent Medical Condition or Better Explained by Another Mental Disorder: While ARFID can coexist with other conditions, such as autism spectrum disorder or anxiety, the eating behaviour itself must be distinct and not fully accounted for by these conditions.

How To Get a Diagnosis in Australia

Initial Consultation with a General Practitioner (GP): The first step is to visit a GP who will review the child’s medical history, growth patterns, and current symptoms. The GP will ask about the child’s eating habits, noticeable weight loss, nutritional intake, and any physical symptoms of malnutrition. If ARFID is suspected, the GP will refer the child to a specialist for further evaluation.
Referral to a Specialist: The child may be referred to a paediatrician, psychiatrist, or psychologist who specialises in eating disorders. These specialists have the expertise to conduct a more detailed assessment.
Comprehensive Assessment: The specialist will conduct a thorough assessment, which may include:
- Physical Examination: Checking the child’s overall health, growth charts, and any physical signs of nutritional deficiencies.
- Dietary History: Detailed inquiries about the child’s typical diet, preferred and avoided foods, mealtime behaviours, and any related anxiety or fear.
- Psychological Evaluation: Assessing for any co-occurring mental health or neurological conditions such as anxiety, depression, or autism spectrum disorder that may influence eating behaviours.
- Behavioural Observations: Observing the child’s reactions to food and mealtime interactions, possibly through structured feeding sessions or parental reports.
Multidisciplinary Team Involvement: Diagnosis often involves a team of healthcare professionals, including dietitians, occupational therapists, and speech therapists. This team approach ensures a holistic understanding of the child’s condition and helps in formulating a comprehensive treatment plan.
Diagnostic Tests: In some cases, additional tests such as blood tests, growth hormone levels, and other relevant screenings may be conducted to rule out underlying medical conditions that could affect eating behaviours.
Formal Diagnosis: After gathering all the necessary information, the specialist will determine if the child meets the criteria for ARFID. This diagnosis is made based on the persistence and severity of the symptoms and their impact on the child’s physical and psychosocial health.
Developing a Treatment Plan: Once diagnosed, the specialist will work with the family to develop a tailored treatment plan. This plan often includes behavioural therapies, nutritional interventions, and ongoing monitoring and support.

Getting an accurate diagnosis of ARFID is essential for accessing the right treatments and support. Early intervention and a multidisciplinary approach can significantly improve outcomes for children with ARFID and their families.

What Other Learning Disorders Are Associated With ARFID?

ARFID is often associated with other developmental and learning disorders. Children with ARFID may also be diagnosed with:

Autism Spectrum Disorder (ASD): Many children with ARFID are on the autism spectrum, where sensory sensitivities play a significant role in their eating habits.
Attention-Deficit/Hyperactivity Disorder (ADHD): The impulsivity and attention difficulties in ADHD can contribute to eating challenges and food avoidance.
Anxiety Disorders: Generalised anxiety or specific phobias, such as a fear of choking, can exacerbate ARFID symptoms.
Sensory Processing Disorder (SPD): Difficulties in processing sensory information can lead to aversions to certain textures and flavours of food.

How To Support A Child With ARFID And Manage Their Condition

Supporting a child with ARFID requires a comprehensive, multidisciplinary approach that addresses both the physical and psychological aspects of the disorder. Here are some key strategies to support a child with ARFID and manage their condition effectively:

Occupational Therapy: Occupational therapists (OTs) play a crucial role in helping children with ARFID, particularly those with sensory-based food aversions. OTs use a variety of techniques to gradually introduce new foods and textures in a non-threatening way. This process, known as sensory desensitisation, involves exposing the child to the sensory properties of food (e.g., touching, smelling, and eventually tasting) in a structured manner. By making these experiences positive and stress-free, children can slowly become more comfortable with a wide range of foods. Additionally, OTs work on improving the child’s overall oral motor skills, which can make eating easier and more enjoyable.
Dietary Management: A dietitian is essential in creating a balanced and nutritious eating plan that meets the child’s needs while respecting their food preferences and aversions. The dietitian will conduct a thorough nutritional assessment to identify deficiencies and develop a meal plan to ensure the child receives adequate nutrients. This plan often includes creative strategies to incorporate essential nutrients into the child’s diet, such as blending vegetables into smoothies or adding protein powders to acceptable foods. Regular monitoring and adjustments to the meal plan are necessary to adapt to the child’s evolving preferences and nutritional requirements.
Behavioural Therapy: Cognitive behavioural therapy (CBT) is an effective treatment for children with fear-based food avoidance. CBT helps children understand and manage their anxiety related to eating by gradually exposing them to feared foods in a controlled environment. This exposure therapy is combined with relaxation techniques and positive reinforcement to reduce anxiety and build positive associations with food. Over time, these therapeutic techniques help children develop coping mechanisms to manage their fears and expand their diet.
Parental Support and Education: Educating parents about ARFID is critical for successful management. Parents need to understand the nature of the disorder and the specific challenges their child faces. Involving parents in therapy sessions allows them to learn strategies to support their child’s progress at home. This might include creating a structured and positive mealtime environment, using consistent routines, and applying techniques learned in therapy. Additionally, parents can benefit from training on how to handle food-related anxiety and how to avoid reinforcing negative behaviours.
Collaborative Care: Managing ARFID effectively often requires a team approach involving paediatricians, psychologists, dietitians, and occupational therapists. Regular communication and collaboration among these professionals ensures that the child’s treatment plan is cohesive and comprehensive. This team approach also helps in identifying and addressing any co-occurring conditions, such as anxiety disorders or sensory processing issues, which can impact the child’s eating behaviour.
Emotional Support and Counselling: Children with ARFID may experience feelings of frustration, embarrassment, or isolation due to their eating habits. Providing emotional support through counselling can help them express their feelings and develop a positive self-image. Therapists can work with children to build their confidence and self-esteem, which can positively impact their willingness to try new foods and participate in social activities involving food.
School and Social Support: It is vital that schools and caregivers are aware of the child’s condition and dietary needs. Educating teachers and caregivers about ARFID can help create an environment that accommodates the child’s needs without drawing undue attention. This support can include making special arrangements for meals, providing safe food options, and ensuring that the child is not pressured or stigmatised because of their eating habits.

By implementing these strategies and working closely with healthcare professionals, parents can effectively support their child with ARFID, helping them to overcome their food aversions and develop healthier eating habits.

NDIS Support for ARFID in Australia

The National Disability Insurance Scheme (NDIS) in Australia provides support for individuals with ARFID, recognising the significant impact it can have on daily life and development. Through the NDIS, eligible children with ARFID can access a range of services tailored to their specific needs, including:

Therapy Services: Funding for occupational therapy, dietetics, and psychological support to help manage sensory sensitivities, nutritional needs, and anxiety around eating.
Nutritional Support: Assistance with obtaining specialised nutritional supplements or tube feeding if required.
Behavioural Interventions: Support for cognitive behavioural therapy (CTB) to address fear-based avoidance and develop healthier eating habits.
Assistive Technology: Provision of tools and equipment that may aid in the feeding process or make mealtimes more manageable.

To access these supports, parents need to have their child’s condition assessed and documented by relevant healthcare professionals and then apply through the NDIS. The NDIS plan will be tailored to the child’s unique requirements, ensuring they receive comprehensive support to improve their quality of life and overall well-being.

For more detailed information on NDIS support and how to apply, visit the NDIS website.

Support for Parents Who Have A Child With ARFID

It is advisable for parents to seek support to manage the challenges of raising a child with ARFID. Here are some Australian resources and support groups:

ARFID Carer Support Group: Run by Eating Disorders Families Australia (EDFA) Offers information, resources, and support for families affected by ARFID. https://edfa.org.au/strive-arfid-support-group/
Butterfly: Offers resources and support for families dealing with ARFID and other eating disorders. https://butterfly.org.au/who-we-are/contact-us/
Parent Support Groups: Joining support groups on Facebook can connect you with other parents facing similar challenges. https://www.facebook.com/groups/145750569442411/

Living with ARFID in the Family

Living with a child who has ARFID can indeed be a challenging journey. Still, it’s important to remember that with the right support, both your child and your family can lead happy and fulfilling lives. The key lies in early and accurate diagnosis, followed by a comprehensive treatment plan that includes occupational therapy, dietary management, cognitive behavioural therapy, and emotional support.

Occupational therapists can help your child overcome sensory-based food aversions through gradual, non-threatening exposure to new foods. Dietitians ensure that your child receives adequate nutrition, even within the confines of their dietary preferences, while cognitive behavioural therapy addresses anxiety and fear associated with eating. Emotional support, both for your child and yourself, is invaluable in managing the psychological aspects of ARFID.

As a parent, it is essential to stay informed and actively involved in your child’s treatment plan. Collaborating with healthcare professionals and seeking support from communities and organisations can make a significant difference. Remember, you are not alone; many families face similar challenges and have found ways to manage ARFID effectively.

With patience, persistence, and the right support network, your child can overcome the limitations of ARFID and thrive. Your family can create a nurturing and supportive environment where your child feels safe to explore new foods and develop healthier eating habits. While the road may be tough, the progress you make will contribute to a happier and healthier family life filled with hope and resilience.

FAQs

How Common Is ARFID?

ARFID is a relatively new diagnosis, and while precise prevalence rates are still being determined, it is estimated to affect about 3-5% of children, particularly those with other developmental disorders like autism.

How Does ARFID Affect A Child?

ARFID can lead to significant nutritional deficiencies, weight loss, and growth delays. It can also impact a child’s social life, as they may avoid events involving food.

Can A Child Have ARFID Without Autism or ADHD?

Yes, a child can have ARFID without having autism or ADHD. However, there is a higher prevalence of ARFID among children with these conditions due to overlapping sensory and behavioural traits.

Can A Child With ARFID Eat Out At Cafes/Restaurants?

Children with ARFID can eat out, but it often requires careful planning and accommodations. Parents may need to bring familiar foods or communicate specific needs to restaurant staff.

Do Children Grow Out Of ARFID?

While some children may see improvements over time, especially with early intervention and appropriate therapy, others may continue to experience challenges into adolescence and adulthood.

What Age Range Can You Tell If A Child Has ARFID?

ARFID can be identified in children as young as infancy and toddlerhood. However, the symptoms often become more noticeable as the child grows and their eating habits become more pronounced. Early signs include severe food aversions and failure to thrive.