Many kids tend to be fussy or picky eaters and avoid certain foods because of taste or texture preference. As parents and clinicians, it can be hard to distinguish between picky eating and an eating disorder that requires treatment such as Avoidant/Restrictive Food Intake Disorder or ARFID. Knowing how to distinguish picky eating from something more severe is pivotal in getting your loved ones the support they need to live a healthy and happy life.
What is ARFID?
Avoidant/Restrictive Food Intake Disorder (ARFID), captures a broad spectrum of restrictive eating behaviors that are not motivated by weight or shape. ARFID behaviors may be present throughout the lifespan. Individuals with ARFID present with a fear of foods in a way that differs from more “traditional” restrictive eating disorders like anorexia nervosa, bulimia nervosa, and binge eating disorder. The etiology (or root cause) of ARFID is not yet clear. Still, research indicates that the fear may stem from knowing they must eat when they have no interest in eating, fearing the temperature might not be what they like, fearing choking or becoming sick, or fearing the consequences of eating a new food. This fear and avoidance of food can lead to inadequate growth or weight loss, malnutrition, gastrointestinal complications, or developmental delays.
Furthermore, it is understood that similar to other eating and feeding disorders, there are subtypes of ARFID to better explain different presentations.
ARFID- Limited Intake
Those experiencing this subtype typically present with reportedly low appetite and/or overall lack of interest in eating. Individuals may be observed taking small bites of food at meals or experiencing prolonged meal times due to slow eating pace.
ARFID- Limited Variety
Those experiencing this subtype typically struggle with eating only a select number of foods based on sensory features such as: texture, taste, appearance, color, smell and/or temperature.
Those experiencing this subtype present similarly to limited intake, though food refusal is often associated with an aversive experience such as choking and/or vomiting.
However not all picky eaters can be diagnosed with ARFID - so how can you tell the difference between the two? There are five key things to consider when differentiating picky eating from the eating disorder ARFID.
5 Ways to Differentiate ARFID from Picky Eating
1. THEY EXPERIENCED FOOD RELATED TRAUMA
Oftentimes, a past traumatic experience with a food will impact the child's response to eating that same food, or others like it, in the future. For example, a child may choke on an orange, and then avoid eating all orange foods. Children with food related trauma may gag or vomit when exposed to certain foods as a reaction to their past negative experience.
2. THE HABITS HAVE NOT IMPROVED WITH AGE
The onset of ARFID can occur when solid foods are introduced or earlier. ARFID is chronic and will not resolve on its own without treatment, whereas picky eating is likely to improve with age. Picky eating will generally start to dissipate by age five. ARFID also impacts older kids, adolescents and adults, even if eating was relatively normal at an earlier age. Look out for worsening food aversions over time.
3. THERE IS A LACK OF ADEQUATE WEIGHT GAIN OR GROWTH
Children who are picky eaters may continue to follow their growth curve and experience normal development. Those experiencing ARFID may struggle to achieve normal weight gain, though not always. In more severe cases, nutrition support (tube feeding or nutritional supplements) are needed to restore weight. Nutrient deficiencies can come along with poor nutrition. Low iron, Vitamin A and Vitamin C are most common, and supplementation may be recommended as a part of treatment.
4. THEY EXHIBIT A LACK OF APPETITE AND INTEREST IN FOODS
Individuals with ARFID may lack either appetite or interest in food. The child may consciously skip meals, eat small portions or simply prefer not to eat. Individuals with ARFID have a tendency to eliminate foods and never reintroduce them back into their diet. They may eat their food slowly. The lack of desire to eat may be related to nervousness surrounding the food or low appetite. The foods that they do eat are often similar in color or texture (such as crunchy or colorless).
5. THEY ARE ANXIOUS AROUND UNFAMILIAR FOODS
The anxiety that individuals with ARFID experience around food is often more severe than a picky eater's level of food-related anxiety. Individuals with ARFID have a small list of acceptable foods. Exposure to foods that are not acceptable will increase anxiety, nervousness and panic. You may find that your child is unable to tolerate any amount of exposure to unfamiliar or unacceptable food. Teens and adults with ARFID who have more autonomy over their food choices will often revert to the same small list of foods and avoid situations where safe foods are not available in order to manage anxiety.
As a parent, it can be difficult to assess whether your picky eater is dealing with more anxiety around food than is expected for their developmental age and stage. If you are concerned that your child or loved one may be struggling with ARFID, it’s important to reach out to find support and put together a treatment plan that will help support improved outcomes and long term wellbeing. The dietitians at NourishRX are skilled in creating treatment plans for ARFID in collaboration with families and other providers. We invite you to reach out today to set up a clarity call to explore what services may be the best fit for your family.
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