Emma is four years old and her favorite foods are chicken nuggets and French fries, but she refuses all fruits and vegetables. She is growing well and has no apparent health concerns. Emma’s parents, like most parents, naturally worry when their child is reluctant to eat a variety of foods or are “picky eaters”.
It can be helpful to know that it is very common and normal for children to avoid foods because of strong tastes, unusual smells, different textures or even just the appearance of a food. Studies indicate that 13-22% of children between the ages of three and eleven could be considered “picky eaters”. With patience, continued exposure to new foods, and time for tastes to mature, most children naturally outgrow their selectiveness and can learn to enjoy a wide variety of foods by the time they are adolescents. Nevertheless, it can be upsetting to parents when a child limits themselves to only a few foods during their peak growing years. Is there a point where “picking eating” becomes dangerous?
Avoidant Restrictive Food Intake Disorder, known more commonly by its acronym ARFID, is a relatively new addition to the list of medical eating disorders. It is not as well known as anorexia nervosa or bulimia nervosa. Because it is less well known, ARFID can sometimes be dismissed as pickiness; however, it is more than “just” picky eating.
Disordered eating symptoms that may lead to a diagnosis of ARFID include:
Poor appetite and/or lack of interest in food
Fears of negative consequences of eating, such as vomiting, choking or an allergic reaction
Selective or limited food choices
AND the disordered eating is accompanied by at least one of the following:
Significant weight loss or failure to grow as expected and not related to any other medical condition
Nutritional deficiency (ex = anemia)
Dependence on liquid nutrition supplements or tube feeding
Impairment in functioning (ex = not being able to eat at school, a friend’s house or in a restaurant)
The major difference between anorexia nervosa and ARFID is that individuals with ARFID do not have body image distortion or an irrational fear of weight gain as seen in anorexia nervosa. The eating changes can come on gradually in young childhood or can occur later in adolescence after an upsetting experience with food such as choking or vomiting. Adults may even be diagnosed with ARFID after years of suffering with disordered eating. The concern comes when the lack of interest in food or the fear of eating interferes with being able to get enough to eat to maintain weight or growth. In such cases the medical consequences of ARFID can be just as severe as in anorexia nervosa.
ARFID diagnosis starts with a thorough assessment by a physician or eating disorders specialist. The health care practitioner will evaluate the history of eating and growth/weight along with a medical and mental health evaluation. Children with ADHD, obsessive compulsive disorder and anxiety disorders are more likely to be diagnosed with ARFID.
Treatment for ARFID depends on the medical complications and severity of the food restrictions. Residential eating disorders treatment or an outpatient eating disorders treatment team is often needed for complete recovery from ARFID. Click here for more information on diagnosis, symptoms and treatment.
What about Emma? For children, like Emma, who naturally prefer the tastes of particular foods over others and don’t have an eating disorder, parents may still be concerned and looking for assistance. The Ellyn Satter Institute is world-renowned for their guidance in feeding children and preventing eating disorders through research and education.