Avoidant-Restrictive Food Intake Disorder, better known as ARFID, is a relatively new eating disorder in terms of its official classification and widespread understanding and acceptance. Because of this, it can be difficult to navigate for families. You may be feeling like those around you don’t understand the challenges you or your child are going through. If you want to learn more about how to help a child with ARFID or let others know more about the journey for someone with ARFID, then you’re in the right place.
Here are 4 stops to make in your journey on the way to making sense of this diagnosis.
Stop 1: What is ARFID?
Knowing what ARFID is at a deeper level than just “picky eating” is incredibly important because it helps you to avoid making incorrect assumptions, while gaining a better understanding of what lies beneath the surface.
ARFID is an eating disorder where a person cannot eat enough to meet their nutritional needs. This is because of many potential reasons (or combination of reasons), including lack of interest, avoidance based on sensory aspects of food, or concern about what might happen if they eat a food. This feeding disturbance also has to be linked with one of the following:
- Significant weight loss (or failing to gain expected weight or faltering growth in kids)
- Significant nutritional deficiency
- Dependence on tube feedings or oral nutritional supplements
- Marked interference with psychosocial functioning
It can start at any age and often shows up in those who also have other challenges or diagnoses such as anxiety, autism spectrum disorder (ASD), obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and attention-deficit hyperactivity disorder (ADHD). In fact, one study showed that one third of children with ARFID have a mood disorder, 72% have an anxiety disorder and almost 20% have an autism spectrum condition.
It can be triggered by psychologically challenging events, like an experience of choking or vomiting. It is also often triggered by a negative experience (or cumulative experiences) with food. Sometimes there may not be anything specific that triggered the onset, rather a compilation of multiple factors that add up overtime.
ARFID can present as avoiding certain food textures, aversions rooted in fears and/or restrictive practices. They may forget to eat meals and have little interest in eating or low appetite. Some other symptoms include a fear of vomiting (emetophobia), choking or having an allergic reaction, avoidance of textures in food and feeling cold.
Stop 2: What isn’t ARFID?
There are many misconceptions related to ARFID. The following are some to keep in mind when addressing your child or loved one with respect to their challenges.
- ARFID is not just a normal part of development that they will grow out of. Your child or loved one is not doing this for attention or trying to make your life difficult. Their behaviour is a form of communication which is saying “I don’t feel safe eating food or being around food”.
- ARFID is not an eating disorder related to body image, even though weight loss is often a sign of ARFID. On the same note, ARFID can occur in conjunction with other eating disorders such as anorexia nervosa (here). This is why seeking support from clinicians skilled in this area is so important to inform the best treatment plan.
- ARFID is not just having some strong food preferences, while still eating enough for the body to thrive. Those with ARFID often need supplementation because they are not eating enough to survive, or grow.
Stop 3: How to help a loved one with ARFID?
Now that we have a better understanding of what ARFID is (and isn’t), learning strategies that you can use to support your child is essential. We know this can be a stressful and intimidating process and you may be looking for a helpful place to start. Here are a few suggestions:
- Avoid pressure at the table. Build trust instead. ARFID can cause severe nutritional deficits and it is helpful to introduce new food options in small increments. Introducing new foods though is extremely challenging for a child experiencing ARFID. Strategies for introducing new foods will vary depending on the age of your child, any other medical conditions they have, their nutritional status, goals, etc. Regardless of the approach that’s taken, it’s important to never force or push new foods on your child. We always want to prioritize building trust between child and parent and a feeling of safety at the table above all else.
- Include your child in food-based decisions. A child experiencing ARFID may have heightened anxiety with food choices and incorporating new foods in their diet. One way to help ease discomfort and to help your child feel a sense of control and safety is by including them in the planning of meals and food exposure. They will likely feel more engaged and empowered when they play a leading role.
- Remember to prioritize your own wellness. It’s common to feel distressed and completely overwhelmed in the midst of taking care of your child. Remember, the best way to help those around you is by making sure that you help yourself first. This may include practicing coping skills such as mindfulness or seeking support from other loved ones or professionals.
- Be patient. ARFID is a challenging disorder and it’s hard to watch your child or loved one struggle. We know you want to do everything you can to help them, and we want you to know that everything you are doing to learn is helpful! Continue to be patient during this journey and be compassionate to yourself.
- Involve professional support. We know you want to support your child, but no one can do everything on their own! Professional support from skilled clinicians in ARFID can help discern the right treatment approach that works best for your child and you/your family!
Which leads us to stop 4!
Stop 4: Get support from others
It’s hard to make progress on the journey without support. If you’re ready for some help, please connect with us for 1:1 support and/or consider joining our ARFID Parent Support Group.
Here are some additional blogs, informative articles and insights from individuals with lived experience with ARFID to add to your reading list:
- NEDA – Avoidant Restrictive Food Intake Disorder
- Eating Recovery Centre – ARFID symptoms and treatment
- Cognitive-Behavioural Therapy for ARFID workbook
- Morgan Gale – I have ARFID
- Rachel Dorsey (Autistic SLP) – What ARFID Feels Like
P.S. If you found this blog post helpful, don’t forget to check out 7 Things you should know about ARFID.
Thank you to the group of OT students from the University of Western Ontario who contributed to this blog post, alongside Shannon Rolph, OT.
