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Every parent struggles with getting their kids to eat something other than french fries and ketchup. And while there are plenty of tricks and tips to expand your toddler’s palate, sometimes picky eating can be a more serious problem.
People with ARFID (avoidant/restrictive food intake disorder) might avoid solid foods or all fruits and vegetables. They might only eat things that are bland, like plain pasta, or things that are crunchy or crispy.
Very often, they don’t feel hungry at all. They may steer clear of the dinner table altogether and pretty soon, it can begin to affect their weight.
Researchers aren’t sure exactly how common it is, although one study found ARFID to affect around 3% of children (Kurz, 2015). It seems to be more common in boys, and surprisingly, most pediatricians have never heard of it (Katzman, 2014). This may be because the official term ARFID is relatively new. The condition, however, isn’t new at all.
Many people who are eventually diagnosed with ARFID report having the condition dismissed as simply picky eating. They also might be told they’ll grow out of it. But when eating habits start to affect your weight, it may be time to visit a specialist.
What is ARFID?
In many ways, ARFID is a lot like anorexia. In both conditions, a person restricts the amount of food they eat.
While people with anorexia do this because they’re concerned about body image, people with ARFID don’t share those concerns. If you notice your child is extremely selective when it comes to food and makes it hard for them to eat a balanced diet, you may have a child with ARFID.
The condition is characterized as a selective eating disorder, which involves problematic eating habits due to:
- Not being able to handle the taste, texture, or appearance of certain foods
- Fear of eating-related problems, such as choking, vomiting, or stomach pain
- A lack of interest in food or eating
While certain other eating disorders may be related to a fear of weight gain or body image concerns, ARFID is different. Here, a person has an aversion to eating––unrelated to how their body looks.
What causes ARFID?
Clinicians don’t know precisely what causes ARFID, but there are a few possibilities.
Some researchers suggest that heightened senses make some people more conscious of how foods taste, smell, and feel. With heightened senses, vegetables might taste extra bitter and fruit might feel too slimy. People who don’t like the taste or texture of certain ingredients may be less willing to try new ones, too (Brigham, 2018).
Traumatic experiences can lead to fear and anxiety about eating. These experiences include choking on food, vomiting, or experiencing an allergic reaction. People with ARFID may choose to avoid particular foods that remind them of the trauma––or avoid eating altogether.
Also, some people simply don’t enjoy eating and treat it as a chore.
Scientists have also found that ARFID is more common in people with other mental health conditions like anxiety disorders and obsessive-compulsive disorder (OCD). Sometimes, treatment for any underlying conditions can help with eating behaviors as well.
Anxiety: signs, symptoms, and solutions
Signs and symptoms of ARFID
ARFID causes different types of eating patterns. Some people avoid eating all food, while others only avoid certain types.
Picky eating is common in childhood and typically improves as kids get older. ARFID, on the other hand, often gets worse with age and usually requires professional treatment (Brigham, 2018).
ARFID can cause significant weight loss or lack of weight gain in children and teens who are still growing. Depending on the situation, ARFID can also lead to nutritional deficiencies.
Symptoms of general malnutrition include dizziness, tiredness, and fainting (Brigham, 2018). In the long term, the condition can affect brain development, bone development, and more.
When is it time to seek medical help?
When eating habits affect a person’s body weight, it might be time to seek medical help.
For adults, this usually means weight loss. There might not be overt weight loss with children and teens, but there could be a lack of age-appropriate weight gain.
The first step is to discuss your concerns with a healthcare provider. They’ll likely ask you about eating habits and behavioral patterns. They can choose to refer you to a mental health professional or nutritional specialist.
Treatment options for ARFID
Severe cases of ARFID could require hospitalization. In these cases, patients are treated with tube feedings where they receive nutrients directly into their body with a tube that goes into their stomach.
They may also be given nutritional supplements and be hydrated through an IV. Once patients are medically stable, treatment typically continues outside the hospital at an outpatient facility for eating disorder recovery (Brigham, 2018).
Psychotherapy, day treatment centers, and eating disorder treatment programs are all great options for outpatient recovery. Cognitive behavioral therapy is a common approach that teaches techniques to help target the underlying cause of ARFID.
Day treatments and eating disorder programs provide structured mealtimes and support to get patients to a healthy weight while adding variety to their diet. Parents of children with ARFID may wish to enroll in family-based treatment and parent training (Thomas, 2018).
Childhood obesity: a growing public health issue
There aren’t any specific medications approved for ARFID, but there are medications commonly used to treat it. Antidepressants like mirtazapine can help with eating anxiety, improve appetite, and result in weight gain. In one small study, children who took mirtazapine (see Important Safety Information) had a faster rate of weight gain (Gray, 2018).
Cyproheptadine is an allergy medication also used to help underweight children. It works by stimulating appetite. One pediatric feeding program reported kids who took cyproheptadine had a better appetite, gained more weight, and developed better eating habits (Sant’Anna, 2014).
If you or someone you know is experiencing symptoms of ARFID, look for a specialist in your area to speak about the various treatment options. If your primary care provider doesn’t have the resources to help you, don’t be discouraged. There are treatment programs and centers that can help a person regulate their eating habits, and lots of trained specialists who can help.
- Brigham, K. S., Manzo, L. D., Eddy, K. T., & Thomas, J. J. (2018). Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents. Current Pediatrics Reports, 6(2), 107–113. doi: 10.1007/s40124-018-0162-y. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31134139/
- Gray, E., Chen, T., Menzel, J., Schwartz, T., & Kaye, W. H. (2018). Mirtazapine and Weight Gain in Avoidant and Restrictive Food Intake Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 57(4), 288–289. doi: 10.1016/j.jaac.2018.01.011. Retrieved from https://sci-hub.do/10.1016/j.jaac.2018.01.011
- Katzman, D. K., Stevens, K., & Norris, M. (2014). Redefining feeding and eating disorders: What is avoidant/restrictive food intake disorder?. Paediatrics & Child Health, 19(8), 445–446. doi: 10.1093/pch/19.8.445. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4220532/
- Kurz, S., van Dyck, Z., Dremmel, D., Munsch, S., & Hilbert, A. (2015). Early-onset restrictive eating disturbances in primary school boys and girls. European Child & Adolescent Psychiatry, 24(7), 779–785. doi: 10.1007/s00787-014-0622-z. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25296563/
- Sant’Anna, A. M., Hammes, P. S., Porporino, M., Martel, C., Zygmuntowicz, C., & Ramsay, M. (2014). Use of cyproheptadine in young children with feeding difficulties and poor growth in a pediatric feeding program. Journal of Pediatric Gastroenterology and Nutrition, 59(5), 674–678. doi: 10.1097/MPG.0000000000000467. Retrieved from https://www.researchgate.net/publication/263289493_The_Use_of_Cyproheptadine_In_Young_Children_With_Feeding_Difficulties_and_Poor_Growth_at_a_Pediatric_Feeding_Program
- Strand, M., von Hausswolff-Juhlin, Y., & Welch, E. (2018). ARFID: food restriction without fear of weight gain. Lakartidningen, 115, E97R. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30226628/
- Thomas, J. J., Wons, O. B., & Eddy, K. T. (2018). Cognitive-behavioral treatment of avoidant/restrictive food intake disorder. Current Opinion in Psychiatry, 31(6), 425–430. doi: 10.1097/YCO.0000000000000454. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30102641/
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.