Understanding Avoidant/Restrictive Food Intake Disorder (ARFID)
Is a pediatric gastroenterologist at the Children’s Center for Digestive Health Care / GI Care for Kids, whose books on nutrition for parents led him to start Nutrition4Kids with his co-founders.
Article in collaboration with:
Mel Heyman, MD
Your child only eats a few foods or refuses altogether? Consider ARFID as a cause
Imagine not feeling comfortable eating certain foods that everybody else seems to enjoy. Might be because of the smell, the way the food feels in their mouth or simply the way the foods make them feel. When someone has trouble with eating like this, it could be because of a condition called Avoidant/Restrictive Food Intake Disorder, or ARFID for short.
What is ARFID?
ARFID is a type of eating problem where people have a hard time eating a lot of different foods. It's not the same as not liking a certain food – we all have preferences! But with ARFID, the problem goes deeper. It's like having an extreme picky eating habit, which used to be called a super picky eater or a selective feeding disorder. When someone has ARFID, they might avoid whole food groups or might not eat enough to stay healthy—and that can cause a variety of problems. And while it was first recognized in children, it's now seen in adults as well, some who have carried their problems with them from their teenage years.
What it's not
ARFID can easily be confused with anorexia nervosa, often just called anorexia, or with bulimia. Both are eating disorders, caused by concerns about weight gain or body image (how someone thinks their body looks, whether that's accurate or not). That's not the case with ARFID which has to do with avoiding foods because of the sensations and / or the difficulties they cause, and not with believing their body is too heavy.
It's also important for parents to realize that ARFID can be considered like one of the Pediatric Feeding Disorders (PFD). But many of the infants and children with pediatric feeding disorders have medical issues or difficulty with their feeding skills, resulting in their problems eating.
Different ways ARFID shows up
ARFID can be a bit tricky to understand because it isn't the same for everyone. There are different ways it can show up. It doesn't have to be all of them, as discussed in a video on recognizing ARFID by Dr. Mel Heyman, a member of the Nutrition4Kids Advisory Board:
- Texture trouble and sensitivities: Some people with ARFID don't like certain textures in their mouth. Foods that are mushy, slimy, or bumpy might not feel right to them. Or foods seem to smell or taste funny.
- Not interested in eating: Some kids or adults with ARFID just don't care about eating. They might not get hungry often and might forget to eat. Or they're so occupied by what they're doing that they don't bother eating or they fill up on fluids and unhealthy substitutes that cut down on their appetites
- Fear of bad things happening: Sometimes, people with ARFID are scared of eating. They might worry about choking, throwing up, or other bad things happening. This fear can stop them from trying new foods or even eating foods they ate before.
- Only a few favorite foods: Imagine only eating a few kinds of foods, like chicken nuggets or plain pasta, all the time—and nothing else Some people with ARFID have a really small list of foods they feel okay eating.
- Fear of trying new foods: New foods can be scary for kids or adults with ARFID. As a result, it can be difficult, even frightening, to go to some social gatherings where food is served, getting in the way of relationships and enjoyment.
Why does ARFID happen?
Doctors and scientists are still trying to figure out exactly why ARFID happens. Sometimes, it's linked to other conditions including
- sensory disorders
- anxiety, depression or the combination
- attention deficit / hyperactivity disorder (ADHD)
- being on the autism spectrum
- illnesses or medicines that cut down appetites
- bad experiences with food
Consequences
ARFID can lead to physical health complications, including weight loss and decreased growth. Even if someone's weight is normal, the lack of essential nutrients like protein, vitamins and minerals can lead to a lack of energy and nutritional deficiencies.
How can someone get help if you suspect an eating problem?
The good news is that people with ARFID can get help to feel better and learn to eat a wider variety of foods. Here are some things that can help:
Talking to a doctor: If someone thinks they or their child might have ARFID, they should talk to a doctor. Doctors can figure out what's going on, whether other problems are causing ARFID or are the result of it. And they can help make a plan.
Seeing a therapist: Therapists can teach people with ARFID how to cope with their worries about food and help them expand what they eat. They can include those who suffer ARFID in support groups and teach them relaxation techniques to conquer their anxieties.
Working with a dietitian: Dietitians are experts in food and nutrition. They can help make sure someone with ARFID is eating enough and getting the right nutrients.
Trying new foods slowly: People with ARFID don't have to jump into eating new foods all at once. They can take it slow and try tiny bits of new foods when they're ready.
Support from family and friends
If you know someone with ARFID, there are ways you can help too:
Be patient and compassionate: Understand that it might take time for them to feel comfortable with new foods. Don't push them to eat something they're not ready for.
Encourage. Don't pressure: Encourage your friend or family member to try new foods, but don't make them feel bad if they're not ready. Positive encouragement can go a long way.
Eat together: Eating with others can make trying new foods feel less scary. Offer to try new foods together, and make it a fun and supportive experience.
In conclusion
Avoidant/Restrictive Food Intake Disorder is all about having trouble with eating certain foods. Some people might not like how a food feels in their mouth, while others might be scared of eating new things. The good news is that with the right help, people with ARFID can learn to feel better about food and try new things when they're ready. If you know someone with ARFID, you can be a great friend by being patient, supportive, and understanding.
Sources
National Eating Disorders Association
Cleveland Clinic
Feeding Matters
Nutrition4Kids
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