Tons of kids go through stages of picky eating and most kids, in general, would rather avoid the leafy greens and broccoli on their plates. But how do you know when picky eating crosses the line and becomes avoidant restrictive food intake disorder (ARFID)? Keep reading to find out the difference between normal picky eating and ARFID, signs and symptoms, and how to address it.
Is Picky Eating a Cause for Concern?
It can be alarming when children refuse to eat certain foods and have a limited selection of foods they like. Parents commonly worry about their growth and development.
Picky eating is very normal in children and is usually no cause for concern. Research shows that normal picky eating during childhood does not have negative repercussions for growth. A study published in the European Journal of Clinical Nutrition found that growth trajectories for children between the ages of 9 and 17 were largely normal, with some association with thinness at certain ages. (1)
In summary, picky eating exists on a spectrum, with the majority of cases being described as normal and not a cause for worry. Normal cases of picky eating can be managed by coordinating with your pediatrician and implementing tools at home until the child naturally becomes more open to new foods with age. Troublesome picky eating is usually a phase that lasts a few weeks to a month.
Signs of Avoidant/Restrictive Food Intake Disorder (ARFID)
ARFID is all the way at the end of the picky eating spectrum and is characterized by ongoing extreme selectiveness around food choices. How do you know if your child has ARFID? ARFID is a feeding disorder or eating disorder that has specific diagnostic criteria and is accompanied by signs, symptoms, and risk factors.
ARFID presents with serious signs and symptoms. When children aren’t eating enough, they face deficiency across a number of critically important nutrients. They are lacking enough calories for energy needs, healthy fats for skin vibrancy, vitamin D for immune support, essential amino acids for muscle growth, etc.
If your child has ARFID, you may notice some of the following warning signs and symptoms:
- Significant weight loss
- Lack of interest in food and eating
- No appetite
- Only express interest in food with certain characteristics
- Increasingly selective eating
- Gastrointestinal discomfort and abdominal pain
- Lack of energy and trouble focusing
- Wearing many layers of clothing
- Difficulty sleeping
- Feeling faint, exhausted, dizzy, or fatigued
- Afraid of choking on food
- Thin hair
- Dull skin
- Muscle wasting
Other factors may increase the likelihood of ARFID. Co-occurring conditions and factors that may contribute to the incidence of ARFID include:
- Gastrointestinal issues: If your child is allergic to certain foods or struggles with acid reflux, these symptoms may make them averse to eating normal amounts of food.
- Hospitalization in early childhood: Being hospitalized for a long period of time as a baby or a toddler may affect eating habits as an older child.
- Anxiety disorders or mental disorders: Children with ARFID tend to struggle with anxiety and mental disorders that affect their life outside of food. Anxiety disorders such as obsessive-compulsive disorder impact a child’s interaction with new foods.
- Sensory disorders: Children with ARFID may have heightened sensitivity to flavors and smells, meaning their experience with food is more intense than for the average person. As a result, what others may interpret as mildly unpleasant flavors may seem overwhelmingly disgusting for children with sensory disorders.
- Autism spectrum or developmental delays: A child with autism or developmental delays is more likely to develop ARFID.
Physicians use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria to evaluate and diagnose ARFID. In order to be diagnosed with ARFID according to the criteria, a child must be experiencing a food disturbance that results in eating an insufficient variety and amount of food to support growth. Unlike anorexia nervosa and bulimia nervosa, ARFID is not associated with a negative body image, and children with ARFID are not concerned about their body shape or weight. Children with ARFID may require oral nutritional supplements or a feeding tube. Physicians will also notice an abnormal growth pattern as well as abnormal blood tests that may reveal anemia, low potassium, and low production of hormones.
What to Do If You Think Your Child May Have a Feeding Disorder
If you’re noticing concerning symptoms and you think your child may have ARFID, the first step is to make an appointment with your pediatrician. Your pediatrician can work with you to set up an appointment with a feeding specialist or a team of providers who specialize in feeding therapy and food therapy. There are even food clinics and eating recovery centers to support your child’s treatment process. Consult your physician to come up with a plan that works best for you, your child, and your family. Thankfully, there are effective treatment options for ARFID so eating habits can be normalized and your child’s growth can get back on track.
It’s important to address and resolve all factors contributing to abnormal eating behaviors. Your child may work with specialists to address the following issues.
Resolving Gastrointestinal Issues
A gastroenterologist will evaluate your child for digestive issues, such as acid reflux, food allergies, structural abnormalities in the digestive tract, or other issues that may impede normal eating. The physician will then help resolve any issues.
Working with Mental Health Specialists
Your child may be evaluated for psychiatric disorders that may be affecting eating habits. It’s also important for children with ARFID to receive cognitive-behavioral therapy in order to identify thought patterns and triggers that may be causing an aversion to food. If your child is diagnosed with an anxiety disorder or other mental health issue, psychiatrists and psychologists will work together to make sure that your child receives appropriate medication and/or therapy to treat the issue.
Working with Ear, Nose, and Throat (ENT) Specialists
An ENT physician can evaluate if your child has congenital structural abnormalities that pose challenges to naturally chewing and swallowing food.
Working with Occupational Therapists and Speech Therapists
For some children with developmental delays or autism, speech therapists and occupational therapists are vital for supporting developmental progress. Occupational therapists also help children and families set up routines and structure to most effectively accomplish tasks necessary for everyday living, such as meal planning and eating.
Establishing Routines at Home
Your child’s treatment team will provide guidance on how to implement therapeutic tools at home in order to support healthy eating habits.
Planning Meals for Balanced Nutrition
As part of the treatment team, a nutritionist can help devise a plan for eating and supplementation as needed, to make sure that your child gets a healthy balance of macronutrients and micronutrients to support healthy growth.
Things to Keep in Mind
If your child has ARVID, rest assured that there are treatment options for successfully managing the disorder and any associated conditions. Treating ARVID is not a quick fix, and it usually requires weeks or months of continued feeding therapy. The hard work is worth it, and it will help equip your child with the eating patterns needed to sustain healthy growth and development, as well as healthy functioning as an adult.
ARVID differs from picky eating because it has serious repercussions for growth and development. Children with ARVID exhibit weight loss, muscle wasting, nutrient deficiencies, and other worrisome symptoms. ARVID can be successfully cured by treating underlying medical conditions or psychological factors, to ensure your child establishes healthy eating patterns to fuel their growth.