What is ARFID?

ARFID, Avoidant/Restrictive Food Intake Disorder, is an eating disorder which affects many children and adults, it used to be called Selective Eating Disorder and is sometimes called extreme picky eating. It is more than just fussy eating but can look like it at first. It often needs help and support to overcome, and won’t be simply ‘outgrown’. This post is to help parents learn more about the condition.

Children with ARFID often:

• Have a very limited variety of foods they can eat (sometimes called “safe” foods)
• Only eat small amounts of their safe foods
• Take a long time to eat and may appear disinterested
• Show an intense fear of a new food or a food not on their safe list

We talked in a previous post about different levels of picky eating, and ARFID would be the most extreme end. Some of the ways to treat ARFID can be used to help children with less extreme picky eating too.

ARFID was added to the DSM-5 in 2013. The DSM–5 is the standard classification of mental disorders used by mental health professionals in the United States, and worldwide. If your doctor is not aware of ARFID you could try referring them to this page https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t18/. To get a diagnosis for your child you usually need a referral from your GP to a psychologist who specialises in eating disorders. The criteria for diagnosis would be:

1. The child is not eating appropriately and this is causing one or more (it doesn’t have to be all) of the following:
   1. Weight loss or lack of expected weight gain/growth
   2. Nutritional deficiency – e.g. if blood tests show low iron or other nutrient
   3. Dependence on supplements or feeding tubes – e.g. Sustagen / Pediasure
   4. Social issues – e.g. unable to visit a friend’s house for dinner
2. The child does not have body image issues (such as with anorexia)
3. The condition is not because of lack of food
4. There is no other medical condition causing it (e.g. teething or sickness)

It can take time but it could be worth getting a diagnosis as it may help:

• To get referrals on to specialists who can treat ARFID 
• When explaining your child’s situation to schools or others
• To allay any parental guilt around the condition
• To support a case for funding for your child (this depends on your location and any other diagnoses)

We know this has been so useful for many families. However it’s not always essential to have the formal diagnosis, if you can get the support and understanding you need without it.

The DSM-5 also mentions that ARFID may sometimes occur with other mental health disorders such as anxiety, obsessive-compulsive disorder (OCD), autism spectrum disorder , attention-deficit/hyperactivity disorder, and sensory processing disorder. This doesn’t mean that they always occur together, but it’s worth bearing in mind.

ARFID is not caused by parenting or weaning methods, or something a parent has done ‘wrong’. More research is still needed, but it is thought that ARFID is often triggered by a combination of factors including:

• Trauma in infancy (such as reflux or choking incidents)
• Food intolerances or allergies causing pain when eating
• Behavioural disorders such as anxiety or ASD
• Being overly sensitive to bitter tastes (aka Supertaster)
• Not being aware of hunger cues
• Poor oral-motor skills
• Sensory processing challenges

However, how we as parents respond to ARFID can make a difference. Getting the appropriate professional help along with supporting your child with ARFID at home may help your child get on track to a healthy relationship with food.

We’ve recently made contact with another Australian parent who is trying to raise awareness of ARFID. Saida Shae has a facebook page ARFID Warriors which aims to share information and help other parents of children with ARFID and adults with ARFID. It’s hard as parents to explain to others about the challenges our kids have when the condition is not well known. If you have a child with ARFID or suspected ARFID please join and share the ARFID Warriors page!