WHEN PICKY EATING IS A PROBLEM:
WHAT PARENTS NEED TO KNOW ABOUT ARFID By Malia Jacobson
regarding their energy needs are influenced Happily, pickiness is a passing by their poor body image. Patients with childhood phase for most kids. It ARFID are not driven by their body image in the changes that occurred in their nutritional can even be a healthy sign that habits.” children are eating intuitively, What is ARFID? according to their own internal Sometimes characterized as extreme cues of hunger or fullness, says pickiness, ARFID is an eating disorder an aversion to food and eating. “This Devan Weir, a registered dietitian involving isn't just picky eating,” says Weir. “ARFID is really extreme to the point where it's causing on staff at THIRA Health, a malnutrition and medical consequences.” mental health treatment center “Patients with ARFID have disrupted for women and girls in Bellevue, food intake based on other concerns, such as texture/color, fear of vomiting, or choking but Washington. also there are physical consequences of their In some children, though, picky eating is an early sign of Avoidant Restrictive Food Intake Disorder (ARFID), a little-known eating disorder that can cause severe nutritional deficiencies, developmental delays and family chaos. The term is unfamiliar to most parents and healthcare providers, even though ARFID affects between 5 and 14 percent of children and nearly a quarter of those in treatment for eating disorders, according to the Journal of Eating Disorders. “Most people with eating disorders are not meeting their energy needs (nutrition intake, energy expenditure) due to their behaviors, says Stephenie B. Wallace, MD, MSPH FAA, Associate Professor, UAB Pediatrics Division of Adolescent Medicine. “For patients with Anorexia nervosa and bulimia, their behaviors
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reduce intake,” Wallace says. “They have poor growth parameters such as significant weight loss, or have nutritional deficiencies. Overcoming this nutritional intake deficits can be a challenge and required frequent evaluations with dietitians and therapists. “The difference between ARFID and picky eating is that the health of children with ARFID is gravely affected by the changes in their nutrition intake” Wallace explains. “Picky eaters continue to grow and develop as expected for their age. A key part of the diagnosis for ARFID is that a nutritional deficiency, significant weight loss or reduced height growth are signs that their health is impacted by their behaviors. Children with ARFID can be affected socially as well as eating in social situations can affect
relationship with family and friends.” Formerly called “selective eating disorder,” ARFID is a relatively new diagnosis defined in the 2013 edition of the DSM, the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. Although experts believe that ARFID is on the rise, plenty of healthcare providers haven't heard of the condition, notes Weir. “Up to 63 percent of pediatricians and sub-specialists are unfamiliar with it, so parents often need to search around to find support and help.” Blood tests don't detect ARFID, making the disorder even harder to identify and treat, according to the National Eating Disorder Association (NEDA). The condition occurs in adults but is more common in children, particularly in those on the autism spectrum. Children with ARFID may have an anxiety disorder or sensory processing disorder. Researchers report that youth with ARFID are more likely to be male and have other psychiatric or mental health conditions. The most visible symptoms of ARFID are similar to other eating disorders and include dramatic weight loss, lethargy, cold intolerance, and digestive problems like constipation, cramps, or “upset stomach.” But unlike anorexia nervosa, ARFID isn't characterized by a distorted body image or fear of weight gain, says Mehri Moore, MD, THIRA Health's medical director and founder.
