What Is Arfid (and what to do about it)
A report came in about a young person going blind because of their eating difficulties. Today, I also had a phone call from the parent of a 5-year old autistic boy who will only eat crackers and is not getting the right help from his therapist.
So, let’s make it clear what ARFID is, what causes it, and what to do about it.
ARFID is a name given to a cluster of eating difficulties. It means Avoidant Restrictive Eating Disorder.
It exists in children who are called fussy eaters and it exists in adults in
various forms. I (Deanne Jade) am an eating disorder specialist and I am a
Selective Eater, there are many foods I just don’t eat because of texture or
taste. But I eat well. You could call me an ARFID case, but I am healthy fit
and very well fed.
An eating disorder is SPECIFICALLY eating disturbances which are motivated by the need to control weight and shape. Not all ARFID behaviours thus satisfy the definition of being a classical eating disorder like anorexia or bulimia. ARFID is a name given to a cluster of conditions which are different. These could include
ANOREXIA NERVOSA in a child. Children as young as 5 can get anorexia. The diagnosis is only valid if the eating motivations are fear of weight gain. Children with anorexia don’t usually complain of feeling fat; they are more likely to complain of tummy aches. It takes a specialist to tease out the weight control issues that are affecting their desire to eat.
SELECTIVE EATING – where a child will only eat bread and jam or crackers. Selective eating is normal in children due to something we call neophobia (fear of eating what is unfamiliar). It can be very dangerous or mild and often changes as a child ages. The REASONS are very diverse. Some children might have early traumatic experiences with choking, swallowing difficulties if given food lumps too soon fear of being sick which they associate with certain foods, or they just haven’t been well trained in eating a wide variety of foods. It is easier for a child to eat a wide variety of foods if their mother has eaten widely and well during pregnancy and breast feeding.
Selective eating can emerge due to unhelpful parenting,
family poverty where parents only give children food they will eat. They cannot
afford to buy vegetables and have them discarded. Parents who want their child to eat often don’t
know how to persuade their child to try something they dislike and give up too
easily or use the wrong skills such as shouting or bribery which often doesn’t work.
SELECTIVE EATING OR ANOREXIA – AUTISM
Arfid behaviours are common in autistic people of all ages; autistics typically have a narrow range of foods they feel able to eat. They may avoid certain colours, only eating yellow food, and commonly experience panic if they are asked to eat anything unfamiliar. The primary problem in autism is what psychologists call “central coherence”- this means problems with how the brain is wired. Wiring is not an illness but it can help make people ill; they find it hard to shift out of persistent unhelpful behaviour.
ORTHOREXIA could be viewed as a form of ARFID. Orthorexia is where people restrict the types of food that they are willing to eat because they think it is bad for them. They may for various reasons start to cut out meat, dairy food, wheat, all carbohydrate because they have developed fixations that such eating is wrong, or they are allergic. Orthorexia is associated with anxiety and in some people orthorexia is linked to weight control, being just another way of being on a diet. Orthorexia in those cases is a classical eating disorder not unlike anorexia. It is a problem when it interferes with life and general happiness. Orthorexia is explained more fully elsewhere on our website.
CHILDHOOD FOOD AVOIDANCE EMOTIONAL DISORDER is not anorexia; it is a stress response, sometimes to drama or adverse experiences during childhood. It is more common in sensitive children. We cannot make assumptions about whether the problem is in the family or in the personality of a child or their environment. A careful assessment must be made.
PERVASIVE REFUSAL to eat is present when a child is unable to take care of themselves in any way and is often the effect of trauma and abuse.
OTHER CAUSES OF ARFID
Restrictive eating can exist in people with other mental health difficulties like schizophrenia where for example, people have delusions about food in general or certain types of food. Delusions of being poisoned can lead some mentally fragile people to avoid eating.
WHAT TO DO ABOUT IT: CHILDREN
Since ARFID takes many forms, the first thing to do with a child is to see a GP, to express your concerns. A GP should track a child’s weight and growth to make sure that they continue to thrive. A GP can see if there are physical problems; it would be wrong to assume that the eating is entirely emotional.
There are things that parents can do at home. Children don’t respond well to bribery or threats. If parents regularly give pea-size portions of disliked food and gently insist that these are eaten, over time (keep going) the child will learn to accept and tolerate new tastes. Thee should be no attempts to fill up with foods high in sugar, like cakes and biscuits, although parents are rightly afraid that their child is not getting enough. If you are very worried, find a way to supplement a meagre diet with appropriate vitamins and an omega 3 supplement which is important for brain health.
Getting a child to cook with / for the family is a useful way to broaden their familiarity with new foods. You can do this with a child as young as 4 or 5 starting with things that are easy like making a smoothie (healthy) which contains a range of fruits and vegetables. We recently made carrot ice cream which our children loved.
Children live what they learn, so they will watch what their parents eat (show enthusiasm about healthful foods). It may be helpful to learn skills to hide vegetables in food, or use other tricks to ensure a child eats a less
diet. Some children grow out of ARFID, but not all.
IF THE SITUATION IS WORRYING
If a GP is worried, the next step would be to ask for an appointment with a child psychologist who will do a proper emotional risk assessment, to find out what KIND of ARFID is present. The psychologist should be able to advise on strategies to help a child eat better. CBT is useful to deal with some forms of ARFID but this is mostly for adolescents and adults.
If you have concerns about inadequate help, please call us for some advice. We have some therapists who are qualified to work with children. Call 0845 838 2040 and speak to someone who cares.