Avoidant Restrictive Food intake Disorder (ARFID) in children 

Avoidant restrictive intake food disorder (ARFID) is an eating disorder affecting in particular food variety, that may lead to nutritional deficiencies, first recognised in the DSM-V criteria in 2013 affecting all age groups

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According to the DSM-5, ARFID is diagnosed when:

• An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:

  • Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).

  • Significant nutritional deficiency.

  • Dependence on enteral feeding or oral nutritional supplements.

  • Marked interference with psychosocial functioning.

• The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.

• The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.

• The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

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Management strategies for ARFID continue to evolve but include nutritional, psychological, sensory-motor and medical assessment, followed by plans focusing on:

• dietary – ensuring that nutritional needs are met to optimise growth and development

• psychological – management of parental/child anxiety and coping with mealtimes

• sensory-motor strategies – relating to the child’s environment, de-sensitisation strategies and the development of oro-motor skills.

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WARNING SIGNS & SYMPTOMS OF ARFID

Behavioral and psychological 

• Dramatic weight loss

• Dresses in layers to hide weight loss or stay warm

• Reports constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy

• Reports consistent, vague gastrointestinal issues (“upset stomach”, feels full, etc.) around mealtimes that have no known cause

• Dramatic restriction in types or amount of food eaten

• Will only eat certain textures of food

• Fears of choking or vomiting

• Lack of appetite or interest in food

• Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens).

• No body image disturbance or fear of weight gain

Physical 

Because both anorexia and ARFID involve an inability to meet nutritional needs, both disorders have similar physical signs and medical consequences.

• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

• Menstrual irregularities—missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)

• Difficulties concentrating

• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)

• Postpuberty female loses menstrual period

• Dizziness

• Fainting/syncope

• Feeling cold all the time

• Sleep problems

• Dry skin

• Dry and brittle nails

• Fine hair on body (lanugo)

• Thinning of hair on head, dry and brittle hair

• Muscle weakness

• Cold, mottled hands and feet or swelling of feet

• Poor wound healing

• Impaired immune functioning

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How our expert Paediatric Dietitian's and Occupational therapists can help?

• ARFID screening 

• Sensory eating analysis 

• Practical recommendations to increase food intake and variety 

• Liase with Paediatricians and other health care professionals 

• Oral nutrition therapy to supplement food intake 

• Food desensitisation techniques

• Increase food variety and diversity through food chaining 

• Increase proprioception and sensory awareness 

• Explain how to feed your child in their optimal environment 

• Reports 

• School meetings