Ricky, a smiling 10 year old boy, came into my office accompanied by his mom. She and his pediatrician were concerned because Ricky was not growing the way he should. Mom says Ricky has always been a picky eater, but his list of acceptable foods has been getting smaller. He doesn’t seem to get hungry much, and says that he’s afraid that if he eats when not hungry he’ll vomit.
ARFID is a fairly new diagnosis within the category of eating disorders. Children (most often boys) with this condition appear uninterested in food or eating. They may express concern about the smell or texture of foods. Unlike the better-known anorexia, body image does not seem to play a role here. Due to limited intake, the child may lose weight or fail to gain weight and height as expected.
Kids with ARFID may also suffer from anxiety, ADHD, sensory issues, and/or gastrointestinal concerns (stomach aches, fear of vomiting or choking). Some are on medication which can also impact appetite.
As is common for kids with ARFID, Ricky wants to be able to eat more foods. He feels self-conscious about his size and is motivated by a desire to grow. He recognizes that his eating habits affect him socially as he hesitates to eat with friends, and causes him anxiety when well-meaning people encourage him to eat beyond his comfort level.
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Children with ARFID are best treated by a multidisciplinary team consisting of a behavioral psychologist, pediatrician, and nutritionist. Strategies include goal setting, changing one’s message about food, and managing anxiety. The nutritionist determines the appropriate amount and content of meals and snacks to promote growth and avoid nutrient deficiencies. Parents play a key role, offering foods according to the meal plan and displaying empathy when the child struggles.
With proper care, Ricky and others like him are able to reduce food-related anxiety and learn to eat a wider variety of foods with adequate nutrition, enabling them to grow healthfully.