Understanding Avoidant Restrictive Food Intake Disorder in Children and Adolescents
For many parents, the hope is that their picky eater will just “grow out of it”, however, researchers at Massachusetts General Hospital (MGH) are putting greater attention on the fact that some children may actually be suffering from an eating disorder known as Avoidant Restrictive Food Intake Disorder (ARFID). This condition can be so severe, that some individuals with ARFID can list all the foods they are willing to eat on a single index card, while others may suddenly refuse to eat anything solid.
ARFID may not be a new problem, but it is the newest form of disordered eating to be recognized (since 2013) by healthcare professionals. Previously defined as a disorder exclusive to children and adolescents, the diagnostic criteria recently broadened the disorder to include adults who limit their eating and are affected by related physiological or psychological problems, but who do not fall under the definition of another eating disorder. ARFID is quite different from other eating disorders because weight and body shape are of little concern to these children and adolescents. More often than not patients who present at MGH for ARFID are seeking to gain weight. However, ARFID may be a risk factor for later-onset eating disorders. Currently, little is known about effective treatments and interventions and the course of illness for individuals who develop ARFID.
In plain language, individuals who meet the criteria for ARFID have developed some type of problem with eating (or for very young children, a problem with feeding). As a result of the eating problem, the person is not able to eat enough to get adequate calories or nutrition through their diet. There are many types of eating problems such as difficulty digesting certain foods, avoiding certain colors or textures of food, eating only very small portions, having no appetite, or being afraid to eat after a frightening episode of choking or vomiting.Because the person with ARFID is likely not receiving adequate nutrition through their diet, they may end up losing weight. Or, younger kids with ARFID might not lose weight, but rather may not gain weight or grow as expected. Other people might need supplements, such as Ensure, Pediasure or even tube feeding, to receive adequate nutrition and calories. And most of all, individuals with ARFID may have social complications at school or work because of their eating problems, such as avoiding work lunches, not getting schoolwork done because of the time it takes to eat, or even avoiding seeing friends or family at social events where food is present.
MGH’s research team is trying to figure out what exactly triggers ARFID and better ways to treat it, focusing on three different, biological causes:
- Some kids are hypersensitive to taste, texture and smell. For example, some foods — especially vegetables — can taste unusually bitter.
- Others describe a traumatic experience, like choking. These kids can become anxious about eating solid foods and avoid them.
- And some kids simply have a chronic lack of interest in food. They lose weight because they fail to eat.
It must be understood that many children develop idiosyncratic patterns of food intake, sometimes referred to as picky eaters, or refusing to eat Brussel sprouts, but have no clinical significance and remit without intervention. This does not constitute an eating disorder. Therefore, a clear distinction must be made between these behaviors and clinically significant symptoms that could otherwise go un-identified or untreated. As ARFID is still a relatively new diagnostic category, there is little data available on its development, disease course, or prognosis. We do know that symptoms typically present in infancy or childhood, but they may also present or persist into adulthood. It is possible that some individuals with ARFID may go on to develop another eating disorder, therefore, seeking professional treatment is imperative. With research initiatives such as that at MGH as well as the creation of a more inclusive diagnostic category for ARFID, those who suffer from this disorder will now be able to receive the care needed, especially so as to deter the development of other, potentially life-threatening eating disorders.
- Significant restrictive eating leading to weight loss, or a lack of weight gain
- Nutritional deficiencies
- Reliance on tube feeding and oral nutritional supplements
- Disturbances in psychosocial functioning
- Food avoidance
- Restrictive eating
- Selective eating since childhood
- Decreased appetite
- Abdominal pain
- A heightened fear of vomiting and/or choking
- Possible food texture issues
- Generalized anxiety
- Gastrointestinal symptoms
- ARFID affects about 1.5% of adolescents, which is nearly the same as the 1.7% diagnosed with anorexia and twice that of the 0.8% dealing with bulimia.
- ARFID also appears to be more common in boys than girls.