Children are often described as “picky or selective eaters” if they only like a few foods, have limited intake, or avoid new foods and foods with certain textures or appearances. Although picky eating is not uncommon, and some even go through phases of picky eating, when a child does not consume enough calories to grow and develop properly, there may be something more than just picky eating.
Avoidant restrictive food intake disorder, or ARFID, is a type of eating disorder that often impacts children and adolescents. ARFID can stem from picky eating from a young age, generalized anxiety, food allergies, obsessive compulsive disorder, gastrointestinal issues, etc. ARFID is different from other eating disorders as the criteria for diagnosis does not include weight or body image concerns. For individuals with ARFID the fear may stem from knowing they must eat, when they have no interest in eating, fearing the temperature might not be what they like, fear of choking or becoming sick or fear of eating a new food.
Treatment for children with ARFID and who are “picky eaters” can look similar depending on the potential causes of “food fear”. One treatment option may be the Sequential Oral Sensory (SOS) approach to feeding, which involves positive exposure to new and/or non-preferred foods. The program allows a child to interact with food in a playful, non-stressful way, beginning with the ability to tolerate the food in the room and in front of him/her, then moving on to managing the smell of the foods, learning about how foods feel on the body and in their mouth, and then enjoying tasting and eating new foods.
ARFID, like picking and eating, is best treated by a team of professionals (physicians, counselors, dietitians, occupational therapists, social workers, speech therapists, etc.). Treatment may include nutrition counseling, medical care, and feeding therapy. Various professionals can help assess and treat the behavioral component to an eating disorder. Mental health providers are licensed professionals who can partner with other professionals on the treatment team to provide support for the child and family’s struggles with feeding. In most cases with children with ARFID, they are a psychologist, behavior analyst, or counselor who have specialized feeding training. If choking is a concern, a speech-language pathologist can do a swallowing and feeding evaluation.
If you have questions about your child’s eating, please reach out to your child’s primary care physician, speech therapist or occupational therapist!