ARFID: Targeting the Root Cause of Food Aversions in Children

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It’s not uncommon for a child or teenager to exhibit picky eating behaviors. But when self-imposed food restrictions begin to affect growth and development, an evaluation for avoidant/restrictive food intake disorder (ARFID) may be needed.

In ARFID, individuals restrict or avoid foods to the point where they are unable to meet the nutritional requirements of the body. Unlike other common eating disorders, however, this occurs in the absence of body image issues or concerns. Common signs include placing increasing limits on foods, portion sizes, or the number of meals per day, as well as verbal aggression, irritability, or feeling overwhelmed during meals.

“ARFID is most often diagnosed in childhood or adolescence, and it is commonly linked to other comorbid conditions,” explains Asad Hussain, MD, Associate Medical Director of Princeton Center for Eating Disorders. “The first step may be to rule out a medical reason with a gastroenterologist. From there, a thorough psychiatric evaluation is vital to shed light on the underlying cause, which leads us to the right course of treatment.”

Conditions that frequently co-occur with ARFID include:

  • An anxiety disorder such as obsessive/compulsive disorder. This can precipitate ARFID, but it can also develop as a result of the fear of eating.
  • Past trauma related to eating, such as choking or excessive vomiting. Those with past trauma may even fear that they will die if they eat certain foods.
  • A sensory processing disorder that involves aversion to the smell, taste, or texture of foods. Occupational therapists at Princeton Medical Center can assess for this condition.

For growing children and teens, inadequate nutrition is a significant concern that can lead to longer-term effects, such as delayed milestones and failure to reach optimal height.

“We focus on weight restoration so that patients are medically stable, while providing psychotherapy and psychoeducation for both patients and their families,” says Dr. Hussain. “Relapse prevention is a key part of treatment from day one, and we offer tools that can be carried forward in the home setting.”

Medication also can be effective for some children and teens with ARFID. Depending on comorbid conditions, neuroleptics or anti-anxiety/antidepressant medications can be used to stimulate appetite and decrease anxiety and impulsivity without negative cognitive effects. When needed, medications are started at a low dose and titrated at a conservative pace to identify the optimal therapeutic dose.

“We strategize day-to-day across disciplines to identify and address patient needs as they evolve,” adds Dr. Hussain. “This type of collaboration helps ensure greater success in treatment.”