Fussy eating and ARFID

Fussy or ‘picky’ eating, is a common behaviour in children where they have a limited range of preferred foods and may be unwilling to try new foods. Fussy eating is generally not a cause for concern, as many children eventually outgrow it as they mature and become more adventurous with their food choices, have positive exploratory and/or vicarious food experiences, and develop their palate.

Avoidant Restrictive Food Intake Disorder (ARFID), on the other hand, is a more serious condition where an individual has a persistent and extreme avoidance or restriction of certain foods or food groups that result in significant weight loss, malnutrition, or other health problems. The eating disturbance may be associated with an apparent lack of interest in food, avoidance based on experienced or feared sensory characteristics of certain food, or fear about adverse consequences of eating e.g., nausea. Over time, these habits tend to become associated with increasing levels of anxiety for the child around eating or in anticipation of eating. ARFID is typically diagnosed in children or adolescents, but it can also affect adults. While ARFID is a feeding disorder, it is not an eating disorder such as Anorexia Nervosa, and is more similar to a phobia of food/s.

The key differences between fussy eating and ARFID are:

Severity: While fussy eating is a mild form of food selectivity that does not affect an individual’s health, ARFID is a more severe form of selective eating that can lead to significant weight loss, malnutrition, and other health problems.
Range of Foods Avoided: Fussy eaters may avoid certain foods or food groups, but they generally have a wide enough range of acceptable foods to maintain a healthy diet. In contrast, individuals with ARFID avoid a much broader range of foods, often to the point where they are unable to consume a balanced and nutritious diet.
Psychological Factors: ARFID is often associated with psychological factors, such as anxiety, sensory sensitivity, or trauma, that affect an individual’s relationship with food. In contrast, fussy eating is typically a result of normal developmental stages or environmental factors, such as texture or taste preferences.

In summary, while fussy eating is a common and usually mild behaviour, ARFID is a more severe disorder that requires treatment to ensure the individual’s health and well-being. While children will often ‘grow out of’ phases of fussy eating, ARFID may well worsen without treatment.

So how do parents recognise ARFID?

Parents can recognise ARFID by observing their child’s eating habits and behaviours. Some signs and symptoms of ARFID include:

Avoidance or Restriction of Certain Foods, and/or anxious distress associated with certain food. Children with ARFID may avoid entire food groups or specific textures, colours, or flavours. They may also have a limited range of foods they are willing to eat.
Lack of Interest in Food: Children with ARFID may show little interest in food, even when they are hungry. They may not have a typical appetite or desire to eat.
Slow Eating or Prolonged Meals: Children with ARFID may take a long time to eat or prolong mealtimes because of their anxiety about food.
Weight Loss or Poor Growth: Children with ARFID may have a failure to gain weight or may experience weight loss. They may also have other symptoms of malnutrition, such as fatigue or irritability.
Gastrointestinal Symptoms: Children with ARFID may experience gastrointestinal symptoms, such as bloating, constipation, or stomach pain, due to their limited food intake.

If parents notice any of these signs or symptoms, they should talk to their child’s doctor or a registered dietitian for an assessment. A diagnosis of ARFID requires a thorough medical and psychological evaluation by a qualified healthcare professional.

What can we do about ARFID?

Treatment for ARFID typically involves a multidisciplinary approach that addresses both the medical and psychological aspects of the disorder. The goal of treatment is to help the individual consume a nutritionally adequate and balanced diet, and to reduce the anxiety and fear associated with eating. Medical screening should also rule out any allergies or intolerances that may be affecting the eating experience.

The following are some of the treatment options that may be used to manage ARFID:

Nutritional Management: A registered dietitian can help develop a meal plan that is tailored to the individual’s needs and preferences. The meal plan should be balanced and nutritionally adequate to ensure that the individual is getting all the necessary nutrients.
Psychological Therapy: Cognitive-behavioural therapy (CBT) and exposure therapy are effective in treating ARFID. CBT helps the individual identify and challenge their negative thoughts and beliefs about food, while exposure therapy gradually exposes the individual to feared foods and encourages positive reinforcement.
Family-Based Treatment: Family-based treatment involves the whole family in the treatment process. It helps parents and caregivers develop strategies to manage their child’s food intake and address any anxiety or fear associated with food.
Medications: In some cases, medications may be prescribed to help reduce anxiety and increase appetite.
Support Groups: Support groups can be helpful for both the individual and their family. They offer a safe space for individuals with ARFID and their families to share their experiences and connect with others who are going through similar challenges.

It is important to seek help as soon as possible if you suspect that your child or a loved one has ARFID. Early intervention and treatment can help prevent complications and improve the individual’s quality of life.

What if it’s just fussy eating? How can that be improved?

If a child is a fussy eater, there are several strategies parents can use to encourage them to try new foods and expand their palate. Here are some tips to help improve fussy eating:

Offer a variety of foods: Offer a variety of healthy foods at each meal, including fruits, vegetables, whole grains, and lean protein. Offer small portions of new foods alongside familiar ones.
Be a role model: Children often imitate what their parents and caregivers do. So, if you eat a variety of foods and enjoy them, your child is more likely to try new foods as well.
Involve your child in meal planning and preparation: Involve your child in the meal planning and preparation process. Take them to the grocery store, let them help with cooking, and make it fun.
Make mealtimes pleasant: Make mealtimes a pleasant and stress-free experience. Avoid pressuring or bribing your child to eat, and don’t make a big deal out of it if they refuse a certain food. Never refuse your child’s request to try some of your food.
Be patient: It can take multiple exposures to a new food before a child will try it. Be patient and keep offering new foods in a non-threatening way.
Use positive reinforcement: When your child tries a new food, provide positive feedback and praise. Even if they don’t like it, praise them for trying something new.
Don’t give up: Keep trying. Children’s food preferences can change over time, so don’t give up on introducing new foods.

By following these tips, parents can help their child overcome fussy eating and develop a more varied and balanced diet. If fussy eating persists, it’s important to consult a healthcare professional or registered dietitian for further guidance and assessment.

Corrie is the Clinical Director and the principal Clinical Psychologist of Sydney Phobia Clinic. Corrie holds a Bachelor of Psychology (Honours) and Master of Psychology (Clinical) from Western Sydney University, and a PhD from UNSW. She has experience across psychological presentations and has worked in the area of severe anxiety presentations and phobias for more than 10 years. Before opening Sydney Phobia Clinic, Corrie worked for 8 years as Clinical Psychologist at Sydney Obsessive Compulsive and Anxiety Disorders Practice (SOCAD). As such, OCD and related concerns are still a strong area of practice for Corrie. Corrie is a registered supervisor, providing supervision for anxiety and OCD related presentations, as well as to training psychologists. Corrie has a PhD from UNSW in the schools of psychology and aviation and is the national lead clinical psychologist for Flight Experience Global managing the delivery of fear of flying programs across Australia.