AVOIDANT FOOD INTAKE DISORDER

AN INTRODUCTION TO AVOIDANT FOOD INTAKE DISORDER (ARFID)

Avoidant food intake disorder is also referred to as a restrictive food intake disorder.

When one tends to avoid eating certain foods or even eat foods in very small quantities, that person could be suffering from avoidant food intake disorder. It is a new diagnostic term that encompasses the now obsolete feeding disorder of infancy and early childhood. Those with this condition have some difficulty with eating or feeding that makes them stay away from certain foods or even eating foods. The resultant effect is that they are unable to ingest a sufficient amount of calories or nutrients via their diet thereby leading to nutritional deficiencies, delayed growth, and difficulty in gaining weight.  In addition to the health issues that occur with this condition, they may also encounter difficulties at school or workplace such as difficulty engaging in social tasks, such as eating with others and sustaining relationships with others.

avoidant food intake disorder
Photo Credit: CFIH

Avoidant food intake disorder is a condition that usually occurs in infancy or during childhood, and can remain till adulthood. It may first look like the picky eating that is common in children. For instance, some children avoid foods of certain smell and feel, including vegetables. This behavior tends to resolve in a short amount of time without causing adverse effect to the child’s growth or development.

A child could be said to have avoidant food intake disorder if:

  • Their eating problem isn’t caused by a digestive problem or another medical condition
  • The eating problem isn’t as a result of food lack or cultural food traditions
  • The eating problem isn’t caused by an eating disorder such as bulimia
  • They are not in keeping with their normal-weight gain curve for their age
  • They failed to gain weight or lost a significant amount of weight in the previous month

Book an appointment with a doctor if your child shows signs of avoidant food intake disorder. Treatment is essential to combat both the medical and psychosocial aspects of the condition.

When intervention isn’t made, ARFID can lead to serious long-standing complications. It is thus necessary to get a precise diagnosis immediately. If your child isn’t eating well despite having a normal weight for age, an appointment with a doctor would still be beneficial.

SYMPTOMS OF AVOIDANT FOOD INTAKE DISORDER

The symptoms of this condition are alike with other conditions that may make the child malnourished. No matter how much you may think your child to be healthy, contact a doctor if you observe any of the following in your child:

  • Appearing underweight
  • Low food intake either with the quantity or frequency
  • An irritable child that cries frequently
  • The child is withdrawn or seems troubled
  • Difficulty or pain during bowel emptying
  • Frequently appears tired and sluggish
  • Vomits frequently
  • Lacks social skills appropriate for his/her age and tends to avoid others

ARFID can be mild at times, with the child not showing signs of malnourishment but rather appearing as a picky eater. Do well to inform your doctor about your child’s eating habit during a checkup.

The lack of essential vitamins and foods in a child’s diet can impart more serious vitamin deficiencies and other conditions. The child’s doctor would have to carry out a more detailed examination to know the best approach to making sure that the child receives sufficient amounts of the essential vitamins and nutrients.

CAUSES OF RESTRICTIVE FOOD INTAKE DISORDER

The specific cause of this condition remains unknown though researchers have recognized many risk factors for the condition such as:

  • Male gender
  • Those below the age of 13
  • Having gastrointestinal symptoms such as heartburn and constipation
  • Having food allergies

Most cases of poor weight gain and malnutrition are caused by some medical conditions linked to the digestive system. In other cases, a physical medical problem is unable to explain the signs and symptoms experienced. Likely non-medical causes of eating difficulties in children include:

  • The child being stressed or fearful
  • The child had a traumatic incident in the past such as choking or severe vomiting and is thus afraid to eat because of that
  • The child lacks attention from a parent or primary caregiver.
  • The child does not like food of certain consistency, smell or taste

DIAGNOSIS OF AVOIDANT FOOD INTAKE DISORDER

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a manual published by the American Psychiatric Association to assist doctors and mental health professionals in the diagnosis of mental disorders. ARFID was added as a new category for diagnosis in the new edition of DSM.

The criteria for the diagnosis of restrictive food intake disorder in a child, from DSM-5, include:

  • The child has a feeding problem such as avoiding certain foods or exhibit a lack of interest in food altogether
  • The child hasn’t gained weight in the previous month
  • Dependence on external feeding or supplements for nutrition
  • Presence of nutritional deficiencies
  • Eating problem not caused by cultural food traditions or a lack of food
  • Eating problem not caused by an existing eating disorder or poor body image

If your child seems to have this condition, you should book an appointment with your child’s doctor who will then weigh and measure your child and plot the values on a chart and compare with national averages. Additional testing may be required if the child’s weight is really low or when there is a sudden change in the child’s growth pattern.

If the doctor establishes the child to be underweight or malnourished, diagnostic tests to rule out certain medical conditions that are limiting the child’s growth would be done and these include blood, urine, and imaging tests.

If the doctor is unable to find an underlying medical condition, they will ask about the child’s feeding habit, behavior, and family environment. Based on the result gotten, you may be referred to:

  • A dietician for nutritional counseling
  • A psychologist who would study family relationships and likely triggers for any emotions the child may be feeling
  • Speech or occupational therapist to check if your child has delayed oral or motor skill development

A social worker or child protection official may be sent to work with your family if the child’s condition is believed to be due to neglect, abuse, or poverty.

TREATMENT OF RESTRICTIVE FOOD INTAKE DISORDER

When severe, hospitalization may be required and the child may need a feeding tube to get adequate nutrition.

Majority of cases have the feeding disorder addressed without needing hospitalization. Nutritional counseling or regular visits to a therapist will help the child combat the disorder. The child may be placed on a special diet or given prescribed nutritional supplements. This will help to increase their weight.

As soon as nutrient deficiencies are addressed, the child would become more alert and regular feeding would be easier.

OUTLOOK

There isn’t much information for now since avoidant food intake disorder is new. Generally, an eating disorder resolves faster if it is addressed as soon as the child starts to show signs of continuous inadequate eating.

When left untreated, an eating disorder can result in delayed physical and mental development that will cause a negative lifetime effect on the child such as speech delays or progression of the condition into adulthood. Seek treatment once symptoms are noticed to prevent complications. Talk to the child’s doctor if you suspect restrictive food intake disorder.

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