Recently a mom called me about her 6-year old son, Ben, who was so picky that he was eating less than 5 different foods. Some days Ben refused to eat at all. Ben had always been a picky eater, his mother told me, but now his pickiness seemed to be getting worse and was causing a lot of stress at the dinner table. Mom was quite certain that her son didn’t have an eating disorder because Ben was not concerned about his weight or fat and he hadn’t lost weight. Mom was relived to report that the pediatrician felt that Ben was healthy and growing as expected. It is possible that Ben has the newest eating disorder, Avoidant / Restrictive Food Intake Disorder (ARFID). ARFID is included in the latest edition of the manual used to diagnose psychiatric disorders.
Here is the diagnostic criteria for ARFID: An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs. The typical ARFID patient is a young child who avoids certain colors or textures of food, eating only very small portions, having no appetite, or has become afraid to eat after an episode of choking or vomiting. While Ben’s health is not yet obviously affected, many kids with ARFID lose weight or do not grow as expected. As individuals with ARFID get older, they often have problems at school or work because of their eating problems – such as avoiding eating with others and/or not taking so much time to eat that they miss class or work.
I haven’t met Ben yet, but I will probably recommend that the parents get up to speed on ARFID. Nutritionist and therapist, Ellyn Satter’s website and books are excellent. Because ARFID is relatively new, research-based practices are lacking, but practitioners, including me, have been working in this area for a number of years. In general, the strategy is to move parents into the role of providing appropriate food without pressuring the child to eat. We find that when pressure is reduced the child often is willing to try new foods. One method of adding new foods is what is called Food Chaining. Parents figure out what flavors, textures, and temperatures the child prefers and then they introduce very similar new foods.