ARFID in children: what does it consist of?

ARFID in children is associated with multiple nutritional complications. We show you everything you need to know about it.

Last update: December 11, 2021

Restrictive Avoidance Eating Disorder (ARFID) is a relatively new eating disorder that is included in the DSM-5. Until very recently it was called selective eating disorder and it used to be confused with anorexia. Today we teach you everything you should know about ARFID in children.

Parents usually have to deal with fussy feeding behaviors of their little ones. This can cause them to miss signs that they actually have a disorder. ARFID in children is very common, so much so that researchers estimate that affects up to 22.5% of the pediatric population. We show you more in the next few lines.

What is ARFID in children?

It is important for parents to know how to differentiate an eating disorder from the typical tantrums caused by consuming certain foods.

Restrictive Avoidance Eating Disorder (ARFID) is a category included in 2013 in the Diagnostic and Statistical Manual of Mental Disorders in its fifth edition (DSM-5). Their inclusion was made in order to collect those patients who did not respond to the characteristics of other disorders. For example, anorexia or bulimia.

Indeed, ARFID patients are not concerned about their weight. They are not dissatisfied with their body image, body shape or size. Therefore, they do not practice eating behaviors designed to lose weight in an unhealthy way.

ARFID is an eating disorder characterized by avoidance of the intake of certain types of food, or in any case of the amount of food eaten. As we have already discussed, it is not related to concerns about body image or weight; so the motivations for behavior are different from those for other disorders.

It is very easy for this condition to overlap with the typical phases of selective feeding of the infantile stage. For this, the DSM-5 specifies the following diagnostic criteria:

  • Significant weight loss (or inability to adjust to weight based on growth stage).
  • Nutritional deficiency
  • Dependence on nutritional supplements or enteral feeding.
  • Significant interference with psychosocial functioning.
  • It is not related to cultural practices or difficulties in accessing a balanced diet.
  • It manifests independently of anorexia nervosa and bulimia nervosa.
  • The disturbance cannot be explained by another disorder or an underlying medical condition.

These criteria serve as a guide when making a diagnosis of ARFID in children. Therefore, only a pediatric or mental health professional can do this. Not all behavior that involves avoidance of food intake can be classified within this disorder. The youngest ones should adapt to the considerations presented.

What are the consequences of ARFID in children?

Feeding during childhood is crucial to ensure healthy development. Changes in frequency, habits or behavior in this sense have great repercussions that do not go unnoticed.

A study published in 2015 in the journal Children’s Health Care found that poor growth and nutritional deficiency are two of the most common consequences of this type of disorder. In effect, the restriction of essential nutrients for development prevents growth expectations from being met according to the infant stage.

Children can also develop delayed puberty (if the behavior lasts longer than expected), dehydration, hypotension, heart complications, reduced bone mass, fluctuations in blood sugar levels, gastrointestinal problems, neurological disorders, disorders endocrines, anemia, malnutrition and many more.

In general, complications will become more severe as ARFID episodes in children spread. Decreased energy, drowsiness, altered moods, and poor concentration are also direct consequences. Ultimately, eating imbalances at such an important stage have severe consequences.

What are the causes of childhood ARFID?

Scientists are not sure why children or adults develop ARFID. Leaving aside the criteria of concern for weight or body image, the following hypotheses are the most likely:

  • Traumatic experiences while eating (a choking episode, for example).
  • Lack of interest in food.
  • Sensory disturbances (they are more sensitive to the taste or texture of food).
  • Underlying digestive disorders (celiac disease, reflux, and so on).

A study published in Journal of Adolescent Health in 2014 found that this disorder is more common in men and patients with generalized anxiety disorder. It is also thought to be more common in those with obsessive compulsive disorder, autism spectrum disorder, and attention deficit hyperactivity disorder.

Childhood ARFID can appear at any age and can last from a few months to several years.. A direct trigger will not always be found, so its causes will sometimes remain unclear. Since it is a recent disorder, there is still much to do about it.

What treatment options are there?

The treatment of ARFID relies heavily on collaboration between pediatricians, child psychologists, and the parents or caregivers themselves.

Given the complexity of the disorder in terms of the consequences it can generate on the health of children, it is prudent to include a treatment as soon as possible. There is no standard alternative as to how to proceed, but it is generally done taking into account the participation of professionals specialized in eating disorders.

In this sense, the team can be made up of qualified pediatricians, dietitians, nutritionists, therapists and psychologists. Sometimes a speech therapist and a pedagogue can be helpful according to the possible circumstances that have triggered the behavior.

The route of action will be determined considering the contributions that professionals can make from their respective fields. Medications may sometimes be prescribed to stimulate appetite or to treat underlying conditions. (anxiety, reflux and others). The important thing is to achieve the following:

  • Adapt to the healthy eating scheme according to the stage of development.
  • Regain the lost weight.
  • Assess the possible consequences that nutrient restriction has had on the body.
  • Improve the relationship that the child has with food.
  • Improve the child’s relationship with his parents and those around him.

Treatment of ARFID in children can be complicated and can take months or years. An early diagnosis can be of great help. In the event that eating behaviors that deviate from the typical tantrums are observed, professional care should be sought to rule out this disorder.

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