Hidden Struggles Of ARFID: How It Transcends Simple Picky Eating

Parents often encounter challenges when it comes to their child’s eating habits, with terms like ‘picky eating’ and ‘ARFID’ or  ‘food aversion’ frequently used. The newer new ‘Pediatric Feeding Disorder’ is also coming onto the scene. While almost all of these terms end up being labeled as ‘Picky Eating by parents and professionals’, it’s crucial to understand the distinctions between these conditions, as it shapes how we approach improving a child’s nutrition and diet variety. This guide breaks down these differences and provides insights into effectively managing each condition.

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Understanding Picky Eating

Definition:

Picky eating is a common phase among children, characterized by a preference for a limited variety of foods and a reluctance to try new foods. It’s a normal part of development for many children.

Characteristics of Picky Eating:

• Preference for specific foods and rejection of others.
• Willingness to eat some variety of foods, albeit limited.
• Often associated with phases of development.

Impact on Nutrition:

While picky eating can limit the variety of a child’s diet, it generally doesn’t result in significant nutritional deficiencies. Picky eaters typically consume enough variety to meet their nutritional needs. We say typically because it really does depend! Some kids who are picky eaters go through a phase where they don’t eat enough variety.

Treatment Suggestions for Picky Eating:

• Exposure and Encouragement:
  • Gradually introduce new foods alongside familiar favorites.
  • Encourage tasting new foods without pressure.
• Creating a Positive Mealtime Environment:
  • Make mealtimes stress-free and enjoyable.
  • Avoid turning eating into a power struggle.
• Involvement in Food Choices:
  • Involve children in meal planning and preparation to pique their interest.

Identifying Food Aversion

The term ‘Food Aversion’ can be used to describe both ARFID & Pediatric Feeding Disorder (PFD).

ARFID vs. Pediatric Feeding Disorder

ARFID Definition:

Individuals with ARFID may experience extreme anxiety or fear about certain foods, leading to avoidance. This avoidance is not due to concerns about body weight or shape, which distinguishes ARFID from other eating disorders like anorexia or bulimia. Instead, it is often related to sensory sensitivities, fear of aversive consequences (such as choking or vomiting), or other issues with food.

Characteristics of ARFID:

• Strong emotional or behavioral reactions to specific foods or textures.
• Usually based on a traumatic event (vomiting, choking) that results in a fear of eating certain foods develops
• Potential for significant nutritional deficiencies due to the extreme limitation in food choices.
• No physical difficulty with chewing or swallowing.
• Sudden and abrupt dropping of multiple foods at once.
• Previously no issues eating.

Impact on Nutrition:

Food aversion can lead to more severe nutritional deficiencies than picky eating. The extreme avoidance of certain food groups can hinder a child’s growth and development and may require intervention from a healthcare professional.

Pediatric Feeding Disorder Definition:

Impaired oral intake that is not age appropriate, and is associated with medical, nutritional, feeding skill, and or psychosocial dysfunction.

Characteristics of Pediatric Feeding Disorder (PFD):

• Difficulty Accepting Age-Appropriate Foods
• Limited Food Repertoire:
• Resistance to Trying New Foods:
• Mealtime Distress
• Oral-Motor Difficulties
• Weight or Growth Issues
• Dependence on Certain Textures or Preparations:
•  Sensory Sensitivities
• Difficulty Transitioning to Solid Foods
• Limited Independence in Feeding

Impact on Nutrition:

PDF usually leads to nutrient deficiency in several vitamins and minerals. Many children with PDF struggle even to take vitamins depending on the severity of their condition, further limiting their nutrition.

Treatment Suggestions

Treatment of ARFID and PFD is quite similar. We recommend the following:

• Professional Intervention:
  • Seek advice and assessments from feeding therapists, specifically trained in oral motor, sensory, and food sensitivities to differentiate properly between ARFID and PFD.
  • Behavioral therapy where a child is forced to eat feared foods is not recommended and can be counterproductive in addressing the root causes of ARFID.
• Customized Strategies:
  • Develop tailored strategies to gradually desensitize the individual to feared foods.
  • Address underlying sensory issues if present.
  • Address underlying oral motor weakness.
  • Address underlying gut and food sensitivities if present.
  • Address environmental factors.
  • Change the approach to talking about food.
• Nutritional Support:
  • Ensure nutritional needs are met through supplements or alternative food choices, as recommended by a healthcare professional.

Tips For Differentiating Between Picky Eating and Food Aversion For Parents and Professionals

• Intensity of Reaction:

• Picky eaters might refuse foods but don’t typically exhibit intense fear or anxiety.
• Food aversion can involve panic, distress, gagging, vomiting, crying.

• Variety in Diet:

• Picky eaters often have a limited but stable set of foods they accept.
• Children with food aversion may have a significantly more restricted diet, often eliminating entire food groups, and dropping foods they used to eat, leading to nutritional gaps.

• Consistency Over Time:

• Picky eating is a phase that children outgrow after a short period of development.
• Food aversion often persists and can worsen without intervention. Children often continue to drop foods from their diet.

• Trigger Factors:

• Picky eating is often developmental.
• Food aversion may be related to traumatic experiences, poor oral motor control, or sensory processing issues.

Differentiating between picky eating and food aversion is essential for addressing a child’s specific needs. While picky eating is a common developmental phase with limited impact on nutrition, food aversion is more complex and can significantly affect a child’s dietary variety and nutritional health. Understanding these differences enables parents and caregivers to adopt the most appropriate strategies, whether it involves gentle encouragement and exposure for picky eaters or seeking professional help for food aversion. By recognizing and responding appropriately to each condition, we can better support children in developing healthy eating habits and ensure their nutritional wellbeing.

Do you need help navigating your child’s feeding issues? If you’re local to Long Island, we would love to meet you and help in person! Give us a call at 516-669-0434 to book an evaluation and we can advise on the best course of treatment for your child’s unique situation.

Don’t live nearby? No worries! Our parent course Picky plate to Clean Slate includes a 2 hour virtual assessment where we can help you get to the bottom of your child’s feeding challenges! Visit this link here for more information.