Written by Stephanie Elliot, the author of the young adults novel, Sad Perfect. As a parent, you’ve most likely experienced some sort of picky eating in your child or children. Toddlers are known for – and prone to – refusing foods that don’t taste good, or look funny, or touch another food on their plate. Some kids are just naturally picky, refusing green vegetables or things that look weird to them. But when does it become more than just picky eating? When do you need to worry that maybe your child isn’t getting all the nutrients he needs? My daughter was an extremely picky eater as a baby and toddler, and we were not initially concerned. We chalked it up to just that – picky eating. But, sandwiched in between two brothers who never refused any foods and excitedly ate lima beans and broccoli, we began to notice that our daughter’s aversion to many foods was becoming problematic. She would cry and scream, sitting at the dinner table, shaking her head back and forth, adamant that she would not be eating what the rest of the family ate. Her main diet as a young child consisted of very basic, plain and white foods, heavy on the carbs, very low on the protein and vegetables. She ate plain bagels and bread, Goldfish, French fries, pizza with the cheese and sauce scraped off, cereal, and waffles (but refused butter and syrup). She ate all sorts of sweets, and on occasion, I could coax her to have a peeled apple slice or a few raw carrots. Her only protein source was peanut butter and Carnation Instant milk. Does this diet sound familiar to you?
Our daughter had ARFID, which is Avoidant/Restrictive Food Intake Disorder. ARFID was first defined in the DSM-5 in 2013, and is an eating disorder and a mental disorder. Children and adults with ARFID refuse a large variety of foods because they fear that eating may cause them to choke or to die. Their fight or flight instincts kick in and they believe that their survival depends on them not eating a particular food. Many people with ARFID have experienced some sort of trauma that ignited their ARFID. Some of these traumas may include a choking incident as a baby or a traumatic birth experience (cord wrapped around the neck, or difficult delivery). Since ARFID is still so very new in the medical world, there is still much to be learned. In my family’s personal experience, we noticed my daughter eating differently at a very early age. As I mentioned, we thought it was just picky eating. What makes ARFID different from picky eating is the impact it has on a person’s mental state. For our daughter, she became extremely anxious around food and at any social event that revolved around eating. If you think about it, that’s almost every event imaginable to a young child. Food is everywhere – at sleepovers, birthday parties, school, weddings, funerals. Food is a celebration, and when our daughter would become agitated and anxious anytime we were around food, we realized the matter of her ‘picky eating’ was more serious. If we went out to dinner as a family, we had to choose a place that would have a ‘safe’ food for our daughter, usually French fries or pizza. If we went to a restaurant where there was no food she would eat, I would pack her a peanut butter sandwich and some raw carrots so she would have something to eat. Our daughter began to withdraw, refusing to go to friends’ homes for fear that there would be a food that she didn’t like or she would be forced to try something. It was embarrassing for her to be at a social event and ‘pretend’ to eat what was available. For her, it was easier to avoid (there’s that word!) doing social things rather than be faced with an uncomfortable eating situation. There are characteristics of ARFID that are different than other eating disorders. ARFID is an eating disorder that is not based on body image or self-esteem. While some children with ARFID may eventually show deficiencies in weight gain and have severe health issues, that was not the case with my daughter. She reached every milestone tracked by her pediatrician. When I would share my concerns with her doctors (and I did – many, many times), I was told that she was fine, she was healthy, she was just a ‘picky eater.’ Back then, the word ARFID didn’t exist, so we didn’t have a diagnosis and get treatment for our daughter’s problem until she was a teenager. Children with ARFID may show signs of depression and anxiety. They are depressed because they tend to isolate themselves from family, friends, and food. To them, it’s easier to stay away from the situations that cause them anxiety. This can become problematic in their school years when they are trying to make friends and establish relationships with other kids. In our situation, we felt we had to deal with our daughter’s anxiety and depression first and the food part could be fixed later. Through intensive therapy, family support, and a terrific and understanding doctor, we were able to get our daughter the treatment she needed so that she could feel comfortable around foods that were not originally safe to her. It was a long road, but recovery is possible! If you are concerned that your child may have ARFID, ask these questions:
- Does he only eat a small variety of foods?
- Does she have rituals or strange/unique habits when eating the foods she is comfortable with?
- Is he anxious around mealtimes?
- Does she make up excuses in order to not eat (not hungry, tired, have a tummy ache?)
- Does he refuse invitations to parties, sleepovers, or visits with friends?
- Is dinnertime a battle?
- Do you find that you’re making something different every night to appease her tastes?
- Is there stress in the family dynamic because of these food issues?
- Does he complain that he’s hungry but then doesn’t know what he wants to/can eat?
- Do you think she is depressed?
- Is his social circle becoming smaller?
- Does she gag or vomit when and if she tries a new food?
The good thing today is that many clinicians, physicians, and psychologists are studying ARFID and learning how to treat it, whether it be through food exposure, therapy, nutrition education, or some other form of therapy. The more we talk about ARFID, the more familiar those around us will become with it, and it will no longer be a mysterious eating issue that your child has to suffer through. Each day, eating disorder specialists are learning more and more about ARFID and the techniques to treat it properly. If you suspect that your child may have ARFID, share your concerns with his doctor.
Stephanie Elliot is the author of the young adult novel, Sad Perfect, which was inspired by her own daughter’s journey with ARFID, Avoidant/Restrictive Food Intake Disorder. She writes for a variety of websites and magazines on topics such as parenting, eating disorders, mental health issues and epilepsy. She is also a book reviewer and editor. She lives in Scottsdale, Arizona, with her husband and their three children. For more info, visit www.stephanieelliot.co, http://stephanieelliot.arfid.com and on Facebook StephanieElliotAuthor. The opinions expressed in this article are those of the author and do not necessarily represent the views of Toddle About.