How To Know If Your “Picky Eater” Actually Has An Eating Disorder
Everything to know about ARFID, the little-known eating disorder that impacts kids of all ages.
Raise your hand if you've experienced the "picky eater" phase. Whether it's your little one who asks for Pop-Tarts all day, every day, or a teen who literally only eats grilled cheese (despite your best efforts to stick a vegetable in from time to time), most parents have been there.
Generally speaking, the picky eating phase passes with time. But for some kids, picky tendencies could actually be evidence of an eating disorder called ARFID, aka "avoidant/restrictive food intake disorder."
If you've never heard of ARFID, don't fret. The disorder has only been acknowledged as an official diagnosis for a decade, and it's not as well-known as other eating disorders, such as anorexia nervosa or bulimia nervosa. But if your child is struggling, you might wonder whether you should seek professional support or if it's truly just a phase they'll grow out of in time.
How to Know It's ARFID
ARFID can affect kids of any age, but it differs from other eating disorders in a few key ways, as Kate Dansie, MSW, LCSW-C, clinical psychotherapist at The Eating Disorder Center in Rockville, MD, tells Scary Mommy. The disorder is characterized by rigid and/or restrictive eating habits, meaning that kids with ARFID frequently avoid foods with specific tastes, textures, and/or colors. Some have extremely low interest in eating in general, while others have an extreme fear of pain, choking, or vomiting that prevents them from eating or limits them to certain types of foods.
Like anorexia nervosa, children with ARFID "share symptoms in that nutritional needs are not met in both disorders," says Dansie. "A child with ARFID does not consume enough calories to grow and develop. Typically, a child with ARFID loses weight or stops gaining weight. Vertical growth is stalled as well. However, individuals with anorexia experience great distress regarding their size and shape. This distress is not present in individuals with ARFID." Essentially, if your child is concerned about their body weight, shape, or appearance, it's more likely that they have anorexia or orthorexia.
"In contrast to ARFID, symptoms of bulimia include episodes of binge eating and recurrent behaviors (such as purging) to prevent weight gain," she adds. And while anorexia and bulimia are typically more common in girls, ARFID appears more commonly in boys, but can impact kids of all ages and genders.
As with other eating disorders, ARFID's impacts are physical and emotional, says Dansie. Along with developmental concerns and/or weight loss, "ARFID can have serious consequences to a child's health. These include gastrointestinal symptoms, impaired immune functioning, and electrolyte imbalances. Additionally, ARFID can have a significant impact on a child's social life, as they often develop a desire to avoid situations where food and eating are involved."
While picky eaters might try a bit of food to appease the person asking or eat around specific items they don't like in favor of ones they do, ARFID is characterized by severe anxiety or discomfort around trying foods or even being near them, says Dansie. Though the specific time frame varies from child to child, she notes that children with picky eating habits that do not improve are more likely to develop ARFID. It tends to develop at a younger age than other eating disorders.
ARFID and Other Concerns
"Children with anxiety, autism spectrum disorders, ADHD, and intellectual disabilities are much more likely to develop ARFID," explains Dansie. "Obsessive-compulsive disorder (OCD) and ARFID do occur together with some frequency, as individuals with OCD can develop rituals related to food preparation and intake." That's why it's crucial to check in with a licensed mental health professional if you believe your child's picky eating phase might be something more serious, as a specialist can help you navigate your little one's specific concerns/symptoms and help find the best path forward for you and them together.
"Treatment for ARFID varies, but it typically involves supporting the child and their family," says Dansie. "With the help of family members and caregivers and a therapist or dietitian, a child can begin to expand foods they are comfortable with using strategically planned exposures. Exposures start with foods and textures the child is very comfortable with and slowly become more challenging as the child builds confidence. It can also be helpful to encourage the child to interact with feared foods using other senses, such as smell, touch, and sight. Other professionals, including psychiatrists, pediatricians, and occupational therapists, are often involved."
It might sound overwhelming, but you're not alone. Your child's pediatrician and/or school counselor can help you find a specialist to suit their specific needs, which will set the course toward recovery. As with other eating disorders, recovery is possible, and there's no shame in seeking out support whenever you or your little one needs it.