Ever wonder if your child’s picky eating is more than just picky eating? While the majority of toddlers and young children experience some type of picky eating as a normal part of their childhood development, there is a line where normal picky eating can become dangerous – and where medical and psychological intervention may be necessary.
Avoidant/Restrictive Food Intake Disorder (ARFID) is characterized by an eating or feeding disturbance that manifests as a failure to meet nutritional or energy needs. It can look much like picky eating – as both those with ARFID and those who are picky eaters have a limited range of food they like or are willing to eat – but there are several important differences to note. Here are some important differentiators between normal childhood picky eating and ARFID.
- An individual with ARFID may demonstrate sudden or significant weight loss. This could be a result of sensory sensitivities and/or aversions to food (most often caused by an adverse event or effect of eating that could include vomiting, choking or a real or feared allergic reaction) that cause restrictive eating.. Developmentally appropriate picky eaters are generally able to maintain weight despite limited food selection and do not typically experience weight loss due to a fear of vomiting or choking.
- Another characteristic of ARFID, specifically children diagnosed with this condition, can be a failure to achieve expected weight gains. This means that a child has fallen off their expected growth trajectory or might experience a failure to thrive or grow from an early age. Adults with ARFID may fail to maintain a weight that is appropriate for their unique nutritional needs. Picky eaters are generally still able to get enough nutrition and calories to maintain growth within their expected ranges on growth charts, or maintain a healthy weight.
- Someone with ARFID may be reliant on feeding tubes or nutritional supplements such as Ensure in order to obtain appropriate nutrition. Picky eater are generally able to eat enough foods and enough variety that they do not require supplementation to meet caloric needs.
- People with ARFID may have interference with psychosocial functioning. They may find it difficult to be around certain foods and thus are unable to be in social situations, eat in cafeterias, attend parties etc. They may also experience intense anxiety around anticipating what food might be available for them at social events, and may even avoid these events in response to their anxiety. A picky eater is generally able to attend social activities with little to no distress about the food that will be present.
- At times, ARFID can be triggered by a specific event or fear that arises, such as a fear of vomiting or choking. At times this will have been triggered by a specific choking or vomiting incident, but it can also arise when someone sees a person vomit and becomes intensely anxious about this happening to them. This fear then results in restriction of food intake to prevent vomiting or choking. A picky eater does not respond to fears as something that drives their eating and food choices.
- Lastly, a lack of interest in food or eating can be a sign of ARFID. Often, people with ARFID will say they are not hungry, do not think about food, and can even forget to eat because food is not a priority for them. In contrast, picky eaters do often feel hungry, are interested in eating the foods they enjoy and do not have the same lack of interest in food and eating.
While there are many differences between an actual diagnosis of ARFID and picky eating, the line can often be blurred. If you have concerns that you or your child’s picky eating may have become a problem, further assessment may be helpful. I invite you to contact Walden’s admissions department at 888-791-0004 to get the assessment and help that you deserve.
Jenna Montanez, LCSW, is an Assistant Program Director, providing supervision and clinical support within Walden’s partial hospital and intensive outpatient levels of care at the South Windsor CT clinic. Jenna received her master’s degree in social work from Washington University in St. Louis, and following graduation began working in clinical day schools. Jenna also has experience in residential and group home care with adolescents with serious mental health and trauma histories. Jenna has been with Walden Behavioral Care since August of 2016. Jenna’s current interests include supervision and training, as well as community based outreach to enhance the education of other professionals, such as educators and primary care physicians, in the area of eating disorders.