Monday 21 October 2019

When does fussy eating become a disorder? What you need to know about Arfid

In recent years, paediatric nutritionists have noticed an increase in the numbers of children and teenagers with Arfid.
In recent years, paediatric nutritionists have noticed an increase in the numbers of children and teenagers with Arfid.
Kirsty Blake Knox

Kirsty Blake Knox

In an ideal world children would voluntarily tuck into cucumber and quinoa, rather than chicken nuggets and chips.

In reality of course, the reverse is usually the case. And most parents occasionally struggle to encourage their children to eat healthily/ consume the full alphabet of vitamins and minerals.

But when does fussy eating start to stray into disordered eating?

In recent years, paediatric nutritionists have noticed an increase in the numbers of children and teenagers with Arfid - avoidant-restrictive food intake disorder - whereby an individual avoids certain foods or types of foods.

In its most extreme cases it results in individuals becoming deprived of essential nutrients which can have a devastating long term impact on their health.

Earlier this month, a teenage boy in the UK went deaf and blind due to a junk food diet of chips, crisps and processed meats.

The 17-year old from Bristol suffered from an selective eating disorder diet, sustained over a decade. He told doctors he did not like the texture of fruit and vegetables and had been dismissed as nothing more than a 'picky eater'.

Eventually his diet resulted in nutritional optic neuropathy; and his mother has now given up her job to care for her son. She has said that the condition has “devastated his life”.

Arfid was recognised only recently; it was added to the Diagnostic and Statistical Manual of Mental Disorders, the pre-eminent resource in the US for diagnosing psychiatric conditions, in 2013.

As a result, there is limited data or literature on its prevalence, although it is thought to be more common in people with autism.

According to Barry Murphy with the Eating Disorders Association of Ireland, Bodywhys, Arfid can manifest for three different reasons.

An individual can have extreme sensitivities to the sensory properties of food. They can often have an aversion to the sound, the smell, the appearance, the colour, taste, and texture of food. They find all these sensory properties triggering and repellent.

Arfid can also manifest itself if a child has a complete lack of interest in food, or if an individual has experienced trauma or a significant event which means they then begin to worry about the food that they eat.

For example, they may have choked on a piece of food and have negative association. They then start to avoid not just that particular food, but other foodstuff reminiscent of it. The more an individual avoids a stimulus, the bigger issue it will become.

According to Dr Jennifer Twyford-Hynes, Chartered Member of the Psychological Society of Ireland, having a 'fussy eater' is not cause for concern.

But parents should keep an eye out for signs that fussy eating is be veering into disordered eating.

READ MORE: Teen went blind after only eating a junk food diet of chips, crisps and white bread

"Fussy eating is a common and normative part of child development," she said. "ARFID differs in severity, as it results in significant nutritional deficiency, dependence on supplemental feeding and/or significantly interferes with an individual’s psychosocial functioning."

Potential signs of Arfid include when a child or teenager avoids entire food groups, or tries to opt out of social events where food is present.

Other indicators include; a sensitivity to aspects of food such as temperature and texture, gagging when presented with food, and a limited diet (with 10 'preferred/ favourite' foods).

Arfid can affect the growth of a child and result in a lack of energy, so if you're child is tired a lot of the time, it may be time to review their diet.

If you suspect your child or teenager may have Arfid, it is essential to seek medical advice.

Parents should not feel guilty if there child has Arfid - this is a form of disordered eating. It is not a case of simply being strict and 'not taking no for an answer' at meal times. This is a lot more complex.

There is no definitive treatment for Arfid but Bodywhys recommend family-based treatment and parent training, as well as cognitive-behavioural approaches.

There are other options out there.

READ MORE: What you should do if you suspect your friend or family member has an eating disorder

Jason O’Callaghan is a hypnotherapist at D4 Clinic and has helped individuals with Arfid overcome the condition via hypnotherapy sessions.

“Arfid can affect two years olds and 22 year olds” he explained.

“Arfid tends to either by physiological or psychological. In terms of physiological a child could be in discomfort when they eat, perhaps they feel ill or dislike the texture. They could have an allergic reaction. But if it continues into teenage years than it becomes psychological.”

When children are young, O'Callaghan said it is the responsibility of the parents to ensure they have a varied diet.

"The reality is that 6 and 7 year olds don’t want to eat like the Happy Pear. If your child is refusing healthy foods – they don’t have AFRID. They may just be a fussy eater. As a parent you really have to be inventive and find different ways for them to engage with their food,” O'Callaghan said.

A very simple technique is encouraging your children to prepare meals with you. If they have created and connected with the food themselves they will be more inclined to eat a meal afterwards.

"Parents have to accept responsibility because they are the ones buying the food."

However if it becomes a psychological issue than it can be more difficult to deal with. One of Mr Callaghan's clients, Alison McGregor from Blanchardstown, ate only waffles and chips for years.

"We break it down," he said. "As people get older they want to change how they eat. You are limiting your life experience. Imagine going on a date in your 20s if you only eat white bread, or waffles.

"To a lot of people selective eating may seem ridiculous but for those living with it, Arfid can control their lives."

How can I ensure my child has a healthy relationship with food?

Dr Jennifer Twyford-Hynes says parents can do the following to ensure their children have a healthy relationship with food.

· A common recommendation is that the parent decides which foods their child eats, the child decides how much.

· Meal and snack times provide an arena in which children and parents work out issues of independence and dependence. If a child is not hungry, they should not be forced to eat. Offering children a selection provides choice and motivation.

· A child may reject a food on one or many occasions yet accept and enjoy it in the future. It’s best to remove uneaten food without commenting on it. It can always be offered again another time.

· It can also be enjoyable to involve children in food preparation, including deciding on a recipe, shopping for ingredients, and preparing it together. Even with a young child, who can help with washing vegetables or mixing with a spoon.

· If mealtimes are a pleasant, enjoyable experience with the family, this can encourage a picky eater.

· Meals don’t have to be complicated or exotic. Include one favourite food as part of the meal.

· Children will also notice the food a parent eats, so parents’ food choices influence a child’s. Take some time to consider your own dietary choices and beliefs about food

· Continue to offer and provide opportunities to try a range of healthy food prepared in various ways.

Online Editors

Editors Choice

Also in Life