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

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 and consume the full alphabet of vitamins and minerals.

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

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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 a 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; 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 of Bodywhys, the Eating Disorders Association of Ireland, 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 they eat. For example, they may have choked on a piece of food and have a 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 an 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 veering into disordered eating.

“Fussy eating is a common and normative part of child development,” she says.

“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 your 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 their 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.

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