
A lot of kids are picky eaters, especially these days and in the US specifically. There are food scientists working hard to ensure that kids crave Pirate Booty more than carrots. Most people, though, can and do eat a variety of foods, and generally intake all the main food groups.
For a subset of kids, picky eating takes on a life of its own. They might only have a rotation of 5 foods that they are willing to eat. They may have strong brand preferences, accepting Tyson chicken nuggets and rejecting the Kroger brand. Perhaps they restrict foods based on their smell, texture, color, or temperature.
These children are not eating within all the food groups and they may be developing nutritional deficiencies. They might be noticeably underweight or overweight. Their eating is starting to impact their daily lives: either their family functioning (e.g., arguing, parents having to make separate meals), school life (e.g., not able to eat school lunch), or social life (e.g., not able to eat at friends’ houses). Their worlds become smaller and smaller and their health is at risk. While this likely begins in childhood, sometimes the picky eating does not resolve and continues into adulthood, causing even more impairment in comparison to other adults.
These kids would likely meet criteria for Avoidant/Restrictive Food Intake Disorder (ARFID). ARFID is an “eating disorder” that has nothing to do with trying to lose weight or be thin. It is characterized by avoidance of food/eating and anxiety or disgust about foods based on their sensory profile.
ARFID was not formally recognized by mental health professionals until 2013, so there is still not a lot of consensus on the best way to treat it. There are, however, cognitive-behavioral treatment strategies that work really well.
Unless someone’s physical health is severely impacted by the condition, generally ARFID can be treated by only a mental health professional in an outpatient setting (e.g., once-a-week therapy), monitored by a medical doctor, and a dietitian is optional. Unfortunately, most providers are unfamiliar with ARFID, and it is hard to know where to place these kids and adults.
Eating disorder centers are poised to accept patients with ARFID. Their classic setup, however, is not ideal. They usually require a higher level of care (e.g., intensive outpatient; several hours of therapy per week) and more frequent medical and dietitian appointments. This can be overwhelming in terms of cost and time spent for someone who is appropriate for once-a-week therapy.
Obsessive-compulsive disorder (OCD) specialist therapists sometimes are familiar with ARFID, but only a small subset of these providers usually work with kids.
Many people and families with ARFID are left wondering, Where can we go for treatment??
As much as I would love this article to provide that answer, I agree that it is incredibly hard to navigate. I don’t believe there are currently enough providers to meet the needs of people with ARFID and their families.
My imperfect answer is to get more familiar with ARFID and the principles of treatment. At the end of the day, the formula is: eat food that can’t stand, learn to tolerate it, eat more of it. For adults, practice makes perfect. For kids, this might involve parents setting up rewards and consequences around eating unfamiliar foods.
The Picky Eater’s Recovery Book is a play-by-play of cognitive-behavioral therapy (CBT) for ARFID, the Harvard-based treatment that is most commonly used currently. For someone who cannot currently access therapy, this will preview everything that would be done with a professional.
Equip Health, an online eating disorder center, provides a lot of information about ARFID in videos and blog posts. They offer treatment as well.
I am going to offer (hopefully continually!) a therapy group for caregivers of kids with ARFID, based on Dr. Katherine Dahlsgaard’s (Children’s Hospital of Philadelphia) protocol. Sign up or get more information here. I also do outpatient CBT therapy for kids, teens, families, and adults with ARFID. Because I am PSYPACT-authorized, I can work with people in most states virtually.
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