Are Food Rules and Restrictions Taking Over Your Child’s Life?

Have you noticed your child becoming more and more restrictive with what they eat or the amount they eat, avoiding specific foods? Do they constantly describe themselves as a picky eater and show no real interest in food?

Maybe they require foods to be prepared in a certain way and mention their fear of eating specific foods due to choking or trouble with the texture. They may also experience fatigue, weakness, dry nails and hair, hair loss, trouble concentrating, and a decrease in bone density. And perhaps your doctor keeps bringing up nutritional concerns about your child’s eating habits, but no matter what you try, you just cannot get them to do anything different.

Picky Eating Can Lead To Other Problems

Food is part of everyday life. And when developmentally appropriate (i.e. when a young child begins to eat solid food), food can oftentimes be a source of stress and struggle at the beginning. However, Avoidant Restrictive Food Intake Disorder (ARFID) is different and can lead to many other health risks.

As is part of the diagnosis definition, a child with ARFID is typically underweight and experiences nutritional deficiencies and/or malnutrition. In and of itself, this can lead to health complications and growth failure in the short and long term. In addition, ARFID also often occurs alongside autism, ADHD, obsessive-compulsive disorder, and other anxiety disorders.*

For you, as the parent, all of this may cause a lot of concern. But with the right treatment, change is possible.

At the OCD & Anxiety Center, we take these diagnoses into consideration as we develop a treatment plan. A therapist that specializes in treating ARFID works alongside you, your child, and their medical team to take important steps to get their anxiety and health back on track.

Anxiety About Food Does Not Need To Control Your Child’s Life

The Eating Recovery Center reports that ARFID is more common in children and adolescents than adults. An ARFID diagnosis involves an eating or feeding issue as shown by persistent failure to meet appropriate nutrition and/or energy needs. This often looks like significant weight loss, nutritional deficiency, dependence on a feeding tube, or oral nutritional supplements. ARFID also impacts psychosocial functioning.*

For a diagnosis, all of these behaviors cannot be better explained by a lack of food or cultural practices and cannot occur during the course of another eating disorder, such as anorexia nervosa or bulimia nervosa.

The Eating Recovery Center indicates that between 5%-14% of pediatric patients in inpatient eating disorder programs and up to 22.5% of patients in pediatric eating disorder day programs have ARFID. While the true prevalence of this disorder is still difficult to detect, estimates suggest it may affect as many as 5% of children.*

Causes of Avoidant Restrictive Food Intake Disorder

There are many different causes or influences that might lead to the development of ARFID. As with most disorders, genetics plays a role. If there is an individual within the family that has/had ARFID or another eating disorder, new generations might be at increased risk.

Environmental factors—how a child witnesses meal preparation in their home or their exposure to picky eating, restrictive behaviors, and diets—can also accidentally influence the development of ARFID. In addition, culture might be another behavioral aspect that can contribute to a diagnosis of ARFID, as some cultures have different moral beliefs about food and might have different expectations regarding how an individual’s body should look.

None of these beliefs and values are wrong in and of themselves, but they could be reinforcing your child’s beliefs and anxiety about food. The fact is, we are all being influenced in many ways every day, and that is why both biological and behavioral factors need to be considered in ARFID treatment.

ARFID Therapy Can Help Change Your Child’s Relationship With Food

Similar to treatment for an eating disorder, addressing AFRID calls for a multidisciplinary team approach that includes parents and caregivers playing an extremely important role in treatment. Due to the many issues that are often involved, you will need to work hand-in-hand with your child’s dietitian, doctor, and therapist.

Here at The OCD & Anxiety Center, we will help to facilitate these conversations—all working together to support you and your child.

What To Expect From ARFID Treatment Sessions

Our treatment sessions for avoidant restrictive food intake disorder are designed to provide education to help break the cycles that have been created, not only with food but also with anxiety. Therapy sessions are skill-based and will help you and your child understand the anxiety cycle. You will also learn to look at behaviors in a different way, including seeing what behaviors are directly and indirectly maintaining the cycle of anxiety and how unhealthy thought patterns are contributing to these behaviors.

Your therapist will also provide parent/caregiver training and education to help you see what your role will be throughout treatment. For example, you will learn how to respond when your child is experiencing distress and offer words that provide support but that do not play into their need for reassurance or avoidance.

Due to the interdisciplinary nature of ARFID, treatment will also include frequent communication and collaboration among all team members, keeping everyone on the same page in order to work together.

ARFID Treatment Methods

At The OCD & Anxiety Center, we always aim to make use of the most evidence-based treatments possible. The most effective treatment for ARFID is called Cognitive Behavioral Therapy (CBT).

Utilizing CBT, we will teach you and your child to identify unhealthy and distorted thought patterns that are contributing to and maintaining the unhealthy behaviors present in ARFID. Your child will learn how to reframe and challenge these thoughts, which can be a helpful first step in changing their relationship with food.

Alongside CBT, treatment also includes exposure therapy for ARFID. This approach will help your child to slowly and gradually face their anxiety and fears regarding specific types of foods and eliminate the need to avoid or restrict them.

For example, your child may practice licking a feared food, taking a small bite, or eating a different brand of an acceptable food, etc. Creating a hierarchy of their fears and facing these experiences helps your child to see that they can get used to the feared food, even if they don’t like it, and thus reduces anxiety.

You, and other loved ones, can also learn how to support your child by challenging their thoughts and stepping into their fears, not allowing anxiety to take over and control them. In addition, you will also learn when to push and challenge your child, how to do so, and how to respond when anxiety pops up.

While all of this might seem impossible initially, with support from an ARFID therapist, change is possible!

Perhaps You Are Considering ARFID Treatment But Still Have Some Concerns…

My child already has a dietitian. What will their role be in treatment?

Partnering with your child’s dietitian, as well as their doctor, will be very important to us. Our specialist will work on the behavioral aspect of ARFID, and your child’s dietitian and doctor will speak to the medical component, helping to ensure that your child’s caloric and dietary needs are met.

Too often mental health creates isolation. Our desire is to create a team around your child to support them as they battle ARFID and get their life back.

How long does treatment take?

Everyone’s treatment is different and individualized to them. CBT for ARFID is a structured, goal-oriented approach, and we expect to see progress in time. We may often set meetings around your child’s meal time so we can practice exposures with you and them. Initially, sessions can also be scheduled more than once a week and then be reduced in frequency as progress is seen.

What role will I play as the parent?

You will play a large role in the treatment process, often attending treatment with your child. Your therapist will teach you about ARFID and the factors that maintain it. For example, they may provide feedback about how to engage with your child around food and how to slowly reduce accommodations. We will also teach you how to motivate your child to attend treatment and practice at home when they are resistant or unwilling.

Your Child Can Learn To See Food Differently

If picky eating and food restriction has removed the enjoyment of food for your child, treatment with The OCD & Anxiety Center can offer you the right tools to help your child break free from the grasp of ARFID. To address further concerns or schedule an appointment, please call us at (630) 522-3124 or email us at info@theocdandanxietycenter.com.

If you would like additional information, please consider reading our newsletter or blog as well.

*https://www.eatingrecoverycenter.com/conditions/arfid#:~:text=Rates%20of%20ARFID%20are%20between,eating%20disorder%20day%20treatment%20program.&text=Prevalence%20in%20the%20general%20population%20is%20not%20known.