If your child or teen has Avoidant Restrictive Feeding Intake Disorder, called ARFID, you want to find the most effective and healthy way to help them get back on their growth curve and expand their food and eating flexibility.
ARFID is hard to deal with because it can look like the child is just being picky or difficult, when in fact there’s so much more going on. Power struggles, despair, and frustration are common, but full recovery is possible!
What is ARFID?
ARFID is a restrictive eating disorder in which the person has strong food aversions and struggles to meet their nutritional and caloric needs. It may result in weight loss and/or a decline in growth rate. Like all eating disorders, ARFID may look like a choice, but it’s much more complicated than that.
Maintaining adequate food intake when you have ARFID can be challenging due to a range of reasons, such as feeling disinterested, dysregulated, or disgusted by food. This can result in your child undereating even when they know they should (and promise to) eat more.
Additionally, they may struggle with eating regularly due to forgetfulness or not recognizing hunger signals, creating a cycle of undereating and overeating. This cycle can lead to binge eating in some cases. A limited acceptance of different foods and other dietary restrictions may also lead to nutritional deficiencies and social discomfort in eating situations.
How can parents help kids who have ARFID?
Parents are vitally important in the treatment of ARFID. In fact, home-based, parent-led treatments are preferred in most cases. The parent’s role in helping kids with ARFID includes:
- Ensuring that the child is consistently fed within a supportive and nurturing environment.
- Implementing a system of boundaries, encouragement, and support around food and eating patterns to create positive associations.
- Co-regulating with the child and teaching them how to manage their emotions in relation to eating.
- Gradually increasing the child’s exposure to different foods and eating situations to help them become more comfortable and expand their ability to tolerate them.
Why is eating so hard?
Individuals with ARFID encounter difficulties with eating for various reasons, such as:
- Heightened sensitivity towards the sensory aspects of eating, including smell, touch, taste, temperature, appearance, and the sounds of eating, whether it’s their own or others around them.
- Exceptional sensitivity to internal cues and sensations like hunger, nausea, appetite, and feeling full.
- Intense emotional dysregulation and anxiety during mealtime, especially when other people are experiencing stress, irritation, or concern.
- Anxious thoughts regarding potential negative outcomes from eating, such as vomiting or choking.
- Lack of interest in eating and/or frequently forgetting to eat.
- Experiencing chronic unexplained abdominal pain, constipation, etc.
How do parents get kids and teens with ARFID to eat?
Getting a child or teen who has ARFID to eat is very difficult. ARFID is not a conscious choice, but a response to internal and external barriers to eating. It may look like your child is being difficult or stubborn, when in fact their body is in a high-stress state and refusing to ingest food.
Treatment for ARFID begins with emotional regulation and, if needed, weight restoration. As long as your child is underweight, the disorder will feel more intractable. So weight gain is often an essential first step. Feeding a child with ARFID is challenging, but possible. I have an online course to help with feeding called SPACE 4ED.
Parents do best in supporting a child with ARFID when they receive training that helps them understand:
- The parent’s role in feeding the child
- How to serve food to minimize triggering ARFID symptoms
- Talking about food and eating in neutral, non-stressful language
- Prompting the child to eat even when they don’t want to
- Validating the child’s experiences with food and eating
- Supporting the child in eating even when they don’t want to
However, ARFID treatment is not just about food and eating. In addition to weight restoration, parents need to help their kids by:
- Developing emotional regulation skills to manage eating situations.
- Establishing a routine of consuming regular meals and snacks with support from others.
- Encouraging the normalization of consistently eating enough food.
- Addressing and reducing anxiety related to food and eating.
- Gradually expanding the variety of foods consumed and potentially incorporating supplements to ensure nutritional balance.
What about residential treatment?
For several reasons, most professionals encourage parents to treat ARFID at home if at all possible. Parent-led treatment for ARFID is preferred in general because residential treatment may:
- Primarily treat people who have body dysmorphia and a desire to lose weight, which is not a symptom of ARFID and can confuse treatment for ARFID.
- Be overstimulating for someone with a highly-sensitive nervous system.
- Not support and/or address younger and non-female kids’ needs, for example, kids under 13, and boys, transgender and nonbinary kids.
However, if parent coaching for your child with ARFID is not working, residential treatment may be necessary and helpful to get your child weight restored. Once they are stable, ongoing home-based, parent-led treatment will be necessary to keep them on track in recovery.
Parent Coaching for ARFID
Getting parent coaching can help you be more effective in supporting your child or teen with ARFID. Eating disorder recovery is possible, but it’s hard, and parents who get support, training, and skills are more effective and less burned out. If you’re interested in learning more, drop me a note:
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Important note: Ginny is a coach, NOT a licensed therapist. She doesn’t diagnose or treat mental illness, addiction, eating disorders, etc.