Ever wonder if your child’s picky eating is more than just picky eating? While the majority of toddlers and young children experience some type of picky eating as a normal part of their childhood development, there is a line where normal picky eating can become dangerous – and where medical and psychological intervention may be necessary.
Avoidant/Restrictive Food Intake Disorder (ARFID) is characterized by an eating or feeding disturbance that manifests as a failure to meet nutritional or energy needs. It can look much like picky eating, as both those with ARFID and those who are picky eaters have a limited range of food they like or are willing to eat, but there are several important differences:
1. Sudden or significant weight loss
An individual with ARFID may demonstrate sudden or significant weight loss. This could be a result of sensory sensitivities, aversions to food, and/or lack of interest in food that cause restrictive eating. Aversions or sensory sensitivities are most often caused by an adverse event or effect of eating that could include vomiting, choking or a real or feared allergic reaction. Developmentally appropriate picky eaters are generally able to maintain weight despite limited food selection and do not typically experience weight loss due to a fear of vomiting or choking.
2. Failure to gain or maintain weight
Another characteristic of ARFID, specifically children diagnosed with this condition, can be a failure to achieve expected weight gains. This means that a child has fallen off their expected growth trajectory or might experience a failure to thrive or grow from an early age. Adults with ARFID may fail to maintain a weight that is appropriate for their unique nutritional needs. Picky eaters are generally still able to get enough nutrition and calories to maintain growth within their expected ranges on growth charts, or maintain a healthy weight.
Someone with ARFID may be reliant on feeding tubes or nutritional supplements such as Ensure in order to obtain appropriate nutrition. Picky eaters are generally able to eat enough foods and enough variety that they do not require supplementation to meet caloric needs.
3. Interference with psychosocial functioning
Those who struggle with ARFID may find it difficult to eat in a variety of settings such as at a friend’s house, in cafeterias, or at events. They may also find it challenging to be around certain types of foods. The intense anxiety experienced can significantly limit their ability to engage in age-appropriate social settings and cause an increase in isolation. Generally, a picky eater is able to attend social activities with little to no distress regarding foods that will be present or the environment itself.
4. Sensory Sensitivities
Although a picky eater may not eat a food due to the smell or look of a food, they often can tolerate a variety of textures, smells, and visual presentations of food with some distress. However, someone struggling with ARFID will have increased anxiety and reported inability to consume foods due to texture, taste, smell, visual presentation, etc. without high distress or other symptoms such as gagging or spitting out food.
5. Adverse Consequences
While a picky eater may also avoid a food due to a negative experience, those struggling with ARFID have an intense aversion to foods either due to the fear of choking or vomiting, witnessing someone choking or vomiting, or a real or perceived allergic reaction. The avoidance of these foods can often be extreme in response to an aversive situation, for example, consuming an all liquid diet after choking. A picky eater does not often express fear as the drive to limited eating or food choices.
6. Lack of Interest in Food or Eating
Lastly, a lack of interest in food or eating can be a sign of ARFID. Often, people with ARFID will say they are not hungry, do not think about food, and can even forget to eat because food is not a priority. In contrast, picky eaters do often feel hungry, are interested in eating the foods they enjoy, and do not have the same lack of interest in food and eating.
While there are many differences between an actual diagnosis of ARFID and picky eating, the line can often be blurred. If you have concerns that you or your child’s picky eating may have become a problem, further assessment may be helpful.
Walden’s Unique ARFID IOP
On the brighter side, for those who have struggled with ARFID, treatments like CBT-AR make recovery possible.
Walden’s unique ARFID Intensive Outpatient program provides highly specialized care from an expert treatment team that is trained in ARFID. It is a 10-week virtual program open to individuals aged 11-17 of all ethnicities and genders.
We know finding care can be tough. Walden is here for you. If you are concerned that you, or a loved one, may have an eating disorder, please reach out by completing the form on this page or email us at intake_coordinators@waldenbehavioralcare.com.
Jenna Montanez, LCSW, (she/her/hers) is an Assistant Program Director, providing supervision and clinical support within Walden’s partial hospital and intensive outpatient levels of care at the South Windsor CT clinic. Jenna received her master’s degree in social work from Washington University in St. Louis, and following graduation began working in clinical day schools. Jenna also has experience in residential and group home care with adolescents with serious mental health and trauma histories. Jenna has been with Walden Behavioral Care since August of 2016. Jenna’s current interests include supervision and training, as well as community based outreach to enhance the education of other professionals, such as educators and primary care physicians, in the area of eating disorders.
*This blog post does not necessarily represent the views of Walden Behavioral Care and its management. The Walden Blog is meant to represent a broad variety of opinions relating to eating disorders and their treatment.
