Does your child prefer bland foods with minimal texture or flavour? Are foods such as pasta, soup and bread a staple in your home? Does your child drink an excessive amount of milk, or prefer cheese and crackers to other foods? Is there a lack of colour in your child's diet? Do you struggle daily to get your child to try new foods and worry that your child is missing important nutrients?
I see patients with such issues every day in my office. Some meet criteria for eating disorders, some are just picky, but all have a commonality – stressed parents who desperately want their child to eat a well-rounded diet.
A commentary published in the July, 2015, issue of the Journal of Adolescent Health showcases an eating disorder that even many pediatricians do not know about. It is called avoidant-restrictive food intake disorder (ARFID), and Dr. Debra Katzman and Dr. Mark Norris, two Canadian adolescence medicine physicians, performed a study to gauge the level of awareness of ARFID among pediatricians. Only 37 per cent had heard of the condition. I imagine that fewer non-physicians have heard of it.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes a technical definition. Essentially, sufferers of ARFID are particularly sensitive to foods with certain textures or smells.
People with the disorder often prefer to eat carb-heavy foods such as bread and cereal, cheese, yogurt, milk and highly processed options such as crackers and candy. Many kids with ARFID will avoid whole food groups, such as vegetables and fruits. Some exclude foods based on colours, sticking to one colour palate like white. Many are sensitive to textures and temperatures, refusing foods with too much or too little crunch or those that are too hot or cold. Sauces are often deal breakers.
One difficulty is that many kids with ARFID have normal body size and weight, according to a 2001 study. Some have significant physical symptoms, with vomiting, gagging or abdominal pain when eating foods outside the comfort zone.
Severely restrictive eating can lead to deficiencies in nutrients such as iron and calcium.
So what should you do if you think your child has ARFID (or that you do)? First, please speak to your health-care provider. Doctors who have not heard of the disorder surely will be able to find a therapist or physician who has. ARFID is often treated through management of anxiety and systematic desensitization, gradually rewarding the introduction of new foods. Relaxation techniques are used to minimize stress.
Although we are not yet sure if we can prevent ARFID, there are strategies to prevent picky eating in general. I suggest incorporating your child into family meals as early as possible. Our six-month-old sits at the table with the rest of the family. Meals are a social experience and kids tend to eat better when enjoying them along with the adults. Offer a variety of foods as early as you can. Speak to your doctor about when to start solids. Our children were eating a variety of fruits, vegetables, grains and proteins early on, and started eating smaller pieces of the same foods we were having at nine months. Finally, avoid turning mealtime into a battle as much as you can. It only sets the stage for a negative relationship with food.
Make the meal table a fun place where you and your children can try new things, share a conversation and a social experience.
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