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Is ARFID The Same As Picky Eating?
A child resisting food and throwing tantrums at mealtime can be worrisome for the parents. Growing kids are often selective about their eating preferences, and parents try everything to widen their menu. Knowing the extent of food rejection is crucial in managing the nutrition of your young one.
Picky eating vs eating disorders is a common concern among parents. Picky eating is a condition in which the child prefers only one type (based on taste, flavor, colour, etc.) of food and rejects accepting any other variety. Also known as fussy eating, or selective eating disorder, it generally arises as a developmental stage in around 50% of children. It may be linked to autism spectrum disorder.
On the other hand, Avoidant Restrictive Food Intake Disorder vs picky eating is a more serious concern. Avoidant Restrictive Food Intake Disorder (ARFID) is a type of eating disorder where individuals have such a limited intake of food that they go into nutritional deficiencies. Extreme picky eating vs ARFID can look similar, but there are subtle differences between the two.
There is a fine line dividing picky eating from ARFID. Beyond that, the perturbing behaviours turn dangerous. How do I know if my child has ARFID or is just a picky eater? If you wonder how to tell if picky eating is ARFID, this article is for you. It discusses what makes ARFID different from picky eating.
5 Key Differences Between ARFID And Picky Eating
There are a few ARFID and picky eating differences. By carefully analyzing your child’s eating behaviors, you can tell them apart:
Weight Changes
Picky eaters create a fuss at the meal table by avoiding a variety of foods. However, the food selectivity isn’t severe enough to induce weight changes. The caloric intake is lower than an average consumer of the same age, but that does not lead to serious issues like weight loss.
In cases of ARFID, the food aversions and restrictions are so severe that they can cause significant weight loss. Sometimes, the changes are sudden too. ARFID eating disorder vs fussy eating shows a stark contrast when it comes to nutritional deficiencies. People with ARFID reject food based on appearance, texture, smell, etc., and can end up with nutritional deficiencies that eventually lead to weight loss. Studies show that, in general, ARFID individuals often have low body weight and require medically guided weight gain interventions.
ARFID symptoms in children may also include body image distortions. In a study, a nine-year-old with ARFID reported very low body weight and a lean figure. However, despite the severe malnutrition, the child positively viewed her body and reported that her thinness was attributed to meeting beauty ideals on social media. She:
- Had a low appetite drive
- Feared trying new foods
- Was scared of having adverse consequences from eating
Moreover, gaining weight for ARFID individuals is also tough. Severe cases of ARFID often rely on nutritional supplements (and even feeding tubes) which becomes an ultimate requirement to regain weight and energy. However, weight maintenance is not a problem for picky eaters.
Intensity Of Reactions
While both individuals show disgust at food, their responses to disliked food items differ. Signs of ARFID vs picky eating in children vary widely. Picky eaters are just selective in their consumption, but ARFID individuals lose interest in eating. Many such people feel overwhelmingly conscious about consuming food. They fear grave consequences, like choking or vomiting. Fear of choking and ARFID is a serious issue, unlike in picky eaters.
Psychosocial Functioning
Poor nutrition in ARFID is linked to abnormal psychological conditions. Children and adults with ARFID fear consuming food, and the intensity varies between individuals, which calls for a custom-tailored approach in managing the food disorder. ARFID and anxiety-related eating behaviors can be significant. Individuals are unable to eat at outings (cafeterias, restaurants, friend’s places, etc.). This negatively affects their ability to interact with peers. Studies show that ARFID has a significant psychosocial impact compared to picky eating. Autistics also find it hard to communicate with others and maintain social relationships.
It has been noted that attending school can trigger anxiety in an AFRID individual. Interaction with other kids and teachers at school tends to make the child anxious, which in turn makes him/her feel weak. It also proves to be a hurdle in their learning journey. Several parents have noted that school attendance becomes even more difficult during the dark winter months (January and February).
Kids with AFRID are psychologically hard-wired to follow strict routines and often resist reductions in their timetables (school, and eating). So, if once established, parents openly welcome these behaviours to ensure sustainable energy and well-being levels. Oftentimes, kids have 1 evening meal a day and won’t consume breakfast. Parents do not have an explanation of why the kid does that but the AFRID child explains that they feel they will get sick on changing the dietary routine.
Sensory Sensitivity
Picky eaters are seen strongly rejecting foods based on colours, textures, and smells, but this aversion stems from a dislike for the presentation of the food. A clinical study revealed that picky eaters, children on the autism spectrum, and ARFID individuals all experience sensory hypersensitivity to foods and have behavioural problems. However, the most pronounced effects were seen in the ARFID group. These individuals showed the lowest food-responsiveness.
ARFID and sensory processing disorder go hand in hand. Atypical sensory sensitivity is strongly related to ARFID. In such people, there is also a greater ratio of food neophobia (the fear of trying new foods). In reality, there is a complex interplay of neurodevelopmental features (including sensory sensitivities) alongside mental health that lead to a noticeable impact on the functional abilities of the child.
Some young AFRID sufferers develop a maladaptive coping mechanism. As they are psychologically and emotionally attached to specific foods, they consume certain food items in high quantities. You might find AFRID people sucking on limes or chewing gums (of specific taste) so much that it becomes problematic. This overconsumption of limited foods and abstinence of others often lands them in trouble. They get nauseous and feel sick. When sick, such kids usually distract themselves by looking at the TV/social media. They may eat through the night to keep the nausea away. Such individuals need their “safe foods” (which may include specific chocolate brands or crisps, etc.)with them at all times. This behavior is not seen in picky eaters.
Management
ARFID managment is more complex than picky eating!
In most cases, parents can alleviate picky eating habits with proper guidance. However, in the case of ARFID, parents have to seek professional help from registered dietitians and nutritionists. The professionals carefully examine the child’s micro and macronutrient requirements and investigate deficiencies. With picky eaters, the aim is just to increase the menu variety, but in ARFID, dietitians have to fulfill caloric and weight requirements as well. Referral to a nutritionist makes it easier for the child to re-engage.
Parents can get some help from Cognitive Behavioral Therapy (CBT). Child and Adolescent Mental Health Services (CAMHS) are services for young people to support mental health. A neuropsychiatric team from the service can assess the problems with an AFRID kid.
In severe ARFID cases, healthcare professionals may need to pass a nasogastric tube for optimal feeding (required for normal body functioning). The method of dietary correction may be the same for both. The ideal approach is to introduce new foods gradually and avoid food triggers. However, ARFID individuals require much more care and attention than picky eaters.
Final Word
Is ARFID a form of picky eating? No! Picky eating or fussy eating is a condition in which growing children reject specific types (textures, colours, etc.) of food. This may be linked to autism spectrum disorder.
Avoidant Food Restrictive Intake Disorder (ARFID) is a newly diagnosed type of eating disorder characterized by a strong rejection of food, significant food neophobia (fear of trying new food), and an innate fear of adverse consequences of eating. ARFID is a more severe form of picky eating where children avert eating out of fear of choking or vomiting. This leads to nutritional deficiencies and loss of weight. Some individuals even experience body image distortions that prevent them from gaining weight (despite low body mass).
When compared to picky eaters, ARFID children have greater sensory hypersensitivity and a higher intensity of reactions to new food. Psychosocial compromises in ARFID are greater and often require professional help (dietitian and nutritionist) for reversal. On the other hand, picky eating is a developmental stage in half of the cases and can be reversed relatively easily.
