Mealtimes can become a daily battle for parents if they have a child who refuses to eat vegetables or insists on the same meal every day. Plenty of kids are picky eaters, but the problem of refusing foods can move beyond picky eating and become far more serious.
Some children develop a little-known eating problem called avoidant/restrictive food intake disorder or ARFID. Many toddlers eventually outgrow selective eating, children with ARFID generally do not. Instead, their restricted diets can result in deficiencies of important nutrients.
Unlike children with eating disorders like anorexia or bulimia, youngsters with ARFID are not concerned about their weight or body image. ARFID is often mistaken for ordinary picky eating, but it is far more extreme and long-lasting.
ARFID children avoid food because they have little interest in eating, are extremely sensitive to certain tastes or textures or have developed a fear of eating after a frightening experience, such as choking or an allergic reaction.
The disorder affects an estimated 2 to 6 percent of children and adolescents. If left untreated, it can lead to poor growth, nutritional deficiencies and significant disruption of family life.
Researchers at Stanford Medicine have found that two different forms of therapy can help children become more open to a variety of foods. The study, the first randomized, controlled clinical trial to evaluate treatments for children with avoidant/restrictive food intake disorder, involved 98 children, ages 6 to 12 from across the United States.
The research team, led by James Lock, MD, PhD, the Eric Rothenberg, MD Professor of Psychiatry and Behavioral Sciences and a member of the eating disorders program at Stanford Medicine Children’s Health, randomly assigned participating families to one of two treatment approaches.
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One approach, called family-based therapy, placed parents in charge of helping their child gradually change eating behaviors. Therapists coached parents on how to respond to food avoidance, while encouraging children to assume more responsibility as they grew older.
The second approach focused more directly on the child. Called psychoeducational motivational therapy, it used games, imagination and age-appropriate activities to help children identify their own reasons for trying new foods, while parents learned strategies to reduce conflict at mealtimes and support their child’s progress.
Researchers tracked each child’s weight and the severity of ARFID symptoms throughout the study. By the end of treatment, children receiving family-based therapy had gained significantly more weight than those in the individual therapy group.
Both treatments produced meaningful improvement in ARFID symptoms, however, giving clinicians two evidence-based options for helping children. For children with ARFID, this development means that they may be able to overcome their fear of certain foods and participate more fully in everyday activities, like birthday parties or family dinners, without the stress of limited food options.
This study marks an important turning point for children with ARFID and their families. Until now, clinicians had little research to guide treatment. Having two therapies that improve symptoms, including one that also promotes healthy weight gain, offers new hope that children can overcome the disorder, enjoy a wider variety of foods and participate more fully in everyday childhood experiences, including those that involve mental health risks associated with limited social interactions.
Children with ARFID can now look forward to a more varied diet and reduced stress at mealtimes.
