What is the difference between ARFID and picky eating?
Children with ARFID will often say they are not hungry, they don't tend to think about food and they can forget to eat or intentionally try to avoid eating. They can become extremely anxious at the thought of eating or even being in a place that serves food. In contrast, picky eaters do feel hungry, they are interested in eating the foods that they like and they don't have the same lack of interest in eating that children with ARFID have.
Picky eating tends to improve gradually over time and it does not have the same health implications that ARFID has. Picky eating can be concerning and difficult to manage for parents but ARFID is more serious as it can be extreme, long term and it can put a child's healthy development at risk.
My own son is an extremely picky eater. He tends to only eat chicken nuggets, pizza, toast, crisps, dry cereal, ice-cream and chocolate but he does love those foods. He is often hungry and enjoys eating. Every now and again he will try a new food; he might only have a bite and never eat it again but he will occasionally try things (including a slice of apple the other week!) Over the years, he has gradually added more foods to his repertoire even though his diet remains limited. He prefers to eat on his own but he can eat with others. He is a healthy weight. His unhealthy diet does concern me but this is an example of picky eating rather than ARFID.
What are some of the signs of ARFID?
- Refusal to eat.
- Lack of interest in food.
- Heightened anxiety around mealtimes.
- Fear of certain foods.
- A fear of choking or vomiting from food.
- Gagging when eating.
- Refusal to eat meals with others.
- Delayed growth, weight loss or failure to gain weight.
- Lack of energy, dizziness or headaches.
- Distress when trying new foods.
- Only eating specific brand foods and foods prepared in a particular way.
- Sensory sensitivities to food textures, colours, tastes and/or smells.
- Eating very slowly and feeling full after only eating a small amount.
- Stomach pains when eating.
Why do some children avoid eating or have a limited diet?
Sensory based avoidance or restriction - some children are sensitive to the taste, texture, smell or appearance of some foods, or they are only able to eat foods at a certain temperature.
Fear and anxiety - some children have had negative experiences with food. They might have choked, vomited or experienced stomach pain in the past. This can lead to fear and anxiety around food or eating, which then leads to them avoiding certain foods or textures.
Low interest in eating and poor interoceptive awareness - some children do not recognise that they are hungry. This means that eating is effortful and not something they enjoy. When the internal body sense is not working properly (the interoceptive sense), the messages are not getting from the stomach to the brain to signal to the child that they are hungry.
Part two...
Remember to look out for part two next week! And in February I'll be discussing Pica; a condition where some children compulsively eat non food items so look out for that too.
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