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Manifestations and Management of Avoidant Restrictive Food Intake Disorder (ARFID) in Children Volume 49- Issue 4

Rajeev Gupta*

  • Consultant Paediatrician, Chairman Central Specialist Committee Royal College of Pediatrics & Child Health
  • Vice Chairman CESR Committee, Royal College of Pediatrics, Ex-Chairman Regional Consultant Committee BMA, Recent Chairman Regional Council British Medical Association, Barnsley Foundation Hospital, United Kingdom

Received: March 30, 2023;   Published: April 10, 2023

*Corresponding author: Rajeev Gupta, Consultant Pediatrician, Chairman Central Specialist Committee Royal College of Pediatrics & Child Health, Vice Chairman CESR Committee, Royal College of Paediatrics,Ex-Chairman Regional Consultant Committee BMA, Recent Chairman Regional Council British Medical Association, Barnsley Foundation Hospital, United Kingdom

DOI: 10.26717/BJSTR.2023.49.007831

Abstract PDF

Introduction

Feeding disorders are a common issue in children, with up to 50% of typically developing children experiencing feeding problems during infancy and childhood [1]. One type of feeding disorder that has gained attention in recent years is Avoidant Restrictive Food Intake Disorder (ARFID), which was introduced as a new diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [2]. ARFID is characterised by a persistent failure to meet appropriate nutritional or energy needs due to avoidance or restriction of food intake. Children with ARFID have a narrow range of acceptable foods and may avoid certain textures, colours, or smells of food, resulting in inadequate nutrition intake. This essay will discuss why managing ARFID is important for children with eating disorders. Thomas, et al. recently argued that current diagnostic criteria for ARFID are limited in their ability to capture the complexity and severity of the disorder and propose a three-dimensional model that takes into account the physiological, behavioral, and psychological aspects of the disorder [3].

Prevalence of ARFID

The prevalence of ARFID is difficult to estimate due to the lack of consensus on diagnostic criteria and assessment methods. However, recent studies suggest that ARFID is a common feeding disorder, with a prevalence rate of approximately 3% to 5% in children and adolescents [4,5]. ARFID is more common in boys than girls, and its onset is typically in early childhood, with a peak in prevalence between the ages of 10 and 14 years [4,6].

Consequences of ARFID

ARFID can have serious consequences for children’s health and well-being. Children with ARFID are at risk of malnutrition, weight loss, and growth failure due to inadequate food intake [5]. In addition, children with ARFID are at risk of developing micronutrient deficiencies, such as iron, zinc, and vitamin B12, which can lead to anemia and other health problems [4]. In addition to these, the potential consequences of ARFID may include, and psychosocial impairmen. Children with ARFID are also at risk of developing psychological and social problems. They may experience anxiety, depression, and low self-esteem due to their limited food intake and the social isolation that can result from their restricted diet (Norris et al., 2018). Children with ARFID may also experience difficulties in school, as their lack of energy and concentration can impact their academic performance [7].

Diagnosis and Assessment of ARFID

Diagnosis of ARFID is based on clinical assessment, and there is no specific laboratory test or imaging study that can confirm the diagnosis. The DSM-5 diagnostic criteria for ARFID include: A persistent failure to meet appropriate nutritional or energy needs, as evidenced by one or more of the following:

a) Significant weight loss or failure to achieve expected weight gain or growth.

b) Significant nutritional deficiency.

c) Dependence on enteral feeding or oral nutritional supplements.

d) Marked interference with psychosocial functioning.

The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice. The disturbance is not due to a concurrent medical condition or a mental disorder. Assessment of ARFID should include a detailed medical history, physical examination, and laboratory tests to rule out underlying medical causes of the feeding disorder. A comprehensive psychological evaluation should also be conducted to assess the child’s cognitive, emotional, and behavioural functioning [5]. Future research on eating disorders in males, including the development of gendersensitive assessment tools and the examination of the role of cultural and societal factors in the development and maintenance of eating disorders in males [8].

Treatment of ARFID

The treatment of ARFID involves a multidisciplinary approach, including medical management, nutritional rehabilitation, and psychotherapy. The primary goal of treatment is to improve the child’s nutritional status and facilitate weight gain and growth. Nutritional rehabilitation typically involves a gradual exposure to a variety of foods to expand the child’s food repertoire and increase their overall nutrient intake. This is done under the guidance of a registered dietitian who can assess the child’s nutritional needs and develop an individualized meal plan that meets their nutritional requirements. Psychotherapy is also an important component of treatment for ARFID. Cognitive-behavioural therapy (CBT) is a commonly used approach, which focuses on identifying and challenging the child’s maladaptive thoughts and behaviors related to food. Exposure therapy is another effective technique used in CBT, which involves gradually exposing the child to feared or avoided foods to reduce their anxiety and increase their willingness to eat a wider variety of foods. Family-based treatment (FBT) is another approach that has been shown to be effective in treating ARFID. FBT involves working with the child and their family to identify and address the underlying factors that may be contributing to the feeding disorder, such as family conflict or high levels of parental anxiety. FBT also emphasizes parental involvement in the treatment process, with parents playing an active role in encouraging their child to eat and providing positive reinforcement for their efforts.

The Importance of Early Intervention

Early intervention is critical for children with ARFID, as the longer the feeding disorder persists, the greater the risk of long-term health and psychological consequences. Children who do not receive treatment for ARFID are at risk of developing more severe feeding disorders, such as hhi, later in life [5]. Therefore, it is important for parents and healthcare professionals to be aware of the signs and symptoms of ARFID and seek help as soon as possible if they suspect their child may be experiencing a feeding disorder.

Conclusion

ARFID is a serious feeding disorder that can have significant health and psychological consequences for children if left untreated. The prevalence of ARFID is difficult to estimate, but recent studies suggest that it is a relatively common disorder that can affect children of all ages. The diagnosis and assessment of ARFID should be conducted by a qualified healthcare professional, and treatment should involve a multidisciplinary approach that includes medical management, nutritional rehabilitation, and psychotherapy. Early intervention is critical for children with ARFID, as it can prevent longterm health and psychological consequences and improve the child’s overall quality of life. Parents and healthcare professionals should be aware of the signs and symptoms of ARFID and seek help as soon as possible if they suspect their child may be experiencing a feeding disorder. With proper diagnosis and treatment, children with ARFID can improve their nutritional status, expand their food repertoire, and reduce their risk of developing more severe feeding disorders later in life.

References

  1. Field DG (2017) Avoidant/restrictive food intake disorder (ARFID). Journal of the Academy of Nutrition and Dietetics 117(11): 1731-1738.
  2. (2013) American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th)., Washington, DC.
  3. Thomas JJ, Eddy KT, Ruscio J, Ng J, Casale KE (2021) Avoidant/restrictive food intake disorder: A three-dimensional model of severity. International Journal of Eating Disorders 54(6): 1079-1091.
  4. Zucker NL, Merwin R, Elliott CA, Vander Laan K, Bulik CM (2015) Psychological and psychosocial impairment in preschoolers with selective eating. Pediatrics 136(3): e582-e590.
  5. Norris ML, Spettigue W, Hammond NG, Katzman DK (2018). Clinical practice guidelines for the treatment of eating disorders in children and adolescents. Journal of Eating Disorders 6(1): 3.
  6. Bryant-Waugh R, Micali N, Cooke L, Lawson EA, Eddy KT, et al. (2019) Development of the Pica, ARFID, and Rumination Disorder Interview, a multi-informant, semi-structured interview of feeding disorders across the lifespan: A pilot study for ages 10–22. International Journal of Eating Disorders 52(4): 378-383.
  7. Fisher MM, Rosen DS, Ornstein RM, Mammel KA, Katzman DK, et al. (2014) Characteristics of avoidant/restrictive food intake disorder in children and adolescents: A “new disorder” in DSM-5. Journal of Adolescent Health 55(1): 49-52.
  8. Thomas JJ, Micali N, Misra M, Eddy KT (2018) Eating disorders in boys and men: Current evidence and future research. European Eating Disorders Review 26(2): 100-109.