Picky Eaters

Picky Eaters

“Picky eaters” - I have been contacted by numerous mothers who are constantly worried about their little ones’ eating habits or should I say lack of eating proper food. Since it is very prevalent nowadays, I thought it would be a good idea to write a blog post about fussy eating or what we call “Avoidant/Restrictive Food Intake Disorder (AFRID)” in mental health.

WHAT IS AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER?

Avoidant/Restrictive Food Intake Disorder or restricted eating in children is a condition where the child (or adult) has an apparent lack of interest in food that is manifested by a refusal to eat and meet nutritional needs. This avoidance is often based on the sensory characteristics of food: smell, color, texture, taste…and a worry that eating the food will lead to aversive consequences.

To meet the diagnostic criteria for AFRID as per the DSM 5 (diagnostic and statistical manual of mental disorders), the child must display a feeding disturbance that is supported by one or more of the following symptoms:

  • Substantial weight loss (behind on the growth curve)

  • Significant nutritional deficiencies

  • Dependence on a feeding tube or oral nutritional supplements

  • Interference with psychosocial functioning (distress associated with eating / affects daily life)

The disturbance should not be due to unavailability of food as well as anorexia nervosa and bulimia and cannot be attributable to a medical condition (DSM V).

AFRID is very common and in most cases it is viewed as a childhood disorder that fades away with age. Nevertheless, many children have not been able to grow out of this behavior and we have seen these symptoms linger onto adulthood as well.

SIGNS TO LOOK OUT FOR

Children who experience AFRID quite often exclude entire food groups from their diet such as fruits, vegetables or meat and have an inability to consume these specific foods. They have a tendency to prefer eating what they label as “safe” and may even limit themselves to a specific food type (way it is cooked for instance) and even a specific food brand (which makes it very difficult for them to eat various types of food when they go out). Sensory characteristics of foods may also be an issue and many children refuse specific foods based on those characteristics (temperature, colour, texture, taste, smell etc). Children who experience AFRID may also report feeling physically ill when forced to consume foods that are not “safe” and may experience physical reactions such as vomiting as well.

Some children and teens with AFRID often experience symptoms of anxiety and/or depression which in turn affects eating habits even more.

WHAT CAN BE DONE

There are many different treatment options that can be beneficial in helping your child overcome AFRID. Behavioral interventions such as “exposure therapy” and “food chaining” have been shown to be beneficial techniques to help children with AFRID. Research has also shown that cognitive behavioral therapy (CBT) is one of the most successful treatments for fussy/picky eaters. CBT for AFRID. CBT is a goal-oriented form of psychotherapy that focuses on helping a person change his/her patterns of thinking or behaviors that are behind the symptoms they may be experiencing. CBT techniques may include identifying triggers and factors that might be refraining the child from eating certain foods (worries, fears). The treatment often includes education about anxiety and avoidance of food, record keeping of eating behaviors and feelings towards specific foods, reinforcement strategies, and thought challenging (to identify false beliefs). CBT also teaches children to cope with the anxiety they feel when exposed to certain foods and reduce the physical symptoms they may experience (muscle relaxation, focused attention strategies and breathing techniques).

Hope this short post can serve as a guideline to some of you and help you lookout for specific signs that may need interventions. As I already mentioned, quite often, AFRID fades away with time as children grow up but if you feel like your child is not being able to engage in daily activities due to his food restrictions, I would highly encourage you to seek help from a mental health professional. If you would like to find out more about AFRID or the treatment options, do not hesitate to contact me.

Dr. Elena

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