Thirteen year old Sam eats only 4 foods: cereal and milk, pasta, peanut butter and bread. His parents have tried begging, “Just try one bite”, bribing, “I’ll give you $20.00 if you try these green peas,” and threatening, “You won’t grow unless you eat protein.” All to no avail. Sam is reluctant to try new foods. He dislikes the texture of eggs, yogurt, mashed potatoes and cheese. He gags on animal proteins. He hates the taste of fruits and veggies. Sam eats painstakingly slow, taking minuscule bites, pausing between bites and his family has typically cleaned the kitchen before he leaves the table.
Sam’s height has increased, however he has not gained weight in 1 year. He avoids social outings with friends because he is embarrassed about not being able to eat pizza or burgers with them.
Sam has Avoidant/Restrictive Food Intake Disorder (ARFID). This disorder has recently been included in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. It is characterized by an inability to take in adequate nutrition for optimal growth, with a negative impact on weight and/or psychosocial functioning. It usually begins before age 6 and lasts longer than one month. There are three ARFID subgroups: sensory, little or no appetite, and aversive.
Overcoming ARFID is possible, however, not unlike other eating disorders, is a process, a marathon and requires much patience. An excellent read is “Helping Your Child with Extreme Picky Eating” by Katja Rowell, MD and Jenny McGlothinlin, MS, SLP
Pam Chin-Lai, MS, RD, LD, CEDRD specializes in the nutritional rehabilitation of eating disorders in children, adolescents and adults.