What Is Avoidant Restrictive Food Intake Disorder?
Avoidant/restrictive food intake disorder (ARFID) emerges as a relatively recent addition to eating disorder classifications. It manifests in children who exhibit highly selective eating habits, often displaying minimal interest in consuming food. Their dietary choices are typically confined to a narrow range of preferred items, often resulting in stunted growth and inadequate nutrition. ARFID typically manifests at earlier stages of development compared to other eating disorders, with a higher prevalence observed among male individuals.
Why Are Avoidant Restrictive Food Intake Disorders Underdiagnosed?
Children who face the avoidant/restrictive food intake disorder (ARFID) are known to be extremely choosy or picky eaters that parents and guardians or the teachers may be having a hard time dealing with them. Individuals with ARFID are easily predisposed to developing gastroesophageal reflux disease (GERD), eosinophilic esophagitis, food allergies, or other systemic medical conditions that can lead to severe feeding problems. Physicians may not attempt to understand the simple or initial symptoms of this condition, as it may be leading to an underdiagnosis and can result in the child suffering from its long term implications. Hence, nutritionists currently are focusing extensively upon the improved understanding of both feeding as well as eating disorders in young adolescents as well as in infants and children.
What Are the Criteria for Children With Avoidant Restrictive Food Intake Disorder?
Criterion for children with avoidant/restrictive food intake disorder include:
Criterion A: These children usually demonstrate eating or feeding disturbance that can be pertaining to one of the given below factors such as:
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Significant loss of weight.
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Severe nutritional deficiencies.
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Extreme dependence on either enteral feeding or oral supplements like nutritional formulas.
These children can be the ones who have a low appetite as well as a generalized disinterest in consuming food. They may also be extremely selective in food choices because of factors such as the smell of food, taste, and texture of foods that can be associated with a psychosocial impact. Avoidance or restrictive eating in these children may often be linked to the fear of consequences of consuming foods they dislike such as choking, vomiting, or frequent nausea.
Criterion B: This group establishes that there is no interference in the eating habits of the child that can be either related to any religious or cultural practices or due to a lack of food availability.
Criterion C: This criterion eliminates factors that do not interfere with a child's eating, such as feeding disturbances associated with other eating disorders like anorexia nervosa (a mental health condition characterized by an intense fear of gaining weight and a distorted body image), bulimia nervosa (an eating disorder characterized by recurrent episodes of binge eating followed by self-induced vomiting or excessive exercise), body image issues, or preoccupation with the child's body weight.
Criterion D: This group demonstrates that the feeding disturbance is not usually because of any underlying psychiatric or medical condition such as gastrointestinal disease, cancers, or malignancies.
How to Arrive at a Diagnosis?
It is essential to know that a professional healthcare provider or nutritionist employs the above criteria to eliminate the factors that are not interfering with the child's eating patterns. By doing so, the nutrition expert can arrive at the exact diagnosis or cause of the child's restrictive food intake disorder. Children and adolescents with ARFID can either present with one or more of the characteristic clinical features discussed in the criterion that would be causing the child to develop a low interest in food or back off from dietary options offered to them. The clinical presentation of children suffering from ARFID would either be categorized into normal weight, overweight, or underweight categories to assess them prior to management. The diagnosis of ARFID is also invariably interlinked with a prevalence of neurocognitive disorders, anxiety-related disorders, autism spectrum disorder, obsessive-compulsive disorder, depression, and attention deficit hyperactivity disorder.
What Is the Management of ARFID?
Because ARFID frequently goes unrecognized by parents, teachers as well as physicians, or pediatricians, current research shows that the efficacy of various treatments in treating this complex thought process or thinking disorder in the child is not fully established. However, limited research studies now focus on the need for developing specialized centers and a multidisciplinary approach that should be employed by physicians towards treating affected children and also motivating their parents or families. Such a multidisciplinary approach or management of ARFID includes the following strategies:
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Close medical monitoring should be done for the child alongside nutritional monitoring.
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Parental education and home instructions should be given to encourage and motivate the child to develop an interest in the consumption of foods or dietary diversity
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Adjunctive pharmacotherapy and hospital treatment should be based on observation of re-feeding behavior.
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Psychosocial intervention therapies can also be a given. For example, cognitive behavioral therapy, family-based therapy, or even individual therapy.
Because of the complex nature of ARFID, the multidisciplinary team for managing the child's food should include physicians, pediatricians, adolescent medical physicians, psychologists, psychiatrists (if needed for prescribing medications), nutritionists or dietitians (for thoroughly educating parents about their role as caregivers in the child's nutritional needs), speech-language pathologists, and occupational therapists.
How to Manage ARFID Children With Underlying Medical Causes?
If the child is suffering from any malnourishment or malnutrition syndromes or medical conditions, the following steps need to be taken.
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Medically stabilization of the patient and appropriate outpatient or inpatient care.
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Restoration of a child's weight and growth in a healthy manner day to day.
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Nutritional rehabilitation of the child by slowly increasing the variety of foods taken.
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Psychosocial management of the child's food-based fears or pain.
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Encouragement and motivation of the children to experience the joy of eating.
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Diversity of nutrient-rich foods and implementing a balanced diet form.
When Should Hospitalization Be Considered for ARFID Children?
For children with severe systemic issues due to malnutrition, those suffering from bradycardia (heart rate less than 60 beats per minute), electrolyte disturbances, seizures (a sudden, uncontrolled electrical activity in the brain), cardiovascular disturbances, orthostasis hypotension (sudden drop in blood pressure when a person stands up from a sitting or lying down position), hypothermia (body temperature less than 95 degrees Fahrenheit) and severe low weight cases, it is advisable to hospitalize and manage the child with the above discussed interdisciplinary team.
Conclusion
The eating disturbances encountered in patients who are children primarily suffering from ARFID can lead not only to a much-reduced volume and diversity of food intake, but can also create a vicious cycle of persistent failure in meeting the child's energy and nutritional needs on a day-to-day basis stunting their growth and body weight, height and endocrine balance. Furthermore, it can be associated with long-term development of psychosocial issues and possibly neurocognitive decline or impairment. Current research studies focus upon the need for widespread awareness as well as recognition of this condition ARFID across global health care providers.
