Feeding Therapy, Adults and Kids from 5yrs

Avoidant/ Restrictive Food Intake Disorder (ARFID)

ARFID is characterised by avoidance or restriction of food overall, or groups of foods, resulting in an insufficient total amount of food or insufficient variety of foods to meet energy and/ or nutritional needs.

Not meeting nutritional needs can of course cause a whole host of medical issues, however for an ARFID diagnosis to apply, the eating problems aren't caused by a medical condition.

There are 3 main clinical indicators of ARFID, and a person might have 1 or all of them:

• Low interest in food or eating
• Food avoidance based on sensory characteristics of the food, eg taste, texture, smell, appearance, or temperature
• Anxiety or fear of negative consequences associated with eating, eg choking, feeling sick, or vomiting

Signs your child's feeding challenges might be ARFID

Around 1 in 300 kids will develop ARFID, and although it's very treatable, it can lead to significant problems related to malnutrition. So if your child meets criteria, it's important to get support. While treatment can take persistence, there are lots of possible approaches, including ways to respect neurodivergent kids' needs and preferences. Here are some signs that you might need more support.

Is/ does your child:

• 'Dropping' their usual accepted foods over time, without adding new ones?
• Eat very few foods, eg less than 20 foods, or miss entire food group/s?
• Dropping in growth chart percentiles, not gaining weight as expected, or losing weight?
• Have sensory sensitivity to foods e.g. taste, texture, smell, temperature, appearance or colour
• Have clear texture, colour, or appearance preferences, and need foods to be presented in the same way every time? (Eg, sandwiches must be triangles with crusts removed)
• Show a lack of interest in food, seemingly low appetite
• Anxious at mealtimes, about things like choking, vomiting, or feeling sick after eating
• Distressed when asked to try a new food. May be unable to tolerate a new or disliked food being on their plate
• Avoidance and/or distress at social activities where food & eating is involved, eg worried about eating at a friend's house or going to parties
• May have difficulty eating with family at the table
• People on the Autism Spectrum and those with Attention Deficit/Hyperactive Disorder (ADHD) are more likely to develop ARFID

Paediatric Feeding Disorder (PFD)

PFD is an umbrella term, covering feeding dysfunction relating to one or more of four domains: medical, nutrition, feeding skill, or psychosocial.

ARFID falls under the PFD umbrella (ticking the nutritional and psychosocial boxes). But a broader PFD diagnosis might be given if your child has a medical condition or disability that impacts their ability to eat, for example. Your healthcare team including a GP, paediatrician, and speech therapist/ occupational therapist will generally work together and compare notes to agree on a PFD diagnosis. If your child has PFD, they'll likely already be seeing a speechie or OT. However we still recommend some additional support from a dietitian, and our team are very happy to work with your existing team!

How can our Feeding Therapy team help?

In your first appointment or two, our dietitians will:

• Assess growth
• Assess nutritional intake and identify nutrient gaps
• Identify driving factors of food avoidance (and rule out an eating disorder, in a sensitive and age-appropriate way)
• Identify other supports / services required e.g. Speech Pathologist, Psychologist, Occupational Therapist

At followups, we work with clients and their caregivers to:

• Find creative ways to improve nutritional adequacy and meet nutritional needs, including supplements if necessary or desired
• Improve food variety
• Build confidence and reduce anxiety around trying new foods
• Reduce meal time stress for all members of the household
• Empower carers with skills to continue to supporting their child to build food variety after feeding therapy has ended

Our Approach

Our dietitians have training in a range of feeding therapies, but base all of our interventions in Responsive Feeding Therapy (RFT). RFT creates a relaxed and low pressure environment around meals, in order to reduce anxiety for both carers and kids at mealtimes. It is a gentle approach, that builds kids' ability to recognise and respond appropriately to appetite cues, and supports them to build age-appropriate autonomy around feeding. Our team are also trained in the Sequential Oral Sensory (SOS) approach, and can use a Cognitive Behavioural Therapy approach for older teens and adults where appropriate.

Role of our Psychology team

While our psychology team don't provide feeding therapy, they can assist with providing support for anxiety and other mental health concerns alongside your child's feeding therapy. Please check ages seen by each clinician on our mental health team here.

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