The Eating Disorder Recovery Blog
What's it like to get help with ARFID?
Last week, I sat with a mum who described feeling very worn out and defeated.
It was just her and I in the consultation. She described how household meals had become stressful and tense. Her child ate only a small range of foods and new foods were refused instantly. Some days foods were accepted, other days not. Family meals felt impossible. She had tried being relaxed and had also tried being firm. She had tried rewards, ignoring it, encouraging “just one bite”, but nothing seemed to work, and her child was now occasionally refusing to come to the table at all. This mother told me she simply did not know next steps and she didn’t know if I could help. She was worried about her child’s growth and nutrient intake. She was worried she had done something ‘wrong’ to have caused her child’s fussy eating.
As an eating disorder Dietitian, one of the first things I feel compelled to do is reassure parents that when a child’s eating feels extreme and stuck, it is not caused by bad parenting. During our session, we began to explore whether her child’s eating might be more than typical fussy eating. We discussed the possibility of Avoidant/Restrictive Food Intake Disorder, or ARFID. Which is what has inspired this blog post today.
ARFID is a recognised feeding disorder. It is not about body image, dieting, trying to control weight, and it is not about the child trying to be difficult. Children with ARFID often avoid food because of strong sensory sensitivities (‘think’ texture, smell), fear of choking or vomiting, or very low interest in food. It is formally diagnosed by a GP or Psychologist but often picked up by Dietitians as the first point of contact with these children and families.
I encouraged this mother to book a GP appointment to talk through her concerns and discuss Medicare care plan referral options. But even before a formal diagnosis, there are a number of helpful steps we can take!
There are a lot of topics that can come up in a typical first appointment, and yours might not be the same. but here’s what we worked on together:
Step 1. Understanding Texture and Food Preferences
First, we looked closely at what her child does eat.
We wrote down:
- Safe foods
- Foods that are always refused
- Preferred textures (crunchy, dry, smooth)
- Textures that cause distress (mushy, mixed, wet)
From this analysis, we could see that the eating preferences were not random, they were sensory. Many children with ARFID experience certain textures as overwhelming. What looks like stubbornness is often a nervous system reacting strongly. Instead of pushing completely new and scary foods, we plan to gently expand within his preferred textures first. If the child likes crunchy foods, we start there. Small, safe steps build confidence and trust!
Step 2: Identifying Nutritional Gaps
Next, we looked at the child’s diet from a nutrition point of view. While we have fancy nutrition analysis software and can assess nutrient intake for each child, there are some common at-risk nutrients that show up regularly. Children with limited diets can miss out on important nutrients like:
- Iron
- Fibre
- Vitamins and minerals
- Calcium
- Protein variety
We talked about adding nutrition into the foods he already accepts. For example, fortifying safe foods or considering supplements if appropriate and needed. The goal here is to reduce risk while we slowly work on expanding the child’s variety.
Step 3: Looking at Growth
Growth is often a concern of parents of children who have ARFID. We reviewed his growth charts together. Was he following his own curve? Had there been any drops?
In this case, growth had slowed slightly but was still within range. That reassured his mum that we had space to work gently, without creating more pressure.
When growth is affected more significantly, that’s when we may involve a wider team — GP, psychologist, dietitian, paediatrician, and sometimes a speech therapist, or an occupational therapist for sensory support. Priority then is around increasing intake of preferred foods to promote catch up growth, before we then work on expanding variety.
Step 4: Reducing Pressure at Mealtimes
This is a very big concern for many parents. When a child isn’t eating, it is natural as a parent to encourage the child. Parents often worry, “What if he doesn’t eat enough?”
What we find is that pressure often increases anxiety for the child. Anxiety often reduces appetite, increases the stress of the child, and may promote more resistance!
There is a strategy we use here called the division of responsibility. This simply involves:
- The parent decides what food is offered, when, and where.
- The child decides whether to eat and how much.
There can be a lot more nuance of course, and we have lots of tips for how to implement this or language to use. However in general, this framework removes battles and puts clear boundaries in place for both the parent and the child. I reassured this mother that we are safe to do this, and that we are monitoring growth and nutrition. A calm mealtime environment is more helpful long-term than forcing bites, and I reassured that reducing pressure is not giving up or being negligent. It is lowering stress for everyone so the nervous system of the child can feel safe enough to eat.
Step 5: Creating a Food Preferences List
Finally, I gave her a simple food preferences checklist to share with her child. The goal was to work through the sheet either supporting the child or leaving them to fill the checklist out alone (depending on age and developmental stage). Reassuring the child that we will not make him eat anything on the list, we want to:
- Circle foods that look interesting.
- Mark foods that feel like a “maybe.”
- Cross out foods that are a definite no.
We re-iterate that there is no pressure to try these foods, we are just exploring. This gives the child a sense of control without pressure and invites curiosity. For many children with ARFID, feeling heard makes a big difference.
When this mother left the session, she told me that she felt a sense of relief that there was work ahead with her child but we had a plan.
If your child’s eating feels extreme, stuck, or distressing (for yourself and/or them!), seek support by talking to a Dietitian who works within the Responsive Feeding Therapy framework. We can help you to get unstuck - understanding what’s really going on is the first step toward helping your child move forward - gently and safely.
Want to find out more about how our team approach kids' (or adults!) feeding challenges?
You can read more on our Feeding Therapy page here.
And if you're ready to get support for yourself or your child, you can make a booking with one of the Dietetics Team here.
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