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When does your child’s picky eating become more than just picky eating? Some children and even adults cross from being picky eaters into an eating disorder known as Avoidant/Restrictive Food Intake Disorder.

Commonly referred to as ARFID, the disorder was first made an official eating disorder in 2013 by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and may affect up to 5 percent of children in the United States. Broadly, ARFID covers children and adults who have issues with eating not associated with body image the way anorexia and bulimia do.

So when is it more than just picky eating? There are several criteria that define the issue.

According to information provided by the Eating Recovery Center, The Carolinas in Greenville, ARFID is an eating or feeding disturbance characterized by a persistent failure to meet appropriate nutritional and/or energy needs. There are many types of eating habits that might lead to an ARFID diagnosis, such as avoiding certain colors or textures of food, eating very small portions, having no appetite, difficulty digesting certain foods, or a fear of eating after experiencing choking or vomiting.

Susan Connelly-Nelson, clinical manager for Eating Recovery Center, said weight loss —or the failure to gain weight as expected — is among the top criteria for diagnosing ARFID. Having a nutritional deficiency is also part of the diagnosis. Some even need the aid of a feeding tube for nutrition, as no foods are safe or palatable. There is also a general lack of interest in food.

Connelly-Nelson is quick to note that this eating disorder is not associated with body image issues or how a person might perceive their personal weight or shape.

“While ARFID and anorexia both deal with weight loss and nutritional deficiency, people with ARFID do not strive to be thin,” she said.

ARFID appears to be more prevalent in individuals who have sensory processing disorders, obsessive compulsive behaviors, or autism, though that is not always the case. One study that was presented when ARFID was first classified in the DSM-5 stated that patients were typically younger than those with anorexia and bulimia and it lasted longer. It was also more prevalent than other eating disorders among males studied — 29 percent versus 15 percent for anorexia and 6 percent for bulimia.

According to Connelly-Nelson, children and adolescents with the disorder will exhibit high levels of anxiety around new foods or even fear certain foods. They can have a fear of choking, vomiting or even have a fear of the texture of specific foods.

When an online group of adults who live with ARFID were asked what they wished others knew about it, most said they wished they could change and eat like regular people. They also said they didn’t want food pushed on them or to have attention given to their issue.

“Most of us have a lot of anxiety about eating around others because of our selective eating. Please don’t call attention to the fact that I only have bread on my plate. It just makes it worse,” said Amanda Brown, who lives in Greenville.

Jennifer Bryan, whose son has ARFID, said as a parent it’s hard to grasp, but she and her family are working to help her son. She urges families who are experiencing symptoms of the disorder to seek help and to find a support group.

“It is hard to understand if you haven't had a family member live it,” Bryan said. “As a parent, I love to eat so many things, so it was even hard for me to understand. Realizing how few people have it was isolating but finding online support groups was awesome.”

Others said that telling parents to let their children go hungry is not helpful. When a child is dealing with low weight, not feeding him only works against treatment. A person with ARFID would rather not eat than eat a food that is not on their palatable list. Likewise, telling parents or those dealing with ARFID to “just get over it” causes more anxiety in the long run.

ARFID can cause heart, liver and kidney problems, anemia, problems with bone density, osteoporosis and gastrointestinal issues. Professionals recommend getting children and adults evaluated as soon as possible if they suspect the eating disorder.

There is hope for recovery. Connelly-Nelson said ARFID is treatable with the help of professionals trained in eating disorders, specifically ARFID, and with family support.

“It is essential that family members learn the skills necessary to help with potential triggers and stressors the child might face in recovery,” she stressed.

Eating Recovery Center, The Carolinas provide information for area families. They offer specialized treatment for children, adolescents and adults struggling with ARFID. Assessments are done by a master’s-level clinician. More information on ARFID and treatment can be found at www.eatingrecovery.com.

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