ARFID Treatment for Children

Avoidant restrictive food intake disorder (ARFID)

Avoidant restrictive food intake disorder (ARFID) is where it is not possible to meet nutritional needs and this can lead to significant weight loss or nutritional deficiency. There is generally not a concern about weight or body image and there is not a lack of food available that causes this condition. ARFID can occur at any age. In children, this condition can affect growth and can affect their psychosocial functioning.

There are generally three types of ARFID that have been recognised, and these include:

• An apparent lack of interest in eating
• An avoidance of eating because of the specific sensory characteristics of the food
• Concern about the negative consequences of eating

For ARFID, a multidisciplinary approach is required that includes treating any medical consequences of the condition, management of nutrition to help increase calorie intake, as well as psychological support. Currently, behavioural interventions have shown to be successful that systematically desensitise children to a wider range of foods. Using behavioural therapy and providing support at the earliest sign possible can help to reduce the long-term effects and the duration of the condition.

As part of the multidisciplinary team, this includes:

• An adolescent medicine specialist or pediatric gastroenterologist who lead the medical management and diagnosis
• A psychologist and psychiatrist
• Dietitian/nutritionist
• Speech language pathologist
• Occupational therapist

The involvement of different subspecialties is specific to the patient’s needs. The treatment goal for ARFID is weight restoration.

In terms of supportive care:

Nutrition

• Starting with safe foods that are nutrient and calorie dense, and then gradually adding other foods for more variety, and working up to the patient’s fear foods
• Supplements can be beneficial if the oral food intake is not adequate
• Support by a dietitian can be helpful

Behavioural Therapy

• Cognitive behavioural therapy is beneficial for children older than 10 years
• The treatment period is 6-12 months and this includes both family and individual therapy
• The focus is nutritional restoration and includes slowly reintroducing certain foods via exposure therapy

Drug therapy

• Generally medication is not first-line treatment and there are no specific medications that have been approved for this condition
• Multivitamins and other supplements, for example vitamin D and thiamine can be used depending on how severe the malnutrition is or to correct specific vitamin deficiencies