Demanding or Disordered? What You Need to Know About ARFID

Do you know a child who runs the show at home? The French call such a child l'enfant roi, "the child king". This character rules their family by acting like a little emperor, often due to blurred parental authority and a lack of boundaries. The child king challenges adult roles and holds the ultimate authority at home. In other words, the kid is spoiled.

Many people who don't fully understand eating problems attribute picky eating to king-like behavior. And I don't think they're completely wrong. In this post, you'll learn why.

Picky eating becomes a problem when it a) interferes with a child's health, b) causes issues with social functioning, and c) creates significant distress. Picky eating that has reached a level where it is causing dysfunction in a child's life is referred to as the eating disorder ARFID, avoidant/restrictive food intake disorder. It is different than other eating disorders in that the restriction does not stem from a desire to attain a certain body type. ARFID can be diagnosed at any age, but it generally starts in childhood. Problems develop because the individual's intake is inadequate or lacks variety.

Why does this happen? Is ARFID simply a matter of a child bossing mom around to be a short-order cook? If parents refuse to give in, can ARFID be avoided? The truth is that parents do not cause ARFID, but they can do things to make it worse or make it better.

So what DOES cause ARFID? Generally one or more of the following: lack of interest in food, sensory sensitivities, and anxiety,

Some children, especially those with co-occuring diagnoses, may not particularly enjoy eating. Food is just not very interesting to them. Other children struggle because they are overly sensitive to smells, textures, and flavors. Sometimes an undersensitivity may cause problems as well. This can lead to very selective eating, which is different than "standard" picky eating in that it stems from a trait rather than showing up as a passing phase. This type of selective eating tends to stay the same or worsen over time rather than getting better on its own. Finally, some children will become very selective because they are afraid of something bad happening when they eat, such as vomiting or choking.

Not every person has to eat every food; it's ok to have preferences! "Regular" picky eating doesn't need intervention. This might look like a child who strongly prefers specific types of foods or brands but eats from all five food groups on a regular basis, can try new foods, is growing well, and doesn't experience problems because of their eating. On the other hand, someone with ARFID will have very narrow preferences for certain foods, cut out entire food groups or eats variety very rarely, refuse to try new foods, and experience problems with growth, health, or social consequences.

When parents see signs of ARFID, they respond in intuitive ways: they either accomodate the child's preferences (allowing the child to be the "king"), or they put pressure on the child by demanding the child eat. Accomodation can look like preparing alternate foods for the child, allowing the child to escape eating situations, and not continuing to expose the child to variety. Pressure looks like using judgmental language, showing a lot of emotion or overwhelm, and getting too involved in having the child "like" the food versus trying the food. Parents can fluctuate between both responses, and while well-intentioned and seemingly reasonable, these responses do not make ARFID better.

The good news is that ARFID is treatable, and parents are a major part of the solution. With guidance, parents learn when to step in and when to step back. They understand how to be neutral and supportive rather than emotional and pressuring. Treatment can take time, but things can absolutely improve, and you'll once again see peace (and not pickiness) reign at your table.