Fussy eating, also known as Avoidant/Restrictive food intake disorder (ARFID), Selective eating disorder, or restricted eating, is a condition where children (or adults) have reduced consumption of certain foods due to preferences in taste, colour or texture. Children who have fussy, avoidant or restricted eating have difficulty digesting certain foods, only eat small portions, and have little or no appetite. These children often have had incidences of vomiting or choking after eating food and are therefore highly avoidant of eating particular foods. As a result of this condition, children are often unable to take in adequate calories or nutrition. ARFID is often viewed as a stage of childhood that is generally overcome with age, however some individuals may not grow out of this disorder and may continue to show these eating behaviours throughout their adult lives.
In order to meet the diagnostic criteria for ARFID, a child must display a disturbance in eating or feeding that is evidenced by one or more symptoms of:
- Substantial weight loss (or absence of expected weight gain)
- Nutritional deficiency
- Depending on a feeding tube or dietary supplements
- Significant psychosocial interference (for example, distress associated with eating certain foods)
- Disturbance not due to unavailability of food
- Disturbance not due to anorexia nervosa or bulimia
Signs that fussy eating has become a problem
Children who have ARFID have an inability to eat certain foods and will exclude large food groups from their diet such as fruits, vegetables or meats. Children tend to stick to “safe foods” and may be limited to certain food types, even specific branded foods. Sometimes children with ARFID tend to refuse food based on colour, texture (too soft or too crunchy), temperature (too hot or too cold) or taste. Some children end up eating only ‘white’ foods such as chicken, potatoes, milk, etc. Sufferers can often experience physical-gastrointestinal reactions to adverse foods such as vomiting or gagging.
Other conditions which are commonly seen with fussy eating
There are many conditions which are known to be associated with ARFID these include:
- Autism spectrum disorders (ASD) – these individuals often have a high degree of selective eating and are sensory in their food selection
- Anxiety disorders- specific food avoidance is often caused by a food phobia that causes high levels of anxiety when a person is presented with a new or feared food.
Treatment for fussy and restricted eating
Cognitive behavioural therapy (CBT) is known to be the most successful treatment for fussy eating. Components of this therapy include the following:
Children and their parents are encouraged to keep a diary of their typical eating behaviours, including information about their beliefs and feelings towards certain food groups.
Education about anxiety and avoidance of food
This involves identifying triggers and factors that might be stopping the child from eating certain foods including worries and fears about certain food types. This also involves giving the child information about what to expect when facing new foods, and thus reduce the discomfort.
Rewards and behaviour charts
These are introduced to encourage coping and brave behaviours towards “facing the fear” of new food groups.
Thought challenging and self talk
This involves helping children to identify any unhelpful beliefs about certain foods and learn strategies to change their beliefs and self-talk to more more helpful and realistic.
Gradual exposure to new food groups (‘stepladders’)
This involves helping children gradually face their fear of certain foods in a step-by-step approach. Each step is practised frequently before moving on to a more difficult step.
An example of a possible ‘stepladder’ with a child who does not eat fruit is as follows (starting with the most achievable goal to the most difficult one):
- Look at 5 different fruits
- Touch and cut up 5 different fruits
- Smell 5 different fruits
- Imagine tasting 5 different fruits
- Taste 5 different fruits with your tongue
- A small bite of 5 different fruits
- 2 small bites of 5 different fruits
- 3 small bites of 5 different fruits
Children are given strategies to help them cope with doing goals on the stepladder such as learning how to relax their body and reduce their anxiety. This includes teaching the child how to relax using breathing, muscle relaxation and focused attention strategies.
If you would like to find out more about our treatment for fussy or restrictive eating, or to book an appointment with one of our child clinical psychologists who provides treatment for this condition, please email or call the clinic on 02 9438 2511.