Eating Disorders Awareness Week is there to do what it says on the tin. And awareness about eating disorders has grown throughout my career. Indeed eating disorders have become synonymous with anorexia nervosa and bulimia nervosa - two devastating mental health problems that call for as much attention as they can get. But both are actually fairly rare. And while I struggle to find people who haven't heard about anorexia and bulimia, I rarely meet anyone aware of other eating disorders.
Picture a child sitting at a table, cutlery in hand and food in front of them. Yet no matter what the parent says or does, gentle bribery, cajoling, threats of 'an early bed', the child simply won't eat. Nearly all parents go through the annoying phase when their child refuses to eat. It usually starts at two. Professionals call it the 'food neophobic' stage of child development. This is normal. Nothing to worry about.
Avoidant/Restrictive food intake disorder or ARFID is actually more common than anorexia and bulimia. It typically starts before the age of five and lasts until adulthood. You've probably at least heard about both children and adults with ARFID, but perhaps known it by another name. The 'picky eater'. But it's a misleading term. What most people call a picky eater is actually a bunch of three separate problems. Two of these are normal. One is a psychological disorder. The term 'picky eater' trivialises the everyday struggle faced by people with ARFID and those around them.
ARFID generally starts between two and five, the same age children hit the food neophobic stage. The difference is the child with ARFID does not 'grow out of it'. Children at this stage generally refuse new foods in favour of things they're familiar with. Although frustrating, the child eats and doesn't lose weight. But children with ARFID tend to avoid and restrict their food, leading to weight loss or nutrient deficiency. They restrict their diet to sometimes only two or three foods that they deem to be safe. Most often these are foods high in fat, sugar and/or salt. And it damages their health.
A child with ARFID often just looks like they are being naughty at mealtimes. They may refuse to follow the adults' requests, run away from the kitchen or dining room and fidget around the table. Again, nothing unusual.. But children with ARFID do this nearly, every time food is put on the table and generally lasts for years. This is when well-meaning people dish out advice. The 'been there, done that' mantra is meant as support. As an eating behaviourist professional and a parent, I can safely say ARFID children are different.
The things that get most children through the food neophobic stage, simply don't work, or more accurately will not work in the same time frame, for children with ARFID. Parents of children with ARFID are desperate to stop the behaviour, desperate to get their child to eat and desperate to have a 'normal' food neophobic child. If anything, they can offer other parents advice. They've almost certainly tried everything. Worst of all, parents of children with ARFID are often publically blamed and sometimes shamed for their child's apparent willfulness.
In more than 10 ten years working with children with ARFID, it is very rare that anything the parents did or do caused the problem. They are not at fault. ARFID is an eating disorder. The child is anxious about food, may have experienced a traumatic event with food or find different tastes, smells or textures of food offensive. The behaviour stems from their interaction with food and has little to do with what the parents have or have not done. ARFID stays with the child. It does not get better with time and harms children's health.
Next time you see that child across the table playing up and refusing to eat, 99 times out of 100 it is just a phase. But alarm bells start to sound if their behaviour does not improve by 6 years of age and especially if the child starts to lose weight. It might be that 1 in 100 case of ARFID. This is when it's crucial to get professional advice to improve the child's diet. When you see that child with ARFID, understand that it is not the parents' fault and your advice has likely been tried, tested and failed. For parents of children with ARFID, that frustrating phase all parents went through is a daily reality, with no signs of improvement.
The road to recovery from ARFID is possible, but is likely to need specialist support. Several specialist centres across the world are available and can help. And I hope this spurs your interest just enough to find out more about other eating disorders beyond those you think you already know about. ARFID is just one. There are others. Disorders like pica and rumination also appear to have lower public awareness than anorexia and bulimia. Maybe it's time to find out more.