Is your child a picky eater or could they have an eating disorder?

For Eating Disorders Awareness Week, here are the signs of the avoidant/restricted eating disorder, ARFID. By Lisa Salmon.

It is not easy to tell whether a child is a fussy eater or has an eating disorder (Alamy/PA)

Although it’s common for children to be picky eaters, parents shouldn’t always dismiss such fussiness as just an annoying stage of childhood.

That’s because some children’s picky food choices stem from the recognised eating disorder ARFID (avoidant/restrictive food intake disorder), which can impact a child’s physical and mental health, and needs urgent treatment before too much damage is done.

The condition, in which children (and adults) avoid certain kinds of foods, eat a limited amount of food, or both, is being highlighted for this year’s Eating Disorders Awareness Week (February 26 to March 3), with the eating disorders charity Beat pointing out that calls to its helpline about ARFID have risen sevenfold over the past five years, from 295 calls in 2018 to 2,054 calls last year.

Unlike more well-known eating disorders such as anorexia, the restricted eating stemming from ARFID isn’t connected to weight, but can be linked to sensory issues, distressing food experiences in the past, or a poor appetite.

“ARFID is a condition where people restrict the foods they eat – maybe the types of food or the amount,” explains Beat clinical advice coordinator, Umairah Malik. “It’s quite different from the eating disorders people might have commonly heard of, in that it’s not driven by weight or shape.

“Instead, it can be driven by things like having a traumatic experience with food – for example a choking incident that’s made them worry about the consequences of eating. People might have sensory challenges around food that makes them sensitive to things such as texture, smells and appearances of food, or it may be they’ve got a lack of interest in food or a low appetite.”

She says these factors aren’t mutually exclusive, so people can sometimes have a combination of them all.

But how can parents tell the difference between picky eating and ARFID?

“When we’re growing up, we all go through a phase where we experiment with different foods, figuring out what we like and what we don’t like,” says Malik. “The difference between ARFID and picky eating is when it starts to have an impact on a child’s life, through physical health and the psychosocial impact. For example, they might struggle with social situations and family life.

“Another difference with picky eating is that some people with ARFID might eat a reasonable range of foods, but they might not eat the right amount of foods, particularly if they fall into the ARFID category where people have a low interest in food and a lack of appetite.

“ARFID can have an effect on a child’s physical and mental health, their growth might not be as expected, or they might need to rely on supplements to get the nutrients they need. It will also have a significant impact on their life in terms of education, school and family life.

“It’s about figuring out what impact it’s having on a child’s life, which is when it would move from picky eating into ARFID.”

Malik points out that disliking one food, for example, doesn’t necessarily mean a child has ARFID – unless disliking that one food is affecting their physical or mental health.

“ARFID is an umbrella term, so it can look really different in different people,” she says. “Some might eat food of a similar colour, they might eat certain textures, they might always have the same meal. Some might eat a reasonable range of foods, but they might feel full after a few mouthfuls and then struggle to eat any more.”

And she stresses: “You can’t tell immediately that someone has an eating disorder just by looking at them.”

Malik advises any parent who’s worried their child might have this disorder to see their GP and ask for a referral for ARFID support. “It might be that you want to take some information on ARFID with you, in case they’re not aware of what it is,” she advises.

If the child isn’t referred for this support, Malik suggests trying the local eating disorders service, or calling the Beat helpline for advice.

“It’s a postcode lottery, but that doesn’t mean it shouldn’t be taken seriously,” she stresses. “We often hear from parents who are really struggling to get help. There aren’t currently any treatment guidelines for ARFID, which means people can experience challenges and barriers to getting the help they need.”

She says treatment such as cognitive behavioural therapy (CBT), and help from dieticians, paediatricians and mental health services can be effective, and points out: “The specific treatment a child needs would depend on their presentation of ARFID. But it’s possible for them to recover, so it no longer has an impact on them physically, their mental health or their social life.”

She adds: “As with other eating disorders, parents can sometimes feel guilt, and we have to reassure them they’re not to blame for their child developing an eating disorder, including ARFID.

“There’s definitely more that needs to be done to raise awareness about ARFID for the public and also with healthcare professionals so they’re able to recognise the signs.”

Malik says there are a wide range of possible ARFID signs, which will vary depending on what type the child has. They include…

1.  Eating a range of foods but consuming much less food than is needed to remain healthy.2. Not gaining weight as expected.3. Developing nutritional deficiencies, such as anaemia.4. Only eating the same-coloured food (e.g. beige).5. Not recognising when they’re hungry.6. Feeling full after only a few mouthfuls and finding it hard to eat any more.7. Taking a long time over meals/finding eating a chore.8. Skipping meals.9. Being super-sensitive to the texture, smell, or temperature of certain foods.10. Being a picky eater.11. Eating the same meals repeatedly.12. Always eating something different to everyone else.13. Avoiding social events where there’s food.14. Being anxious at mealtimes, chewing food carefully, and taking small bites.

You can call the Beat helpline on: England: 0808 801 0677, Northern Ireland: 0808 801 0434, Scotland: 0808 801 0432, Wales: 0808 801 0433.