Introduction 

In 2019 I was approached by a number of parents with children who might commonly be described as “fussy eaters”. Having a child with food difficulties can be enormously stressful and upsetting. It often has a family-wide impact, making families dread meal-times and avoid social occasions. At the point of contacting me mums, dads and grandparents are often at the point of tearing their hair out. E mails land in my inbox with subjects such as ‘HELP!’ or ‘Please help my child eat properly’; the situation feels desperate and miserable.

The good news is that there are solutions to this problem and light at the end of the tunnel. In some cases, the point of solution starts with accepting your child may not be a fussy eater at all, they may actually be suffering from a food avoidance disorder. After much consultation, in 2013, a more extreme reaction to food was finally recognised as an eating disorder in the American diagnostic and statistical Manual of Mental Disorders. It is described as Avoidant and Restrictive Food Intake Disorder (ARFID).  This condition essentially means your child suffers from extreme hypersensitivity and anxiety around food, and the ‘disinterest’ you often see is a bravado used to mask an intense fear and phobia. Understanding this is the first part of solving the problem, along with understanding that you are not to blame for this problem. It’s easy to understand the parental feelings of guilt – feeding children, and therefore keeping them alive, is the single most important task of being a parent. If this goes wrong, for whatever reason, it is natural to look for reasons why. However, the eating behaviours we see in AFRID are mainly due to particular development traits, such as sensory hypersensitivity, neophobia and disgust and rarely occur because of what parents have done or not done. Accepting this is an important starting point too as a parent who does not feel to blame and is reassured is a parent who is able to follow an intervention plan.

Signs your child may suffer from AFRID 

Here are some clues that your child may suffer from this condition: 

1. They may only eat very few foods
2. They show brand loyalty (the packaging predicts the safety of the food)
3. They only eat one flavour of an accepted food
4. They only eat certain foods specific to context
5. They show extreme anxiety if offered new foods or foods they don’t like (anxiety may be expressed in the form of feigned disinterest or lack of appetite)
6. They may gag or vomit if offered new foods or foods they don’t like
7. They don’t seem hungry. There is a lack of interest in eating and the child will go for long periods without food or asking for food
8. Your child avoids foods because of their sensory characteristics – they react to the sight, taste, texture and smell of food
9. They may be concerned about the consequences of eating foods or certain foods. They might be worried about choking or vomiting
10. They may fail to gain weight, but this is more likely where ‘safe’ and accepted foods are withheld or not available
11. They may show nutritional deficits because of the limited range of foods that are accepted
12. They have problems with social situations because of their avoidant eating and restricted diet. The child might be very anxious around food and therefore unable to join in with family mealtimes or social activities where food is involved  

What next? 

If some of all of these signs are present, then it may be time to consider seeking support with your child’s eating difficulties. A nutritional therapist with experience in this area can take them through a process of desensitisation (breaking down the eating process into single-sensory experiences by dealing with sight, sound, smell, touch and taste separately) and also tackle their food anxiety, whilst providing support and clear guidance for parents on what to do and what not do. The processes involved do take some time and patience, however the right therapist can totally transform family life by communicating with your child in the right way and showing you how to do the same.

If you are worried your child may be suffering from Avoidant and Restrictive Food Intake Disorder, here are a few tips on approaches to avoid, which may help get your started whilst you make a decision about embarking on a bigger process of change.

1. Do not apply pressure to eat (because this worsens anxiety), this includes:
   1. Encouragement (for example, clapping or cheering when a child eats and giving too much attention to the child at mealtimes)
   2. Persuasion or prompting – comments such as ‘Eat up, it tastes lovely’ or playing games with food
   3. Guilt – comments such as ‘Eat up, there are starving children in…’ or using the adult’s own emotional state: ‘It will make me happy if you eat’.
   4. Siting in front of a new food – for example, not letting the child leave the table until the food is eaten
   5. Threats – comments such as ‘If you don’t eat, I’ll…’ or applying punishments or consequences.
   6. Forcing – for example, holding a child down or pushing food in the mouth when the child is crying
2. Do not hide or disguise foods (because their hypersensitivity means they will probably notice and feel a sense of mistrust as a result), this includes:
   1. Hiding medicines or supplements
   2. Hiding a ‘healthy’ food such as a vegetable in a preferred food
   3. Adding extra calorie sources such as butter, milk or cream in a preferred food
   4. Changing the appearance of a food to make it more likely to be eaten, for example, cutting foods into favourite shapes
   5. Putting new foods into familiar packaging to ‘trick’ the child into accepting the new food
3. Do not withhold preferred foods (because it is likely to result in increased anxiety and food refusal)
4. Do not use rewards and bribery (because no reward or bribe is enough to overcome their intense anxiety)
5. Do not leave your child to go hungry (because they already lack recognition of hunger and therefore they really will go hungry!)

I am a Nutritional Therapist (N.F.H Dip MFNTP) Cook and Caterer, inspired by the Aegean & Mediterranean. I am based at my clinic in Stoke Sub Hamdon and work with clients across Somerset, Dorset, Devon and Wiltshire.  I also work with people further afield via Skype and telephone.  I am active on Facebook, Instagram and Linked-In as Hayley Frances Nutrition and can also be contacted at hayley@hayleyfrancesnutrition.com/07586717678.

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