Overview
Avoidant Restrictive Food Intake Disorder (ARFID) is characterized by a persistent disturbance in eating or feeding, leading to significant nutritional deficiency or adverse consequences on health without associated distress related to body image or size. 2Diagnosis
Key diagnostic criteria include significant restriction of food intake leading to weight loss, nutritional deficiencies, or dependence on enteral feeding 2.
Assessment may involve nutritional evaluations, growth charts, and clinical interviews to assess the nature and impact of food restriction 2.
Distinguishing ARFID from other eating disorders requires ruling out body image concerns central to anorexia nervosa and binge/purge behaviors typical of bulimia nervosa 2.Management
First-line treatments include nutritional rehabilitation, often requiring medical supervision to address nutritional deficiencies 2.
Psychological interventions such as cognitive behavioral therapy (CBT) tailored for ARFID can be effective 2.
Family therapy may be beneficial, especially in pediatric populations, to support behavioral changes and nutritional intake 2.
Specialized feeding therapy (e.g., sensory-based interventions) can be crucial for children with sensory sensitivities affecting food intake 1.Special Populations
Pediatrics: Early intervention focusing on sensory integration and supportive mealtime practices is critical 1.
Enteral dependence: Specific protocols for weaning children off nasogastric/gastrostomy tubes should follow evidence-based principles including clear definitions of tube dependency and oral eating transitions 2.Key Recommendations
Implement a multicomponent intervention package in childcare settings to enhance vegetable intake, which can serve as a foundational approach to improving overall dietary acceptance in pediatric ARFID 1 (Evidence: Moderate).
Adopt standardized definitions and protocols for managing enteral dependence in ARFID, emphasizing evidence-based practices in transitioning children from tube feeding to oral intake 2 (Evidence: Strong).
Incorporate family-based therapy and sensory-focused feeding interventions as adjunctive treatments to address behavioral and sensory aspects of ARFID 2 (Evidence: Moderate).References
1 Zarnowiecki D, Kashef S, Poelman AA, Cochet-Broch MO, Arguelles JC, Cox DN et al.. Application of the multiphase optimisation strategy to develop, optimise and evaluate the effectiveness of a multicomponent initiative package to increase 2-to-5-year-old children's vegetable intake in long day care centres: a study protocol. BMJ open 2021. link
2 Dovey TM, Wilken M, Martin CI, Meyer C. Definitions and Clinical Guidance on the Enteral Dependence Component of the Avoidant/Restrictive Food Intake Disorder Diagnostic Criteria in Children. JPEN. Journal of parenteral and enteral nutrition 2018. link