Parents and Carers – Selective Eating vs ARFID

Session 2

Understanding the body

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When anxious, our appetite is
reduced and therefore eating can
be even more difficult.

However, the longer the child goes without
eating, the more sick they will feel, as there is no food in their
body.

Anxiety also gives the feeling of 'feeling sick' and for some children, they will avoid
eating due to the fear of being sick.

Understanding anxiety and the link with hunger

We all feel anxious over various things; however, for some children the anxiety is there all the time.
This will impact their ability to
communicate clearly, engage in
activities, sleep and eat.
That is why we want them to be
able to understand how the anxiety
impacts their bodies and think
about strategies on how to better
manage this.

Anxiety curve

The graph shows three lines:

Green – expected anxiety with new situations – anxiety starts lower, during the situation it goes higher and over time, it reduces as you know what to expect.
Yellow - expected anxiety when you avoid situations - anxiety starts higher as you know you are avoiding a situation. Over time, the anxiety remains really high as there is no opportunity to expose ourselves to new situations.
Red – expected anxiety when you expose yourself to situations - anxiety starts lower, goes up when faced with a new situation, but then the more you expose yourself, the lower the anxiety will be.

Why preferred foods are important

Preferred foods are often calorie-dense food, so you can eat more without feeling full too quickly.

Preferred foods can be used for weight gain (if needed) OR to increase interest in food again.

Preferred foods tend to be 'processed foods' (in packaging), and this is because young people with ARFID know what to expect from that food, and there are no surprises. This is the same reason they tend to be brand loyal.

Energy levels at school

If a young person doesn’t eat all day at school, or eats very little, they will get very tired and disengage. When they try to eat, they could feel full very quickly and/or will still continue to feel hungry.

It is important to explain that there might be other hunger signals rather than a rumbling stomach, i.e. headache, moody, irritable, sleepy, lack of energy, lack of concentration, more sensitive and hyperactivity.

Energy levels

It is vital for young people to have energy throughout the day, especially at school when they need extra energy to learn. However, many young people with ARFID won't eat regularly. This could be due to lack of hunger, feeling anxious, or not wanting to eat at school - to name a few examples.

Some strategies:

Talk to school about it and ask them to allow preferred foods at school.

Lots of children will tolerate drinking at school – think about fruit juice,
smoothies, hot chocolate or milkshake.

See if school can provide a quiet room for them to eat, the
dining hall tends to be quite overwhelming.

Keep a timetable and planned meals.

Use of alarms to remind them to eat.

Interoception

Interoception is called the 8th sensory system.

It is the ability we have to read our internal body signals when we are hungry, when we are thirsty, when we need to go to the toilet, if we are hot or cold.

Most children, especially autistic individuals, struggle to recognise these signals and therefore find it difficult to know when to eat and sometimes when to stop eating.

Interoception