Building a positive relationship with food and your body
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Professionals – Selective Eating vs ARFID
Understanding eating and treatment
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NOT helpful things to do
Hiding foods they don’t like – they will find out and this will impact their trust in you.
Letting them go hungry – they will enjoy not having to eat, which will further impact their lack of hunger.
Pressure to eat or finishing on time – it will increase anxiety rather than making them eat faster.
Not giving their preferred food - they won’t start eating other foods if you limit the amount of preferred foods.
Having the idea of “good” and “bad” food – food is food and if they are only managing a few foods, this is ok for now.
Strategies for treatment - by age
What is ARFID – Avoidant/Restrictive
Food Intake Disorder?
APPARENT
LACK OF
INTEREST IN
EATING
- SOS – Sequential Oral Sensory approach to feeding.
- CBT-AR – Cognitive Behaviour Therapy for ARFID.
- UP-A - Unified Protocol for transdiagnostic treatment in Adolescents.
- Food exposure.
- Food chaining.
- 6 steps to eating.
- Messy play.
FOOD AVOIDANCE BASED ON
SENSORY
CHARACTERISTICS
OF FOOD
- Routine.
- Timetable.
- Explaining hunger/fullness.
- Window of opportunity.
- Motivation work.
- Team work.
- Other strategies.
CONCERN ABOUT
AVERSIVE
CONSEQUENCES
OF EATING
- SOS.
- CBT-AR.
- UP-A.
- Food exposure.
- Working on emotions.
Messy play
• The child does not have to eat the foods presented to them.
• It is about exploring food with the child.
• It is about sharing an experience with the child.
• Regularly reassure the child that they are 'ok'.
• It is about getting messy – wash hands at the end.
Use different food characteristics, for example:
• Large dry foods.
• Medium dry foods.
• Fine dry foods.
• Liquids/drinks.
• Sticky foods.
6 steps to eating
There is an exercise called “6 steps to eating”, which can help expose children to new foods. It helps to know more about the food and which aspects of it is difficult. Start with the least difficult aspect that is looking at the food and work your way to the most difficult one to the most difficult one that is eating the food.”
Visual
What does it look like?
- What colour is it?
- What size is it?
- What shape is it?
Touch
What does it feel like?
- Is it wet or dry?
- Does it feel cold or hot?
- Does it feel bumpy or rough?
Smell
What does it smell like?
- Is it a weak or strong smell?
- Is it a nice smell?
Taste
What does it taste like?
- Does it have a strong taste?
- Is it sweet or salty?
- Is it spicy?
Texture/Sound
What is the texture like?
What sound does it make
in your mouth?
- Does it sound loud when you chew it?
- Is it crunchy?
- Does it get soft quickly?
The child is not expected to eat the food and if they feel they can’t keep it in their mouth, it is okay to spit it out.
Swallow
Any other sensation?
- Any other sensations to talk about?
The child can start by taking a small mouthful and gradually increase quantity as they feel ready to.- Emphasise that they are not expected to eat the food!
- Outside of mealtimes.
- To try and stick to a routine so they know what to expect.
- Use different places to practice.
Other strategies
Fade in - adding small amounts of food they don’t like into food they like.
Add some spice – ketchup, curry, salt, honey, sugar.
Food chain – try similar foods i.e. veggie chips with same format to potato chips.
Change presentation – salted vs. unsalted.
Deconstruct – break down the food, e.g. pizza, try with a piece of bread, add tomato sauce, add cheese.
They need to agree with these strategies!
Paediatrician's role
• To assess for any underlying and potentially treatable contributing factors, such as a history of gastroesophageal reflux disease due to cow's milk protein intolerance, premature delivery with subsequent feeding difficulties due to reduced acquisition of oral motor skills, organic disease including enteropathy due to coeliac disease and metabolic diseases.
• To assess the risk for micronutrient deficiencies as evident from the pattern of food restriction.
• To assess, if the patient is underweight, for complications of protein/energy malnutrition including cardiac complications and the impact on bone density.
• To monitor, if required, nutritional rehabilitation in the underweight patient by admission with daily blood tests to rule out refeeding syndrome.
Medication
Medication is not the first line of treatment, however there is research on the use of medication.
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