Building a positive relationship with food and your body

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Professionals – Avoidant Restrictive Food Intake Disorder

Session 3

Understanding eating and treatment

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Why eating is not on easy task

TUBE TO TEACH CHEWING

FOOD TO TEACH CHEWING

NOT helpful things to do

Hiding foods they don’t like – they will find out and will impact their trust in you

Letting them go hungry – they will enjoy not having to eat and this will impact even more their lack of hunger

Pressure to eat or finishing on time – it will increase anxiety and it will not make 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
- CBT-AR
- UP-A
- Food exposure
- Food chaining
- 6 steps to eating
- Messy play

FOOD AVOIDANCE BASED ON
SENSORY
CHARACTERISTICS
OF FOOD

- Routine
- Timetable
- Explaining hunger/fulness
- 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

Food chaining

• Teenagers and adults usually bring their own motivation to add a new food
– despite their sensory issues (i.e. – teenager that wants to be able to go
out with friends and eat pizza)

How could we work with that?

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, not to the child.

• Regularly reassure the child that they are “ok”

• It is about getting messy – wash hands at the end

• Use different food characteristic, for example:

• Large dry foods
• Medium dry foods
• Fine dry foods
• Wet drinks
• Sticky foods

6 Steps to Eating

Visual

What does it look like?

- What is the colour?

- What size is it?

- What is the appearance?

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 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 makes
in your mouth?

- Does it feel loud when you chew it?

- Is it crunchy?

- Does it get soft quickly?
*Not expected to eat, it is ok to spit it out

Swallow

Any other sensation?

- Any other sensation?

* Small mouthful is ok and gradually increase quantity

- 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
- To use different place 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 x unsalted

Deconstruct – break the food i.e. pizza – try with a piece of bread add tomato sauce add cheese…

THEY NEED TO AGREE WITH THESE STRATEGIES!

Paediatrician role

• Assessment for underlying and potentially treatable contributing factors like history of gastroesophageal reflux disease due to cows-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 risk for micronutrient deficiencies as evident from pattern of food restriction.

• To assess if patient is underweight for complications of protein/energy malnutrition including cardiac complications and 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.