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Rate My Hospital Kids' restricted eating disorder 'more than just picky eating'

Canadian children and teens with persistent avoidance of food can face serious complications which health-care professionals and parents should be aware of, two doctors say.

A commentary in Thursday's issue of the Journal of Adolescent Health reflects on the first two years of a new category of eating disorder.

The picture of a child with Avoidant/Restrictive Food Intake Disorder or ARFID varies from longstanding feeding and eating difficulties to not eating adequately for a prolonged period after a stressful event.

It could be a five-year-old who doesn't like the texture or flavour of most foods and prefers soft foods that don't require much chewing, such as pasta or oatmeal. She struggles to get enough nutrients to grow and develop normally and is severely underweight. Or a 10-year-old boy who refuses most food for 18 months after nearly choking. He goes to the emergency department with a failure to gain weight and a history of anxiety disorder.

"This is more than just picky eating," said Dr. Mark Norris, a specialist in adolescent health at the Children's Hospital of Eastern Ontario in Ottawa, one of the authors of the commentary.

"These are kids that aren't meeting the mark and that are falling off and suffering medically and psychologically as a result of their deficiencies in intake."

Norris said he and Dr. Debra Katzman at Hospital for Sick Children in Toronto wrote the commentary to educate health-care providers about the realities of the illness so they won't dismiss it.

"This is likely an illness that affects quite a few Canadians and probably provides parents with a significant element of distress," Norris said. "Despite the severity of the illness, we know very little about it formally and initial indications would suggest that it's not something that's easily treated."

The researchers have started collecting data from children presenting to pediatricians and eating disorder programs to estimate how common it is.

Dr. Howard Steiger heads the eating disorders program at the Douglas Institute in Montreal and was involved in discussions about renaming ARFID in the DSM-5, psychiatry's diagnostic manual.

"Unlike anorexia nervosa, it's not driven by body image concerns or fear of becoming overweight but more by all the other possible reasons you could be turned off food," Steiger said.

Adults with ARFID may be disgusted by physical properties of food, which affects how they function at school, at work and socially. They may fear getting sick from food or reacting to additives, Steiger said.

As with eating disorders, the treatment for ARFID is to help people who are uncomfortable with food or have overly rigid rules around it.

Norris suspects children with ARFID do better with a multidiscplinary approach from psychologists, psychiatrists, pediatricians, occupational therapists and dietitians.