Feeding a Child with ARFID and a Narrow Range of Foods

Helping a Child with ARFID to Eat

Feeding a child with ARFID is challenging and most parents are not adequately prepared. Children with ARFID are not just “picky eaters” and may not respond the same way as other children. Well-meaning advice you may have received—such as, “They will eat when they are hungry,”—often does not work for children with ARFID. In fact, this advice could be dangerous.

ARFID stands for Avoidant Restrictive Food Intake Disorder. People with ARFID struggle to eat enough in terms of volume and/or variety and it affects either their health or their social functioning in a detrimental way.

Below are some strategies that stem from CBT-AR (the treatment that we provide for people with ARFID) and our work with families with kids with ARFID over several years. Note that these are general strategies and not all will work for all families.

Provide Food Regularly

When feeding your child with ARFID, provide food regularly, ideally 5 to 6 times a day—every 2 to 3 hours. This can be 3 meals and 2 to 3 snacks, or it can be 5 to 6 “eating episodes.” Do not rely on your child—who may find eating to be a chore or who does not have a reliable hunger signal—to ask for food. This consistency will help ensure your child gets enough. It will also help improve digestion and regulate hunger cues.

Serve Preferred Foods

Serve a preferred food at every eating episode. This applies even if your child’s preferred foods are pasta, french fries, and candy. Eating something is always of utmost importance. We emphasize volume over variety. Only after your child is eating enough regularly do we even start to work on adding new foods at mealtimes to round out nutrition.

Try to reduce stress at meal and snacktimes. Kids with ARFID have sensory superpowers and their senses are easily overwhelmed. This has likely inadvertently led to many overwhelming and negative eating experiences. Now is a chance to rebuild more positive eating experiences. Try to keep meals calm and low-pressure.

Consider Caloric Density

Choose foods with an eye toward increasing calories. Foods that are higher in fat will go a longer way to nourishing someone who struggles to eat an adequate volume of food. Assuming your child is amenable, when you have a choice of food, pick the higher-calorie version. For example, a slightly larger granola bar covered in chocolate can add an additional 80 kcal. Whole milk has more calories than milk with less fat.

Increase the Volume of Preferred Foods

Try to increase the volume of preferred foods. It’s okay for now if you are giving your child multiple cookies and French fries. Your child needs nutrition. Giving them more of their preferred foods is more important than adding more fruits and vegetables.

Reduce Pressure When Offering Novel Foods

When offering or presenting new foods, it is best to do it in a low-pressure way. This can mean doing it outside of mealtimes. Or maybe you offer a taste from your plate of a novel food you are eating. When you do so, do not have any expectation that they will like it. In fact, do not even ask whether they like it. It is best to keep their experimentation focused on neutral descriptors of the appearance, taste, smell, and texture of the food. Do not appear to have or express too much excitement. This only increases the pressure. It’s best to be neutral to slightly happy about them trying a new food and neutral about them liking a new food.

Rotate Foods

Among their preferred foods, rotate foods as much as possible. This can help the inevitable “burn out” that happens when they eat a single food so much that they tire of it.

Present Meals (and Snacks) With Multiple Elements

Try to present meals made up of different components that satisfy the different components of their sensory profile. Every person has a degree of sensory-specific satiety, but people with ARFID are much more sensitive to it. They may sometimes tire of a food mid-meal but continue eating if other options are available. Serving meals with multiple components—such as a Lunchable or a mini-charcuterie board—can encourage them to eat a larger overall volume by satisfying different parts of the palate.

Understand The Sensory Preferences of a Child With ARFID

Be aware of their sensory preferences. If your child likes crisp food, catering to that preference can help. For example, an air fryer, toaster oven, or convection oven can help make food crispier. If your child likes softer foods, think of foods that meet that sensory profile. If they struggle with softer foods, you could introduce a soft food on a crunchy food:  cheese on a cracker, or avocado on a chip. Presenting foods in this way can make them more acceptable.

Involve Your Child in Food Preparation (if they are willing)

Invite your child to help with cooking, plating food, or merely being in the kitchen while a parent is making a meal. You can show them and even allow them to smell the different ingredients. This can be another way to increase interest in exploring new foods and exposure to foods even when they aren’t eating. This can also be a great tool in reducing stress around mealtimes.

Strategies for Introducing New Foods To Your Child With ARFID

Include Your Child in the Process

You should always try to enlist the child in trying a new food. Children often have ideas of foods they want to try or are more open to. Encouraging their involvement in the decision to try foods reduces anxiety and contributes to better outcomes. They will likely be more engaged in the process if they feel like they had agency along the way.

When introducing new foods, consider the most palatable version of a food and be willing to experiment with different forms of it. For example, packaged food is more predictable, reliable, and consistent. This is one reason people with ARFID like foods like Cheez-Its and McDonald’s highly-consistent french fries. Fresh foods and non-chain restaurant food have much more variability.

Understanding this can be helpful. A fresh blueberry may present in many ways:  firm, mushy, sweet, or sour. But, if you freeze a blueberry, the flavor will be a little more muted and it will be firm every time. This is where the dried or frozen versions of foods can be a helpful first foray: frozen blueberries or grapes, dried mango, veggie straws or veggie sticks.

Keep it Easy

Start with slight variations of preferred foods, such as:

• A different brand of preferred food
• A new flavor within the lineup of the preferred brand
• Foods your child used to eat but hasn’t had recently

Similarly, a blueberry muffin can be an easier way to introduce blueberries.

Introduce New Foods Gradually

When doing exposures to novel foods, go slow. Encourage your child to start with just a bite or two. And, if they are willing, see if they can do it multiple times—up to 10 (over the same number of days) with the same food. It’s not likely that your child will like a novel food on the first try. Toleration is a more realistic goal. And, repeated exposures help to increase familiarity and tolerance of a novel food.

Make Use of Different Strategies When Working on Incorporating More Foods

Chaining

Chaining is the creation of a chain between a food they already eat and a new food that would support their growth and health. Examples of logical chains are:

• Starting with a preferred McDonald’s chicken nugget, you can later present a home-baked dinosaur chicken nugget; then a baked breaded chicken filet; then a fried chicken breast; then a roasted chicken breast
• Starting with a McDonald’s French fry, present frozen French fry baked at home; then a roasted potato; then a baked potato
• Alternatively, from a Mcdonald’s French fry you can move to a home-baked French fry; then a home-baked sweet potato fry; then a roasted sweet potato; then a baked sweet potato

Fading it In

Start with a preferred food and add a small portion of a novel food. Then gradually increase the proportion of the novel food and fade out the preferred food. For example:

• To introduce peanuts to a peanut butter eater, you might start with smooth peanut butter and then start to serve peanut butter with some chunks of peanuts and then eventually present peanuts alone.
• If ice cream is a preferred food, you could add some blackberries. Over time, you may be able to increase the proportion of blackberries, then eventually serve blackberries with a dollop of whipped cream, and eventually, blackberries alone.

Deconstructing

For a more complex food start with one component of the food at a time and then layer on individual components individually.

• To work on a food like a taco, you could start with a plain tortilla, and then add chicken and then salsa, etc.
• If pizza is a goal you could start with just cooked dough and next add sauce, then cheese, then sauce plus cheese, and eventually toppings!

Switch it Up

Try different versions of novel foods. If one version of a food is not met with success, try a different form. For example, raw carrots are totally different than cooked carrots. Raw spinach is very different from cooked spinach. Frozen grapes and frozen bananas are much firmer than their non-frozen counterparts. Dried mango is more acceptable to some than fresh mango.

Consider an Incentive System

Asking a child with sensory superpowers to try an unfamiliar food is asking them to fight their innate tendency to cling to the familiar. Using rewards—ideally presented immediately in the form of a sticker, marble, or point that can be redeemed later—for trying new foods or incorporating a less preferred food—can be helpful.

Consider High-Value Items

Consider nutritional supplement shakes—such as Pediasure, Ensure, or Boost—if your child is open and not getting enough nutrition from preferred foods. These can provide added nutrition in both calories and fortified vitamins and minerals. Similarly, if you can find a fortified protein bar that your child likes, this can be super helpful when you are on the go and a preferred food is not readily available.

Keep New Foods in Rotation

Once a novel food is tolerated, it is essential to keep presenting it with some regularity. This requires serving it at least once or twice a week. Doing so should help ensure the gains are maintained. If you stop presenting a food, it may become unfamiliar again and you might need to start with exposures again in order to reincorporate it.

Always Check with Your Pediatrician About Feeding Concerns

It’s essential that your growing child gets enough food to continue their growth and development. If you have concerns about your child’s eating, please speak to your pediatrician. If they recommend additional services, please follow their advice.

If something in this guide contradicts with messages you are receiving from your MD, dietician, or therapist, go with your treatment team’s message. Your family’s providers know you and your situation better than we do. Do what works best for your family. There is no “one-size-fits-all” approach for families feeding children with ARFID. Other families may have benefitted from strategies that may not work well for your family.

Parents Can Support Their Children’s Nutritional Needs While Accommodating Their Sensory Sensitivity

Although feeding a child with ARFID is challenging, it is possible to increase their flexibility. With support and patience and a long-term game plan, you can help your child with ARFID and sensory sensitivity make progress.

Get Help for ARFID in California

Our eating disorder specialist therapists are here to help. We can provide CBT-AR for children and teens with ARFID. We can provide services in our office in Los Angeles or online therapy to people anywhere in California. We also offer a monthly support group for parents of children with ARFID. Contact us to learn more or get started.