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Picky eating; not just nutritional but a psychological condition too

Posted:  Monday, July 06, 2015

Most children of Shayla’s age (10 years) have a list of foods they dislike and actively refuse to eat. But, Shayla has a different problem altogether. Ever since a big piece of toasted bread got lodged in her throat and put her in pain, she started avoiding foods fearing the same predicament. With much parental coaxing, she now consumes easy to chew foods such as oats, pasta, and softened or pureed foods. The effects are very much showing on her health; she is the smallest child in class and often keeps sick.

The troublesome part is children like Shayla are not rare. It led doctors to create a new category of eating disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) in the year 2013. The category is called the Avoidant/Restrictive Food Intake Disorder (ARFID). Now, 2 years since, a commentary by experts reflected that physicians need to be familiar with the diagnosis to further study the range and depth of eating difficulties seen among children, adolescents and adults. In addition, eating disorder specialists are also assessing outcomes and effectiveness of various interventions.

Experts from The Hospital for Sick Children (SickKids) and the Children's Hospital of Eastern Ontario (CHEO) participated in the commentary, which was published in the Journal of Adolescent Health.

The category ARFID builds on the rarely studied previous diagnostic category of Feeding Disorder of Infancy or Early Childhood. It is described as substantial restrictions or challenges with food intake, associated with weight loss or lack of expected weight gain in the context of significant physiological and/or psychosocial distress.

In a time when food forms the basis for many social interactions, the presence of this condition may impose not just psychological but social restrictions on an individual. Imagine a teenager accompanying friends but unable to eat pizza. Talking about the condition, the researchers say, "ARFID is not just about picky eating -- it's a very challenging diagnostic category in the DSM-5. These kids have complexity, and this condition persists for long periods of time and requires treatment to address both the medical and psychosocial aspects of the condition. If left untreated, children and teens may be left with serious, long-term complications."

According to the researchers, parents can play a pivotal role by alerting the paediatrician or healthcare provider when their children display unhealthy eating behaviour. Drawing attention to such behaviour early on rather than letting the problem last would be the better thing to do.

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