Little is known about the most effective treatments especially for young people with avoidant/restrictive food intake disorder (ARFID). In general, treatment is similar to that offered to children and teens with anorexia nervosa.
The main goals of treatment include:
- achieving and maintaining a healthy weight and height
- achieving healthy eating patterns
- increasing the variety of foods eaten
- learning ways to eat without fear of pain or choking
In-hospital medical treatment
If your child is at an extremely low weight and is medically unstable (slow or irregular heart rate or low blood pressure), they will need to be admitted to hospital so their heart rate, blood pressure and weight can be monitored closely.
ARFID causes some children to lose a lot of weight and cut out many foods from their diet. While in hospital, your child will receive the nutrition they need to help them return to health. Their activity may also be limited.
Your child's healthcare team will adjust the amount of nutrition throughout your child's hospital stay so your child can regain weight in a steady, regular pattern. The goal is for your child to receive the amount of nutrition that their body requires to gain weight and reintroduce a variety of foods that they may have cut out during their illness.
As a parent or caregiver, you will typically be involved in feeding by helping to supervise meals with your child. The goal for discharge is for your child to be at a medical status that is considered safe to be out of hospital (at a safe weight and with a regular heart rate and blood pressure).
Outpatient treatment with a care team
If your child with ARFID is medically stable and does not need an in-hospital stay, you will be seen by an outpatient eating disorders program. There, your child will be cared for by a team of specialists, including a psychiatrist, psychologist, dietitian, adolescent medicine doctor or paediatrician, nurse or social worker. These experts will work together to come up with the best possible care plan to meet your child's unique needs.
Your child will visit the hospital to come to appointments, but they will not stay overnight. These hospital appointments will include psychological treatment to address the eating disorder and regular checks of your child's weight, heart rate and blood pressure. The weight checks help your child's team see how much weight your child is gaining. Weight gain is a vital part of returning the body back to health.
Because ARFID is a relatively new eating disorder, health-care providers are just learning more about the best treatments. Currently, one of the first treatments recommended for young people with ARFID is an outpatient treatment program called family-based treatment (FBT), which focuses on recovery of the eating disorder. Parents/caregivers play an essential role in the treatment and recovery of their child. FBT includes 3 treatment phases.
- Phase 1 focuses on weight restoration. Parents, supported by the therapist, take responsibility for making sure that the adolescent is eating sufficiently and also takes on all meal planning and preparation.
- Phase 2 is when substantial weight recovery has occurred, and the adolescent gradually assumes responsibility for their own eating.
- Phase 3 is when weight is restored, and the focus is on general issues of adolescent development.
Another treatment that is currently being studied is cognitive behavioural therapy (CBT) for patients with ARFID ages 10 through older adults. CBT involves working with a therapist and addressing relationships between thoughts, feelings, and behaviours. CBT for patients with ARFID is most often family-supported for children and adolescents and involves psychoeducation, treatment planning, addressing the eating issues, and preventing relapse.
The treatment can also involve using methods such as exposure therapy, in which a therapist will work with the adolescent and family to reintroduce foods they fear or have been avoiding.
Nutritional treatment
Families can sometimes be surprised by how much nutrition their child needs just for their body to start to rebuild and get back to a healthy weight. If your child is receiving treatment, it is best to reintroduce all the foods that your child cut out while they developed the eating disorder and have them eat a variety of foods from all the food groups.
Behavioural interventions
Behavioural interventions are techniques to help someone learn to change their behaviour. One type of behavioural intervention is "exposure therapy". This involves exposing a child with ARFID to a food they may fear or avoid, in a safe setting, so that they may overcome their negative feelings towards it. Another method is called "food chaining". This involves introducing new foods that are similar to those already preferred by the child so that they are more likely to try them.
Psychological therapy
Some children and teens with ARFID may also experience depression and/or anxiety. If this affects feeding, they may benefit from CBT and other treatments for their underlying condition. CBT is a type of goal-oriented psychotherapy to help someone change the patterns of thinking or behaviour that are behind their mental health difficulties.
Medication
If a child has anxiety or depression and it interferes with their ability to function or take part in their eating disorder treatment, they may be prescribed medication along with psychological therapy.
The most common medications prescribed are antidepressants, but sometimes people with ARFID may also be prescribed anti-psychotic medication to help them with very severe anxiety or distorted beliefs.
At SickKids
SickKids has an eating disorder program that treats children and teens who are struggling with symptoms of anorexia nervosa, bulimia nervosa and avoidant restrictive food intake disorder. For more information on our program visit: www.sickkids.ca/adolescentmedicine/eating-disorders-program
Further information
For more information on avoidant/restrictive food intake disorder (ARFID), please see the following pages:
ARFID: How to help your child at home
Please visit our teen mental health hub for teen-specific resources on treatment and outcomes for avoidant/restrictive food intake disorder (ARFID).
Resources
NEDIC – National Eating Disorder Information Centre (Canada)
NEDA – National Eating Disorder Association (United States)
American Academy of Pediatrics – Eating Disorders in Children
BEAT – Beating Eating Disorders (United Kingdom)
Kelty Eating Disorders (Kelty Mental Health Resource Centre, BC Children's Hospital)
Children's Hospital of Eastern Ontario – Eating Disorders
ANAD – National Association of Anorexia Nervosa and Associated Disorders (United States)