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Bucks Eating Support Collaborative

ARFID & PANDAS

Bucks Support Services | ARFID-PANDA | Young female frustrated with food.
Avoidant Restrictive Food Intake Disorder (ARFID)/Selective Eating
Many people (especially children or teens) go through phases of “picky” eating. While this is normal developmentally, some children and adults struggle more with these selective eating patterns, leading them to develop problems that can be helped with therapy. This is called Avoidant Restrictive Food Intake Disorder (ARFID).
Children with ARFID often do not consume enough calories to grow and develop properly. Meals may become very challenging, causing parents to become exhausted. Children with ARFID may have an apparent lack of interest in eating or food. They may avoid foods based on the characteristics of food. Children with ARFID often struggle to meet appropriate nutritional and/or energy needs, sometimes leading them to be much smaller/less well-developed than peers.
Adults and young adults with ARFID may have similar concerns. They may find that their eating patterns cause problems in their relationships (fights with others, inability to engage in social experiences that involve food). They may also struggle with sensory sensitivity or feel that eating is an aversive experience.
Unlike Anorexia, people who have ARFID generally do not have distress about body shape, size, or weight, although that may develop.
The providers at Bucks ESC who specialize in ARFID can support people of all ages who struggle with selective eating. They take special care to help clients and families to rule out any biological underpinnings and/or post-infectious causes of sudden changes to eating behaviors. Such rule-outs can include PANS/PANDAS (Pediatric Acute Onset Neuropsychiatric Syndrome/Pediatric Acute Onset Disorders Associated with Strep). Bucks Eating Support is a PANS/PANDAS-aware collaborative. Dr. Stacy Hunt is a member of the PANDAS Physicians Network and speaks often on the topic. With this background, providers are looking at the whole picture and working closely with physicians and dietitians to differentially diagnose ARFID from PANS/PANDAS related food intake issues. Working closely with a dietitians who specialize in working with ARFID, the providers at Bucks ESC use a variety of techniques that strengthen people’s relationship with food and weight stability.
ARFID Q&A
ARFID, or Avoidant Restrictive Food Intake Disorder, is health condition in which a person is unable to get adequate nutrition through their diet. Common eating problems include difficulty digesting certain foods, avoiding certain colors or textures of food, eating only very small portions, lack of appetite, or fears of eating following a frightening experience such as choking or vomiting. Significant nutritional deficiencies may require in a need for supplemental nutrition; there may also be significant weight loss and interference with social or educational functioning.
  • Not Picky eating
  • Not from a lack of food or cultural values
  • A primary disturbance in body weight or shape and is not due exclusively to anorexia or bulimia nervosa
  • Not due to a medical condition or due to another mental health disorder
When working with a client who struggles with ARFID or selective eating, family involvement is key to a successful treatment model!Parents and other family members play an important role in therapy and implantation of skills and food challenges at home in addition to working individually with the team to obtain their own support through this challenging process! About Suhagra
People who struggle with ARFID or selective eating often have a limited number of foods that they prefer eating. Desensitization allows for clients to create a hierarchy or list of foods that they would like to attempt to incorporate into their diet. Food challenges are typically done both in and out of therapy and nutrition sessions to offer clients support in practicing skills needed to increase foods they are comfortable eating.
EMDR (Eye Movement Desensitization and Reprocessing) helps clients to get past food and other traumas that may underlie selective eating. This is used in conjunction with food desensitization and can sometimes allow treatment to proceed at a faster pace.
The dietitian will complete a full assessment to evaluate the medical, development, and feeding dynamics of the past and present. You will work together to implement the trust model of feeding called the Division of Responsibility of Feeding. This will allow you and your child to start partnering together to establish a plan that both honors and respects a positive mealtime. You will get guidance about providing clear structure that will help support your child in trying new foods. Follow up sessions will be used to support both the parent and child in establishing the good relationship with food. These may be used to help coach parents or provide food exposures.
PANS/PANDAS Related Restrictive Eating
Children suffering from Post Infectious Neuro-Inflammation very often have eating and feeding concerns. These symptoms present similarly to ARFID but have some distinctions. If your child has new or recently increased food avoidance or eating restriction along with other mood and behavior changes, it might be due to PANS/PANDAS. Food restrictions and OCD are two of the primary symptoms of PANS/PANDAS. The PANS/PANDAS eating disturbance presentation often involves sensory issues, fears of choking or contamination and ritualistic behaviors. Unlike ARFID, PANS/PANDAS related food intake disturbances require collaboration with the medical team for proper treatment of the post infectious syndrome while addressing the eating concerns through work with one of our therapists. For more information on PANS PANDAS symptoms, you can visit the ASPIRE website.
  • Our Therapeutic approaches:
  • HAES Health at Every Size
  • Individual therapy to support children, teens, adults and families
  • CBT/DBT to teach specific skills and strategies to target anxiety (coping skills, self-soothing)
  • Food desensitization to increase nutritional choice and flexibility
  • Collaboration with dietician and medical providers
  • Neurofeedback
  • Eye Movement Desensitization and Reprocessing