Avoidant Restrictive Food Intake Disorder (ARFID) is a complex feeding and eating disorder
where individuals severely limit the amount or variety of foods they consume. This can lead to
malnutrition, poor growth, and developmental delays, significantly impacting their physical and
mental well-being. ARFID is commonly seen in children with Autism Spectrum Disorder (ASD),
sensory processing disorders, intellectual disabilities, certain syndromes, and conditions
associated with brain damage.
This blog explores ARFID and how behavioral therapy, speech therapy, and occupational
therapy can help manage it.
What is ARFID?
Unlike traditional eating disorders such as anorexia or bulimia, ARFID is not typically associated
with body image concerns. Instead, the causes are more diverse and may include:
Sensory sensitivity: Certain textures, tastes, or smells of food can cause aversion.
Fear of choking or vomiting: Previous negative experiences with food can create anxiety around
eating.
Low appetite or interest in eating: Sometimes linked to underlying medical or neurological
conditions.
The consequences of ARFID are severe, ranging from nutritional deficiencies to social
challenges, as eating in social settings becomes a struggle.
Therapeutic Approaches for ARFID
- Behavioral Therapy – Developing Positive Mealtime Experiences:
Behavioral therapy focuses on creating a positive and stress-free environment around food,
helping children gradually expand their food repertoire.
Meal Exposure and Desensitization: Therapists introduce non-preferred foods in small, non-
threatening amounts, pairing them with rewards or encouragement to reduce anxiety.
Positive Reinforcement: Celebrating small wins, like trying a new food or taking an extra bite,
motivates children to continue improving.
Meal Structure and Routine: Establishing consistent mealtime routines can reduce anxiety and
encourage regular eating habits.
For example, a child fearful of trying vegetables might start with simply having them on their
plate, then touching or smelling them, and eventually taking a bite over several sessions.
- Speech Therapy: Enhancing Oral Sensitivity and Feeding Skills
Speech therapy is instrumental in addressing oral motor challenges and feeding skills in
children with ARFID.
Oral Sensory Normalization: Speech therapists use activities like brushing the inside of the
mouth, blowing bubbles, or using chewy toys to reduce oral sensitivity.
Oral-Motor Exercises: Techniques such as jaw-strengthening exercises or tongue movements
help improve chewing and swallowing skills.
Feeding Skills Development: Therapists work on transitioning from pureed to solid foods by
introducing foods with varying textures and guiding children through the chewing and
swallowing process.
For instance, a child resistant to textured foods might begin by tolerating mashed foods before
progressing to soft solids like bananas or scrambled eggs.
- Occupational Therapy: Addressing Sensory Challenges
Many children with ARFID have underlying sensory processing issues that make certain foods
feel overwhelming. Occupational therapy focuses on these sensory sensitivities.
Sensory Integration Therapy: Activities like deep pressure, swinging, or proprioceptive exercises
help regulate sensory responses, making mealtimes less overwhelming.
Food Exploration Activities: Therapists use play-based approaches to introduce different food
textures and smells, encouraging gradual desensitization.
Improving Mealtime Tolerance: OT helps children remain seated during meals, tolerate the
presence of various foods, and engage in the eating process.
For example, a therapist might create a game where a child squishes peas or touches sticky
rice to reduce tactile aversions before they are expected to taste the foods.
Bridging the Gap: A Collaborative Approach
While each therapy offers unique tools, their combined efforts yield the best results. For
instance:
Behavioral therapy establishes a welcoming environment.
Speech therapy builds the skills needed for effective eating.
Occupational therapy resolves sensory challenges.
Working together, these therapies not only improve a child’s nutrition but also their relationship
with food, fostering long-term health and independence.
Conclusion
Managing ARFID requires patience, creativity, and a multidisciplinary approach. Whether it’s
creating positive associations with food, normalizing oral sensitivity, or addressing sensory
aversions, each therapy plays a critical role in helping children with ARFID thrive.
As caregivers and professionals, our goal is to empower these children to overcome their
feeding challenges, enabling them to lead healthier, happier lives—one bite at a time.