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Avoidant and Restrictive Food Intake Disorder (ARFID) - (DRAFT)

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Overview

ARFID is when someone avoids certain foods, limits how much they eat or does both.

Beliefs about weight or body shape are not reasons why people develop ARFID.

Possible reasons for ARFID include:

negative feelings over the smell, taste or texture of certain foods
a response to a past experience with food that was upsetting, for example, choking or being sick after eating something
not feeling hungry or just a lack of interest in eating

Who to Refer

There is no funded service in the BNSSG area for children with Extreme Food Refusal or Avoidant Restrictive Food Intake Disorder (ARFID). Please see below referral criteria for further assessment

Service	Criteria
UHBW Paediatric Nutrition and Dietetic Service	Funded service: Any CYP who is known to a community paediatrician with any feeding/eating concern (not including an Eating Disorder). Non-funded service: Any CYP who has either a diagnosed nutritional deficiency or faltering growth (NICE definition ie fall of 2 centiles/static growth for 3 months or more). The team aim to assess the nutritional adequacy of the diet and make suggestions for improvements. Additional appointments are offered at the discretion of the managing dietitian for surveillance of the treatment plan. They are not able to offer behavioural interventions for food refusal/limited diets. We welcome re-referrals if the child or young person’s diet has changed since their initial appointment and there are new concerns that they are not meeting nutritional requirements, however, this needs to be stated clearly on the referral. Any CYP on a Child Protection Plan or Child in Need
General Paediatrics	Any CYP with faltering growth (NICE definition) for exclusion of an alternative cause of significant weight loss e.g. malabsorption/gastrointestinal problems. This is for a one-off appointment and then discharge back to primary care and dietetics.
CAMHS	Any CYP who meet RED criteria on MEED guidance (namely rate of weight loss or severely medically compromised)
Specialist eating disorder service	Any CYP who is under the CAMHS service for management of ARFID can be seen in the Medical Assessment Clinic

Resources

1) NG75 Faltering growth: recognition and management of faltering growth in children )

Resources for Patients, Carers and Professionals

The following resources may also be helpful to families and professionals:

Resources for the families with fussy/restrictive eaters - This can be used to signpost families to webinars and other resources to support them with their child’s diet.

BEAT website - https://www.beateatingdisorders.org.uk/types/arfid

Endeavour - ARFID carer support group - Beat (beateatingdisorders.org.uk)

RCPsych website: https://rcpsych.ac.uk/mental-health/problems-disorders/avoidant-restrictive-food-intake-disorder-(arfid)

ARFID Awareness https://www.arfidawarenessuk.org/

Be Body Positive Parents/carers ARFID Module Session 1 - Be Body Positive Session 1 - Be Body Positive

Henry organisation https://henry.org.uk/fussyeating

ARFID - Avoidant and Restrictive Food Intake Disorder - A guide for parents and carers by Rachel Bryant-Waugh.

Food Chaining - The proven 6-step plan to stop picky eating, solve feeding problems and expand your child’s diet by Cheri Fraker, Sibyl Cox, Mark Fishbein and Laura Wabert.

Food Refusal and Avoidant Eating in Children including those with ASC. A practical guide for parents and professionals by Gillian Harris and Elizabeth Shea.

The Autistic Teen’s Avoidant Eating Workbook by Elizabeth Shea.

The Fussy Eater’s Guide To Exploring Food: A Book For Children by Alison Butterworth, Samantha Sergeant and Kay Toomey.

The Nutrients Of Human City by Oliver Street.

The Picky Eater’s Recovery Book: Overcoming Avoidant/Restrictive Food Intake Disorder By Jennifer J Thomas.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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