Avoidant Restrictive Food Intake Disorder (ARFID) Simple Suggestions Series – Creating supportive mealtimes

Produced in collaboration with:

• Bedfordshire and Luton Mental Health and Wellbeing Services provided by East London NHS Foundation Trust
• North East and North Cumbria Mental Health, Learning Disability and Autism Partnership

1. A lot of emotional arousal around mealtimes can be managed by considering the sensory sensitivities of your child. This means thinking with them in detail about the ways in which what they see, smell, touch/feel, taste, and hear impact how they eat and feel about eating. This includes both the characteristics of the food and the environment around them. You should also consider the impact on them from the different experiences that they feel in their body. This includes orientation, balance and internal feelings/senses. This process is called understanding a ‘sensory profile’. A good understanding of this helps you to better know how to tailor and create an ideal eating environment for your child.
2. Think about how meal/snack times are best managed by your child and try to practice that. For example, making meal choices on behalf of your child can help to reduce anxious over-thinking. This works as long as you choose from agreed safe foods and planned experiments. Using logical and visual steps and keeping the same routine can also make it more manageable to follow. Examples of this include eating at the same time, in the same seat, with the same crockery, or knowing that foods will be kept separate from one another.
3. Taking the focus off eating can be a useful tool for reducing the anxiety and/or physical feelings (interoception) associated with eating. Some examples can include using fidget toys and puzzles, music, books, TV, podcasts, or conversation. For some young people it’s more helpful to eat away from others to reduce the sensory exposure to food smells, noises, and visuals. For others, eating together at family meals can be helpful and normalising. Ultimately, the best choice is the one that is the right fit for your child.
4. Devising a meal schedule can be helpful. Helpful details can include meal timings, food types and quantities, or specifics like certain brands. Knowing this detail in advance can help to decrease worry and increase predictability and a sense of control.
5. Where fixed and predictable plans are helpful, it is often inevitable that at some point this is unachievable. An example of this is that the specific brand is unavailable to buy. One way to help support this it is to come up with a contingency plan together with your child. Finding out which aspects would be the worst if altered is a good place to start. Alternatively, they may have a ‘safe meal’ which can always be on-hand.
6. It’s very difficult but try and stay relaxed and calm. Try to avoid anxiously watching your child’s eating or an anxious build up to mealtimes. Practicing some breathing or calming techniques before/after mealtimes can be helpful. Keeping a journal for your emotions can help you to better manage the challenges. You are not to blame for your emotions, and you are in a stressful situation that is not your fault. But remember that your child will feel your anxiety and so helping you too, can also help them.
7. Supporting your own emotions helps to help your child when their emotions feel extreme. sometimes despite all your planning and preparation efforts, something can still go ‘wrong’. This causes lots of arousal or emotion. When this happens, having a toolkit of basic strategies to reduce arousal can be helpful. These will be different for each person so try to think, and work through together, about what sensory input relaxes them and work with this. Some examples might include using dimmed lights or finding a quiet ‘time out’ space. Using tactile objects like fidget toys or engaging in movement like throwing a ball against an agreed/designated wall can also help.
8. Where you are managing an energy deficit (not enough calories and/or weight loss) try to increase safe foods slowly over time. For example – this could mean trying to add one more chip to the plate each day/every few days until a normal portion size is reached. You could also try using nutritious fluids if these are tolerated / accepted. Examples of these include milk, milkshakes, fruit juice, smoothies, hot chocolate. Alternatively, you can try offering regular small snacks. Giving nutrition little and often can help to reduce the feeling of fullness and be a useful strategy.
9. Regular eating is vital, especially when your child is at school. Trying to discuss with school about what support they can offer can be very helpful. Examples of this might be that school is able to find a separate and quiet space to eat meals. Or they may be able to agree to foods that can be taken into school which do not comply with their school food policy.
10. Consider behaviour ‘modelling’ as much as possible, and as much as this is tolerated by your child’s ‘ideal mealtime environment’. This means trying foods at the same time, eating the same foods, or eating different foods whilst you’re around the young person. For some people, this modelling behaviour helps to demonstrate that a variety of foods is safe. Eating family meals together in this way is often very helpful.
11. Comments from extended family/friends/people can be difficult to handle. They can quite often add (more) pressure on to how you and your child are feeling. A good strategy can be having some prompt answers ready for any questions. Example include: ‘thank you for your concerns and we are doing ok’; ‘I don’t expect you to understand and yet you need to respect…’; and ‘My clinician/GP/doctor/therapist/dietitian is aware and told me to do this’. Think about what words or phrases might work for you, and what you and your child feel comfortable with saying. Having something pre-prepared can help you feel more in control of the process you are going through.
12. Socialising whilst trying to complete a meal can feel like the worst possible combination to some. Others might find this a welcome distraction. You need to decide with your child about how best you can approach the social and/or cultural aspect of eating. Think with them about how these occasions can be adjusted to their needs. This will maximise their chances of success and reduce their feelings of anxiety and overwhelm. In some cases, the management of social and socio-cultural eating might mean that they do not partake at all – and this is ok. It is important to remember that for a parent/carer without ARFID this may feel like a restriction or ‘missing out’. But for a child with ARFID, this may instead feel like a ‘welcome break’, leaving them feeling heard and supported in their preferences.

You will find further information and practical tools on these topics on the PEACE website .

C.Ellison, RD and P.Falcoski, RD (January 2024)