Picky eating is a relatively common problem in early childhood and affects nearly half of children. However, when children refuse to eat enough food so that it affects their health they can be classified as suffering from avoidant/restrictive food intake disorder (ARFID). This condition may occur as frequently as one in twenty children. The affected children frequently report that they are fearful about eating food because it might cause them to choke, make them feel as sick or nauseous, and can have a terrible taste. They typically say they are not hungry, eat very small portion sizes, and sometimes take a very long time to eat.
Health effects of ARFID include inadequate weight, poor growth, and delays in physical and mental development. ARFID is different from anorexia as affected children do not have a distorted body image. ARFID often occurs in association with anxiety, obsessive compulsive disorder, attention deficit hyperactivity disorder (ADHD), and autism spectrum disorders.
There are many different potential causes of ARFID including genetic, psychosocial, and psychological factors. The genetic/psychosocial factors become evident in families in which a number of individuals deal with eating difficulties. Psychological factors can include experiencing a choking event or other unpleasant event involving food early in life. For example, one of my patients stopped eating meat after choking on a hamburger, and another patient stopped eating fruit when another child poured a bowl of applesauce on his head.
When patients develop obsessions or compulsions about avoiding certain foods this can cause great difficulty for them. Some patients with ADHD cannot sit still long enough to eat adequately.
Treatment of ARFID often requires the help of a multi-disciplinary team of professionals, and sometimes even intensive in-patient therapy. Family therapy is indicated as part of treating a child dealing with ARFID when family dynamics can make or break the situation. For example, parents who insist that the child cannot leave the table until the meal is consumed can prompt their child to become defiant.
About a third of children referred to me with ARFID have responded well to use of out-patient hypnosis and counseling. Most non-ARFID picky eaters respond to use of hypnosis as long as they are willing to work on their diet.
Often, the first step in planning how to use hypnosis for ARFID is to identify the original trigger, if possible. If the affected child is of school age, he or she may respond well to a technique involving reimagining the event that triggered their fear of food. The child is instructed to imagine that they knew how to calm themselves with hypnosis at the age when their ARFID began. Then, they imagine reliving the scary event while remaining calm. Thereafter, many of the children report resolution of their fear, and begin to eat more readily.
Children who complain that they dislike the taste or texture of their food can be taught to use hypnosis to alter their perception of the food in their mouth. For example, to change their perception of the taste of food, I teach children how to change the flavor of water to that of their favorite drink. “Take this water and taste it to make sure it tastes like water,” I tell them after giving them a filled glass. “Now, close your eyes and imagine that the water is the color of your favorite drink. Now smell the water and make sure that it smells like your favorite drink. Now taste it.” The majority of children will say it tastes like their favorite drink, and then drink it greedily. I suggest they use the same technique for food.
If children complain that they might choke or have a hard time swallowing, I suggest that they imagine their throat to be as large as an Olympic sized swimming pool.
Finally, making a game of increasing their food intake usually goes over big. I promise to reward children with Pokemon cards, candy, or small toys in exchange for each new food they eat, or for eating everything served to them on their plates.
Children with avoidant/restrictive eating disorder sometimes respond very well to hypnosis and counseling that is directed at the underlying cause(s) of their eating issues.
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