Dr. Kay A. Toomey – Picky Eaters vs Problem Feeders vs Avoidant/Restrictive Food Intake Disorder (ARFID)

Outline

Prevalence of the Problem

• Picky eating
• Problem feeding
• ARFID

The Complexity of Feeding/Eating

• 7 areas of human function
• How children learn to eat (or not)

How to Complete a Comprehensive Feeding Assessment

• Medical/organs
• Oral-motor skills
• Sensory-motor skills
• Postural and motor skills
• Nutrition
• Learning/cognition
• Environment

Differential Diagnoses Criteria, Research and Limitations

• Picky eating
  • Able to tolerate new foods on plate
  • Decreased range or variety of foods that will eat
  • Frequently eats a different set of foods than the rest of the family
• Problem feeding
  • Restricted range or variety of foods
  • Refuses entire categories of food textures
  • Cries and “falls apart” when presented with new foods
• ARFID
  • Accept a limited diet in relation to sensory features
  • Food refusal is related to aversive or fear-based experiences
  • Extreme pickiness; distractible and forgetful

Treatment Approaches – Align Treatment w/Diagnosis

• Systematic desensitization
• Flooding/escape extinction
• Eating disorders

Case Studies: When Assessments Go Well, and When They Don’t

• Picky eating –
  • Case 1 = 2 ½ year old male with limited number of accepted foods he will eat, variable eating from one day to the next, issues staying at the table
  • Case 2 = 2 ½ year old female with restricted food range, over reliance on liquids for calories and swallowing assistance
  • Case 3 = 9 year, 8 month old male with lack of healthy proteins per parents, and no vegetables in his food range
• Problem feeding –
  • Case 1 = 3 year, 10 month old female with a G-tube, born at 26 weeks gestation, complicated medical history
  • Case 2 = 4.25 year old female born with congenital Rubella, poor weight gain, restricted food range, episodes of gagging and coughing, episodes of refusing to eat
• ARFID –
  • Case 1 = 15 year old male with chronic “chok-y” sensation, significant weight loss, hospitalized in an Eating Disorders program
  • Case 2 = 13 year old male with difficulties eating food at school, restricted food range per parental report, refusal to eat vegetables

Practical Feeding Strategies for Pediatric Feeding Disorder

• Routines and environmental supports
• Matching foods to a child’s skillset
• Reinforcement
• Management of maladaptive behaviors

When to Refer

• Red Flags
• Picky Eater vs Problem Feeder criteria