Supporting Parents of Children with ARFID: Tips for Dietitians Working with Younger Children

Avoidant/Restrictive Food Intake Disorder (ARFID) is a challenging diagnosis that requires a nuanced approach, especially when working with younger children under the age of 7. At this developmental stage, children often view food simply as something they like or dislike; they are not yet capable of making the cognitive connections needed for meaningful involvement in their own recovery. Because of this, supporting children with ARFID relies heavily on the guidance, motivation, and perseverance of their parents. Below are strategies and tips that dietitians can use to empower parents in creating a positive environment for progress.

1. Create a Positive, Pressure-Free Mealtime Environment

A supportive mealtime environment is one of the most powerful tools for encouraging children with ARFID to gradually expand their food comfort zones. Here are specific ways to guide parents in achieving this:

• Remove Pressure at the Table: Children should feel that they are in control at mealtime, which reduces anxiety and resistance. Encourage parents to avoid statements that bribe, reward, or coax the child into eating a particular food. Instead, let the child come to the table with an empty plate, allowing them the autonomy to decide what (and how much) to place on it.
• Serve Meals Family Style: This approach helps children visually assess and select their own foods. Family-style dining can make the experience less intimidating, as children see familiar foods alongside new ones and feel empowered to make their own choices.
• Offer a Safe Food: Including a familiar, accepted food item at each meal helps the child feel secure at the table. This gives them the option to eat something they know and like while being in close proximity to other foods.
• Limit “Food Talk”: Remind parents to avoid talking about food in ways that pressure the child. Rather than instructing a child to “try one bite,” encourage parents to use curiosity-driven comments. For example, they might say, “I wonder what sound this carrot stick would make if I bite it,” or casually mention, “This is a kiwi; it tastes like a strawberry but looks different.” This type of language helps to reduce resistance by making food exploration seem more like play than a requirement.

2. Increase Exposures: Introduce Foods in Non-Threatening Ways

Frequent, gentle food exposures can help children with ARFID begin to feel more comfortable with new foods without the pressure to eat them immediately. Here are some creative methods to suggest:

• Cooking Together: Invite the child to help in meal preparation. Tasks like washing vegetables, stirring ingredients, or plating food can help them become more familiar with the sights, smells, and textures of various foods in a low-stress way.
• Play with Food: Encouraging sensory exploration through food play can help children interact with new foods in a safe and enjoyable manner. For example, suggest that parents have their child make a fruit rainbow or use toothpicks to make fruit kabobs. These activities allow the child to touch, smell, and visually examine foods without the pressure to taste, helping build comfort and familiarity.

3. Teach Parents the Art of Food Chaining

Food chaining is a technique that can be invaluable for children with ARFID. It involves introducing new foods that are similar to existing favorites by making small changes in color, shape, texture, or flavor, gradually expanding the child’s accepted food list. Here’s how to guide parents in food chaining:

• Start with a Familiar Food: Identify a food the child already enjoys. Then, brainstorm slight variations to introduce over time. For instance, if a child loves pancakes, parents might consider using cookie cutters to present them in different shapes, adding a small amount of blended strawberry for color, or experimenting with texture.
• Make Gradual Changes: Advise parents to make only one small change at a time to avoid overwhelming the child. For example, if the child enjoys cheddar Goldfish crackers, the next step might be to try a similarly shaped white cheddar cracker, then gradually move to other flavors or shapes.

This process helps children build trust in food while gradually expanding their palate in a safe and predictable manner.

4. Recognize Wins and Build Confidence

One of the most impactful things a dietitian can do is help parents recognize and celebrate the small wins that are part of the ARFID journey. Working with a child who has ARFID is a marathon, not a sprint, and each small step forward is a victory that reinforces the parents’ efforts.

• Help Parents Identify Wins: Small accomplishments might go unnoticed by parents who are hoping for major breakthroughs. Point out these “micro-wins” during your sessions, such as a child sitting at the table for 5 minutes instead of 1, placing a new food on their plate, or agreeing to help cook.
• Encourage Positivity and Patience: Progress with ARFID can be slow and incremental. Helping parents stay motivated and patient through these small successes can bolster their confidence and perseverance, which are essential for long-term improvement.

Final Thoughts

Supporting parents in helping their child with ARFID requires compassion, creativity, and patience. By guiding parents to foster a positive mealtime environment, increasing gentle food exposures, and introducing food chaining, dietitians can empower families to make progress, one small step at a time. The journey with ARFID can be long, but with consistent support and encouragement, each meal becomes a stepping stone toward a more positive and varied relationship with food.