Chapter 6 - Evolution From Feeding Disorders to Avoidant/Restrictive Food Intake Disorder

Abstract

Eating disorders of infancy and early childhood are classified as “feeding disorders,” encompassing a spectrum of issues that contribute to an infant or child's pathologic interactions with eating. The nosology controversy led to significant confusion. Patients with feeding disorders were referred to as “severe picky eaters” and “problem eaters.” Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) utilized restrictive criteria that led to underdiagnosis. The DC: 0-3R expanded the diagnostic criteria, creating six main subtypes. Finally, DSM-5 regrouped them under a single category, “Avoidant/Restrictive Food Intake Disorder” (ARFID). ARFID criteria can be applied to individuals of all ages, a key to thinking about how these feeding disorders evolve over time from infancy into older childhood, adolescence, and finally, adulthood. This chapter discusses the three most common feeding disorders. Infantile anorexia is a condition in which hunger cues are dysregulated, creating disinterest in eating. In sensory food aversion, a hypersensitivity to taste, texture, etc., leads to food avoidance. Finally, in posttraumatic feeding disorder, a traumatic event can lead to a potentially life-threatening eating phobia. This chapter deals with the identification, etiology, and treatment of these feeding disorders. Successful and sustainable recovery must be a family affair. A significant part of treatment includes training parents to improve the parent-child interactions that may inadvertently contribute to these illnesses. The earlier these disorders are identified and treated, the faster and more successful the intervention is. If untreated, these feeding disorders can have significant long-term physical and emotional consequences, including development of comorbid sleep disturbance, anxiety, and persistence into adulthood.