Understanding ARFID: clinical characteristics of patients who meet avoidant/restrictive food intake disorder criteria in a multidisciplinary pediatric growth and nutrition clinic
John, Roshen Thomas
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INTRODUCTION: Feeding difficulties are commonly multifactorial in nature, and no uniformly agreed-upon classification system for feeding difficulties currently exists. The Diagnostic and Statistical Manual of Mental Disorders (DSM)-V included a new diagnosis called Avoidant/Restrictive Food Intake Disorder (ARFID), created in order to address the weaknesses of the DSM-IV-text revision (TR) classification system by better capturing the range of feeding difficulties typically found in clinical practice. Little is known about the clinical characteristics associated with meeting the ARFID criteria, and no studies have investigated ARFID prevalence and associated clinical characteristics in patients below the age of 8 years. AIM: To describe the clinical characteristics of a sample of patients referred to Boston Children Hospital’s Growth and Nutrition Program, including the prevalence of ARFID, and identify clinical characteristics associated with meeting the criteria for ARFID. METHODS: We examined prospectively collected data from 69 subjects, age 9 months to 7 years, referred to the Growth and Nutrition Program for feeding difficulties and/or malnutrition between November 2013 and April 2016. Data was collected from caregiver-completed questionnaires, including the Behavioral Pediatrics Assessment Scale (BPFAS), and each patient’s electronic medical record. RESULTS: Premature birth (32.3%), digestive conditions (69.2%), developmental conditions (56.9%), food allergy (20.3%), and meal duration of over 30 minutes (36.2%) were common. Problematic feeding behaviors such as refusing to eat (62.1%) and gagging or vomiting when given new foods (29.2%) were also common. Strategies caregivers used to increase food and liquid consumption included offering only foods the child likes (60.9%) and feeding in front of the television or electronic devices (30.4%). 90.8% had a BPFAS score above threshold. 83.1% of the sample met criteria for ARFID. No statistically significant relationship was found between meeting ARFID criteria and having a BPFAS score above threshold, and there was no statistically significant relationship between meeting ARFID criteria and having a food allergy, having a first-degree relative with a food allergy, or with any of the feeding behaviors or strategies we investigated. CONCLUSION: This study suggests that the majority of patients between the ages of 9 months to 7 years with feeding difficulties referred to the Growth and Nutrition Program meet the criteria for ARFID. While no statistically significant relationship was found between ARFID and the investigated clinical characteristics, further analysis involving a larger sample of patients will be useful for better understanding the clinical characteristics associated with ARFID, and assessing ARFID’s clinical utility.