Significant weight loss
or poor weight gain
MANAGING MALNUTRITION IN CHILDREN WITH
AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER (ARFID)
Avoidant/restrictive food intake disorder (ARFID) is a term which is used for individuals with sensory sensitivity who may avoid eating certain foods due to aversions to specific tastes, smells or textures or who have a general lack of interest in eating or a low appetite.1
ARFID is different from anorexia nervosa, bulimia nervosa, and related conditions in that beliefs about body weight and shape do not contribute to food avoidance.2
There are many reasons why a person may avoid or limit the amount they eat, including:1,3
Negative feelings towards
the smell, taste or texture of
certain foods
Having a distressing
experience with certain
foods, such as choking,
vomiting or other forms of
gastrointestinal distress
Not feeling hungry or
interested in food
ARFID often leads to selecting eating behaviours, which can result in poor growth, weight and vitamin deficiencies, as well as other health issues.1,2
ARFID is often diagnosed in older children and younger adolescents but can be present in younger children.5 Psychiatric comorbidities, such as anxiety, autism and ADHD (attention deficit hyperactivity disorder), can also lead to an increased risk of ARFID.1
Children with ARFID often eat smaller portions of food and may experience a lack of appetite or anxiety around eating, which can often lead to insufficient energy and nutrient intake, causing:5
Significant weight loss
or poor weight gain
Poor growth
Bone weakness and
increased risk of fractures
Lower energy levels,
weakness and fatigue
Cognitive impairment
Weakened
immune system
Poor wound
healing
Increased risk of
mortality
ARFID and comorbidities associated with disease-related malnutrition can also have a significant impact on children’s quality of life. Children with ARFID may avoid social gatherings for fear of not being able to eat, or peer pressure to do so. Insufficient growth due to nutritional deficiency may also cause a lack of peer acceptance, reduce self-esteem and lead to limitations in social interactions.5
Dietary assessment should be part of routine clinical care in children as there is an increasing prevalence of restrictive dietary behaviours that can put them at risk of disease-related malnutrition.5
Although ARFID can often lead to nutritional deficiency and can impact weight and growth in children, it is important to note that it can also be diagnosed in children who are a normal weight or overweight; for example, if the child consumes a lot of high-energy food and drinks that they perceive as safe. Using only weight and height centiles as part of the diagnostic criteria could mask ARFID and the associated nutritional deficiencies, such as deficient protein, fats, carbohydrates, vitamins and minerals.5
Assessment for malnutrition in children with ARFID should include:5
Nutritional history
Dietary intake
assessment
Physical examination
Presence of clinical physical
health consequences
Given the complex nature of ARFID, nutritional assessment and management may require a multidisciplinary team, such as the child’s GP, gastroenterologist, psychiatrist, dietitian or neurologist.5
A validated nutrition screening tool for use in hospitalised children from 2 weeks to 16 years of age.
A validated, easy-to-use digital nutritional awareness tool that supports HCPs in completing a nutrition-focussed consultation.
MUAC Z-score tapes are a simple, inexpensive and easy way to measure malnutrition risk in children.
Therapeutic management of children with ARFID should be based on the child’s age, development and the severity of the disease and should also take into account input from the parents/carers of the child.5
In children with ARFID who are not meeting their nutritional requirements, interventions may include oral nutritional supplements or tube feeding. However, the latter is often used as a temporary measure to supplement calorie intake to stimulate the drive to eat and a transition to oral feeding.1 Where tube feeding is indicated, consideration of withdrawal is an integral part of the treatment plan. Patients will need to be weaned by reducing calorie intake via the tube feed.5
Children with ARFID will have very specific treatment and management needs depending on their condition and circumstances. Physical health and nutritional improvement should therefore be monitored continually, taking into account hydration, body weight, height and nutritional status.5
PaediaSure® Plus
PaediaSure Plus is suitable for the dietary management of children weighing 8 - 30 kg with, or at risk of developing, disease-related malnutrition. PaediaSure Plus provides 1.5 kcal/ml and is available both as a 500 ml Ready to Hang tube feed and as a 200 ml oral nutritional supplement.
PaediaSure® Compact
PaediaSure Compact is a 125 ml oral nutritional supplement suitable for the dietary management of children weighing 8 - 30 kg with, or at risk of developing, disease-related malnutrition. It has been specifically developed for children who may benefit from a smaller volume, as an alternative to ready-to-drink supplements which are 200 ml in volume. Each bottle provides 301 kcal (2.4 kcal/ml) and 8.4 g of protein. The milkshake style oral nutritional supplement is ready-to-drink and available in three delicious flavours: banana, strawberry and vanilla.
PaediaSure® Peptide
PaediaSure Peptide is suitable for the dietary management of children weighing 8-30 kg with malabsorption or children who experience symptoms of poor feed tolerance.
PaediaSure Peptide is 1.0 kcal/ml, with 100% proteins broken down to peptides*, 50% fat as medium-chain triglycerides (MCT) and clinically lactose free. PaediaSure Peptide is available both as a 500 ml Ready to Hang tube feed and as a 200 ml bottle. It is available in vanilla flavour and is best served chilled.
*Peptides are partially broken down proteins, which makes them easier to digest and absorb in the gut than whole proteins.
Learn more about Pedi R-MAPP nutritional awareness tool in this article by Dr Luise Marino, RD PhD. The article explores how any why Pedi R-MAPP was developed and the step by step process for how to use it.
This consensus article from Iva Hojsak and colleagues highlights the importance of dietary fibre, an essential nutrient that is crucial for children in health and disease. Differing functional properties according to fibre type, whether bulking or fermentable, are discussed and benefits for health explained. Practical information is provided for clinicians and practitioners to help children meet their fibre needs.
References:
1. Thomas JJ et al. Curr Psychiatry Rep 2017;19(8):5.
2. Beat Eating Disorders, 2024. ARFID. Available online: https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/types/arfid/ Last accessed February 2024.
3. NHS, 2024. Eating Disorders. Available online: https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/eating-disorders/overview/ Last accessed February 2024.
4. Lucarelli L et al. Front Psychol 2018;9:1608.
5. Białek-Dratwa A et al. Nutrients 2022;14:1739.
SESSION TIMEOUT
You have now gained access to ProConnect for a limited time. We will now verify your details before your account becomes fully active.
You are now able to freely access all resources and education during this visit to the ProConnect website. An email will be sent to you within 2 working days to activate your account which will complete your registration process.
Added to Bag
ENSURE PLUS
1 x 220 ml
Flavor: Apple
1,5 kcal / ml
Nutrition Information
| Unit | Per {ml-col-1} ml | Per {ml-col-2} ml |
| Unit | Per {ml-col-1} ml | Per {ml-col-2} ml |
| Unit | Per {ml-col-1} ml | Per {ml-col-2} ml |
footnotes
Product details not available.
You are about to exit for another Abbott country or region specific website.
Please be aware that the website you have requested is intended for the residents of a particular country or region, as noted on that site. As a result, the site may contain information on pharmaceuticals, medical devices and other products or uses of those products that are not approved in other countries or regions.
The website you have requested also may not be optimised for your specific screen size.
Do you wish to continue and exit this website?
UK-N/A-2200465 | July 2022
This website is for UK HCPs and UK Patients only. If you are outside of the UK please visit our global website Abbott.com
If you choose "I am a patient/carer”, you will be entering a website intended for patients and carers which has information on Abbott products. Products on this website are to be used under medical supervision. If you have questions about the product information discussed on this website, you should consult with your healthcare professional.
Stay Connected