Sudden ARFID in 8yo - stopped eating solids

[BillieOxford79]

Hello, my son (8) who has largely always been a brilliant eater, suddenly slowed down eating and used his hands one day 3 weeks ago, and the next day said he couldn’t swallow- only have liquids. Overnight he stopped eating and has been living off soup and smoothies for 3 weeks. He was crying at first and starving but now seems to have accepted this and also lost his appetite. The GP suspects this is ARFID - it is such a shock and we have no idea why it’s occurred- has this happened to anyone else’s child in the same way, and are there any treatment success stories out there? I am aware there are children & families dealing with far worse, so I’m sorry if this is insensitive - I am just struggling with this as he has lost weight and it’s heartbreaking to see (being monitored by the GP and being referred to a clinic), so please be sensitive and I would appreciate only messages of support, thank you. Obviously I am being supportive for him and non-judgemental/ removing any pressure- and keep my stress for the evenings, just trying to make as much safe food available throughout the day as possible. It’s such a shock and hard to adjust when he’s the same in all other ways x

Did the GP check his throat? Just wondering if there is some pain he is experiencing that is putting him off.

If not, hopefully this will bump some responses on ARFID

This is not ARFID and he needs proper investigations. Ask for paediatrics to see him. This is fairly serious as it was such a quick onset.

Maybe check for anxiety too. Are you aware of anything that may have changed in his environment? When mine is bad, it’s like my throat constricts and I cannot swallow solid food. It seems an exceedingly quick onset for AFRID.

Lack of ability to swallow could be something mechanical or neurological. It could also be ARFID of course, but this is worth a 2nd opinion. Doesn't mean it's too serious - as PP said , anxiety can be a cause. I lose ability to swallow if I don't sleep enough.

Has his throat been checked? Did it start after eating anything that could have had bones in it? Any abdo pain or possibility of reflux? Any choking or vomiting episodes prior to this starting which may have scared him?

Thank you all SO much for your kind and quick responses. I took him to a second GP today to be checked again and they said there’s nothing wrong physically - no glands up, nothing. It just doesn’t feel right to me, although he is a very sensitive soul and had initially attributed the lack of eating to being scared he will choke. But we have talked through that and he isn’t sensitive about choking now at all but the eating restriction continues. He has swallowed solids (he would eat wotsits but takes nearly an hour to suck them, and will very occasionally eat an Oreo but also takes 15 minutes or so- obviously I’m trying to make fat and protein centred soups but I’ll take any wins at the moment and those are the only solids going in). It feels so fast to suddenly have a child with ARFID- can this happen? No trauma at school or home and he was happy. Somewhat tired and disappointed to be back at school after the holidays but this feels extreme. He previously had selective mutism and does show more anxious tendencies. If it is some hidden/ underlying anxiety - do I see a child psychologist or an ARFID / eating specialist? I have no idea how to approach him and navigate meal times, totally guessing and don’t want to exacerbate anything. Thank you so much for any help x @parthyphibday @Frozensun @cerbitude @Spookyspaghetti

This happened my niece years ago after a choking incident. She was anxious and terrified to ear solids. I think she was 10 at the time. Her parents went with it to minimise further anxiety and she moved onto then eating the same thi v for maybe 6months ie specific breakfast, lunch and dinner foods and the following year she went back to normal again. 20 now and it never came up again. You being calm and breezy while offering safe options is important. Try not to over quiz and just validate and stay curious regarding what's going on. I know it is very difficult.

Did they check inside his mouth, teeth, gums, tongue, roof of mouth etc as well? There could be pain there which means he can’t eat as usual

Whilst it can often be linked to ND sensory issues I feel it's rare for ARFID.ro just suddenly develop...

..has he experienced any negative experiences with food? Like perhaps nearly choking on food? Or having a reaction to food?

Im told up age 5 I ate everything, but then I had a stomach bug and ended up being milk intolerant. Which had horrendous effects (especially as a kid) if I accidentally consumed any and I've struggled with food ever since x

sounds like anxiety

My son has a restricted diet. Can he hold food in his mouth? Could he sniff it, feel it or lick it?

ARFID is certainly not the first thing that would come to my mind.
I’d request a swallowing assessment.
I would also look to rule out MS.

I know a few children with arfid, and all of them have had very restrictive patterns of eating since toddler days - what you are describing is not at all typical.

I think that I would want more physical investigation before assuming this is psychological. Has he had a scan to make sure that he doesn’t have any sort of blockage anywhere?

It's a very atypical onset for ARFID. I'd try and find a dietician who works in this field for a proper assessment. It's not really in the scope of diagnosis for a GP.

Same thing happened to my cousin a few years ago and it was anxiety-based and came out of nowhere. She gradually started eating thicker liquids over time and then resumed a normal diet, but it took a while. There was never really an explanation but she wasn't sure herself where it came from. I suspect the food was a manifestation of something else.

Exact thing happened when my son was 7. He gagged on something and then panicked and refused to eat anything hard or crunchy for weeks. We just kind of ignored it and distracted him and eventually he started eating properly again.

We tried an online therapy programme for my son by a man called Felix Economakis (https://www.theguardian.com/food/2022/nov/05/i-have-never-eaten-cucumber-onion-or-an-egg-can-i-cure-my-extreme-food-phobias). Felix describes how most cases of ARFID stem from some traumatic experience with food. My son felt this wasn’t the case for him, however I can definitely pinpoint several incidents that have impacted his eating.
The sessions were good and made an impact, however I do need to revisit as I’ve been a bit too relaxed…my son’s ARFID is massively inconvenient but not as serious as what you describe.

ARFID can absolutely be sudden. It does not need to develop over a long period of time.

This happened to DN also when she was around 9. Denied any choking episode but it was so sudden and years later she admitted she had choked on a sausage. Took months of non pressurised transition back to solids. She is also highly sensory generally. Still can’t swallow tablets at 16. ARFID is usually not so sudden. The dietician can give advice, but things like adding peanut butter to smoothies, cream to the soups etc will increase his calories. I recall that drier foods were a problem for her, so foods like mash with gravy went down easier. Also make sure he isnt tipping his head back when swallowing- lots of people think that that position helps with swallowing but it actually closes the throat more. Neutral position opens up the throat,

Had he been sick recently with sore throat? The child I know did have restrictive eating before diagnosis but was thought to be quite fussy/pariticular with food. They then had a mild strep infection which overnight changed them to being terrified of choking, food sticking , throat closing up and panic attacks about food and had basically a liquid diet for a long time. They were diagnosed with ARFID and PANS. They are doing much better now but still do have food issues 3 years later. They are based abroad though and did get therapy/help better suited than what’s available here.

Also happened to my child after a choking incident. She was scared to swallow, felt like her teeth couldn’t chew things up small enough to prevent her choking on them. It took her days to tell us the real reason she didn’t want to/couldn’t eat. We stuck to yogurt and soup, and talked through her anxiety as well as looking at the specifics of how eating/swallowing/breathing works. This latter conversation seemed to help most - she was reassured that eating wasn’t as scary as it felt and she slowly got her confidence back. She still eats slowly though.

We had a very similar thing happen, it was so stressful and very difficult to find the right pathway. We saw a speach and language therapist for a swallow assessment and ENT to rule out sinus issues and then a paediatrition to look for physical causes. Apparently there is a condition called EOE Eosinophilic esophagitis which can cause issues with swallowing and it can’t be seen by simply looking - I think it is diagnosed with an endoscopy.
(Although we didn’t need one in the end) Eventually we saw a psychotherapist and we did have a diagnosis of ARFID but only when physical causes had been ruled out. ARFID is a psychological disorder and my understanding is a diagnosis needs to be made by a psychiatrist not a gp.

i would push for a referal to paediatrics. There are community level speach and language therapists who may be able to see you quickly so this would be worth looking at. The whole process was painfully slow and we had to make a few trips to the children’s a&e for assessment in the meantime.

what clinic has he been referred to? it is a postcode lottery and our local area doesn’t have support for ARFID although some do. In the end we went privately for therapy which helped. Have a look at the dsm ( the official criteria for diagnosis of ARFID and also have a look at EoE to see how the symptoms fit both. Can he articulate what he feels is the issue? Mine couldn’t.

If he is losing weight then I would keep going back to rule out medical causes. The less they eat the smaller their appetite also the stress of the situation will affect this too. Try keep a record of the weight loss and rough calorie intake if you can..

I am typing this quickly and am half asleep but will come back if I think of anything else helpful.

just to add we are in a much better place now and eating has improved, but it was the most difficult challenge I have had to face as a parent so sending my support your way

Can’t help thinking this and the selective mutism are linked. How did you overcome that?

Yes as other posters have said gradually working to increase textures slowly can be helpful. Things like wafer biscuits that dissolve in the mouth - kinder bueno etc are a good thing to start with… home made cheese sauce is calorie dense. Try those tiny pasta shapes when he is ready, with lots of sauce

does sound like anxiety - what with that the mutism has he had a paediatric assessment
what does the GP offer? oh i see he has been referred. that is good
a dietitian?

Please make sure you see a paediatrician and physical causes are fully excluded before you go down the arfid/psychological route