The world of Tzu Chi January 2020 (Vol.118)

2020 • 01 58 ellness Is Your Child Truly a Picky Eater? Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterized by resistance towards or selective interest in certain types of food. It is caused by a complex combination of genetic, psychological and socio-cultural factors, yet often mistaken for picky eating. Translated by Goh Hwe Yong A 17-year-old British teenager was recently featured in the news for losing his vision as a result of his routine diet that consisted of only potato chips, crisps and bread daily without any fruits or vegetables since leaving primary school. A few days after the news was released, I was dining at a restaurant when I overheard a mother cautioning her child, who was helping himself to a portion of fries: “Stop stuffing yourself with fries! A teenager overseas lost his eyesight from eating them every day!” I turned around, curious as to the child’s response, only to see him intently savouring each morsel, blissfully oblivious to his mother’s warning. I was tickled by the child’s self-assured nonchalance. After mealtime, I read the news report aloud to my daughter Rui Jia over a serving of fruits and asked her if the excessive consumption of fries was the root cause of the teenager’s loss of vision. I would frequently share nuggets of knowledge on nutrition with Rui Jia, but at the same time, I equally value her opinions on the topics I have raised. Rui Jia replied, “Assuming this teenager has been sharing the dining table with his parents for most of his life, isn’t it odd that he subsisted on fries alone while his parents had proper meals? If his parents were aware of his reliance on fries, why didn’t they introduce fruits and vegetables to his diet?” Rui Jia has yet to be exposed to avoidant/ restrictive food intake disorder (ARFID), an oft- misunderstood eating disorder prone to being mistaken for picky eating. ARFID also differs from anorexia in that patients characteristically resist or exhibit selective interest in certain types of food based on colour, texture, taste or smell. The teenager in the news is a living example; he is attuned to a diet of fries, potato chips and bread. Similarly, some patients are inclined towards foods mashed into puree form, such as mashed potatoes or cauliflower, while others insist upon a daily diet of white bread. Several thrive exclusively on rice and noodles and avoid all other types of food – fish, meat, poultry, fruits and vegetables. The dietary choices of ARFID patients are driven by negative experiences or a fear of unpleasant consequences associated with particular types of food, which, if consumed, tend to evoke anxiety, nausea or gagging. More than meets the eye Our society is led to perceive a child who exhibits selective avoidance of food as nothing more than a picky eater. Common parenting approaches in dealingwith apparent picky eaters vary from seeking professional help to coaxing or even coercing the child during mealtimes. However, ARFID is caused by a complex combination of genetic, psychological and socio-cultural factors. Rather than exhausting one’s patience forcing meals on the child, exasperated parents are encouraged to consider