Is this Picky Eating or ARFID? with Rosan Meyer, PhD, RD

00:00:00.460 --> 00:00:03.660

<v SPEAKER_1>Are you about to start solid foods, but you don't know where to start?

00:00:03.660 --> 00:00:06.780

<v SPEAKER_1>Or maybe you started with some purees and now you want to make a switch.

00:00:06.780 --> 00:00:14.580

<v SPEAKER_1>The best place to get started learning about starting solid food safely is my one hour online video workshop called Baby-Led Weaning For Beginners.

00:00:14.580 --> 00:00:27.880

<v SPEAKER_1>I just re-recorded this free training and it's packed with videos and visuals on how to safely prep Baby-Led Weaning foods, what it looks like for the first few days, how to reduce choking risk, and what to do if your baby has an allergic reaction to food.

00:00:27.880 --> 00:00:36.520

<v SPEAKER_1>Everybody on this free training gets a copy of my original 100 First Foods List, so you'll never run out of ideas about what to feed your baby next.

00:00:36.520 --> 00:00:40.080

<v SPEAKER_1>You can get signed up for this video workshop at babyledweaning.co.

00:00:41.420 --> 00:00:51.200

<v SPEAKER_1>If you have one hour to dedicate to learning about Baby-Led Weaning, come take this free online video training and grab your copy of that original 100 First Foods List while you're there.

00:00:51.200 --> 00:00:56.280

<v SPEAKER_1>Again, head to babyledweaning.co to get signed up, and I hope to see you there.

00:00:57.640 --> 00:01:00.800

<v SPEAKER_1>What type of bib are you using for Baby-Led Weaning?

00:01:00.800 --> 00:01:09.960

<v SPEAKER_1>Personally, I'm not a fan of those tent-like contraptions that go over the whole tray or over your baby's body, the super long sleeve ones that can restrict the baby's range of motion.

00:01:09.960 --> 00:01:13.240

<v SPEAKER_1>And also, the silicone trough bibs can be really heavy.

00:01:13.240 --> 00:01:14.660

<v SPEAKER_1>They drag baby's head down.

00:01:14.660 --> 00:01:20.160

<v SPEAKER_1>Plus, the trough blocks your baby's ability to get up close at the table to explore their new foods.

00:01:20.160 --> 00:01:25.220

<v SPEAKER_1>But the bibs that I do love for Baby-Led Weaning are from a company called Vaprin Baby.

00:01:25.220 --> 00:01:27.660

<v SPEAKER_1>Now, Vaprin is a small mom-owned business.

00:01:27.660 --> 00:01:30.160

<v SPEAKER_1>Their founder, Kelsey, has designed the perfect bib.

00:01:30.160 --> 00:01:33.400

<v SPEAKER_1>She calls it a Vaprin, which is a hybrid between a bib and an apron.

00:01:33.400 --> 00:01:35.920

<v SPEAKER_1>It does not restrict your baby's range of motion.

00:01:35.920 --> 00:01:37.520

<v SPEAKER_1>So Vaprins are a pinafore style bib.

00:01:37.520 --> 00:01:39.520

<v SPEAKER_1>They tie under your baby's shoulder blades.

00:01:39.520 --> 00:01:42.800

<v SPEAKER_1>So it's not like all up in their neck, which can be a really negative sensory experience.

00:01:42.800 --> 00:01:47.120

<v SPEAKER_1>Plus, babies can't untie or rip off Vaprins when they get older, which is an added bonus.

00:01:47.120 --> 00:01:54.100

<v SPEAKER_1>Vaprin makes these huge lightweight splash mats that you also need to put underneath your baby's chair for minimizing the BLW mess.

00:01:54.100 --> 00:02:00.400

<v SPEAKER_1>You can get 10% off of everything at Vaprin Baby with my affiliate discount code, KD10.

00:02:00.400 --> 00:02:02.180

<v SPEAKER_1>Again, the discount code is KD10.

00:02:02.180 --> 00:02:02.840

<v SPEAKER_1>Here's a pro tip.

00:02:02.840 --> 00:02:08.200

<v SPEAKER_1>If you're shopping Vaprins, the size toddler bib is actually the right one for babies six months to two years.

00:02:08.200 --> 00:02:12.760

<v SPEAKER_1>So start with toddler and then you size up to the preschool size Vaprin for your older babies and toddlers.

00:02:12.760 --> 00:02:15.500

<v SPEAKER_1>So the code again, KD10, vaprinbaby.com.

00:02:15.500 --> 00:02:27.260

<v SPEAKER_1>If you want to hear more about Kelsey's journey beginning her business, go listen to episode 118 where I interview her, the Vaprin founder about how she built what I think is the best baby-led weaning bib out there, Vaprin.

00:02:29.280 --> 00:02:35.700

<v SPEAKER_2>I'm appalled when I get a six-month-old referred to me with a referral and saying this child has aphid.

00:02:35.700 --> 00:02:36.740

<v SPEAKER_2>That's not possible.

00:02:36.740 --> 00:02:38.320

<v SPEAKER_2>We've missed something.

00:02:38.320 --> 00:02:41.260

<v SPEAKER_2>You and me both know the child is not born with aphid.

00:02:41.260 --> 00:02:46.700

<v SPEAKER_2>If your child is below two and a half, three years of age, it's unlikely your child has got aphid.

00:02:47.240 --> 00:02:50.900

<v SPEAKER_2>It's likely your child has got a normal picky eater.

00:02:50.900 --> 00:02:58.440

<v SPEAKER_1>Hey there, I'm Katie Ferraro, registered dietitian, college nutrition professor, and mom of seven, specializing in Baby-Led Weaning.

00:02:58.440 --> 00:03:12.400

<v SPEAKER_1>Here on the Baby-Led Weaning with Katie Ferraro podcast, I help you strip out all of the noise and nonsense about feeding, giving you the confidence and knowledge you need to give your baby a safe start to solid foods using Baby-Led Weaning.

00:03:17.745 --> 00:03:29.905

<v SPEAKER_1>I'm not sure if this is social media doing its dirty work again, or a hot topic or trend in parenting groups, but for whatever reason, I've definitely seen an uptick in interest in, as well as questions about ARFID.

00:03:29.905 --> 00:03:36.265

<v SPEAKER_1>So ARFID stands for Avoidant Restrictive Food Intake Disorder, and ARFID is a type of eating disorder.

00:03:36.265 --> 00:03:40.025

<v SPEAKER_1>I'll have parents who have a baby who's not entirely into, let's say, broccoli.

00:03:40.025 --> 00:03:45.845

<v SPEAKER_1>Okay, they won't touch the broccoli or touch the green foods, and the baby's eating less food than the parents would otherwise anticipate.

00:03:45.845 --> 00:03:53.245

<v SPEAKER_1>So now they're online and they're googling picky eating and babies, and then they get led down a rabbit hole and they discover ARFID, and now they're like, oh my gosh, my baby has ARFID.

00:03:53.245 --> 00:03:58.745

<v SPEAKER_1>My guest today is here to tell you that your baby does not have ARFID.

00:03:58.745 --> 00:04:00.225

<v SPEAKER_1>My guest is Rosan Meyer.

00:04:00.225 --> 00:04:05.445

<v SPEAKER_1>She's a PhD dietician and an internationally renowned expert in pediatric nutrition.

00:04:05.445 --> 00:04:09.985

<v SPEAKER_1>Rosan is a nutrition professor at the University of Winchester in the United Kingdom.

00:04:09.985 --> 00:04:15.165

<v SPEAKER_1>She's a specialist in food allergy, energy expenditure, feeding difficulties and faltering growth.

00:04:15.285 --> 00:04:22.605

<v SPEAKER_1>So like all of the kind of sad negative stuff that I know you guys all worry about, but she is such a wealth of information.

00:04:22.605 --> 00:04:25.025

<v SPEAKER_1>I love any opportunity I have to chat with her.

00:04:25.025 --> 00:04:30.785

<v SPEAKER_1>And so when I was asking around about who to interview about ARFID and what it is and what it isn't, everyone's like, you got to have Rosan Meyer on.

00:04:30.785 --> 00:04:32.465

<v SPEAKER_1>She was gracious enough to do this interview.

00:04:32.465 --> 00:04:34.925

<v SPEAKER_1>Rosan's been on the podcast previously.

00:04:34.925 --> 00:04:41.165

<v SPEAKER_1>In episode 110, we talked about catch up weight and why starting solid foods early will not help your baby gain weight.

00:04:41.165 --> 00:04:49.165

<v SPEAKER_1>She was also back on in episode 266, where we talked about infant weight loss, what to do when the doctor says your baby is not gaining weight.

00:04:49.165 --> 00:04:50.725

<v SPEAKER_1>And Rosan is really known.

00:04:50.725 --> 00:04:56.065

<v SPEAKER_1>She's just such a wonderful way of interpreting some kind of complicated data, particularly growth charts and centiles.

00:04:56.065 --> 00:04:59.965

<v SPEAKER_1>And if you're worried about weight loss, definitely check out some of her resources.

00:04:59.965 --> 00:05:07.505

<v SPEAKER_1>She's online at rosanpediatricdietician.com, and that's spelled the British English way, P-A-E-D.

00:05:07.505 --> 00:05:10.525

<v SPEAKER_1>She's also on Instagram at Rosan Pediatric Dietician.

00:05:10.945 --> 00:05:18.625

<v SPEAKER_1>I'll link to all of the resources that she mentions, because the vast majority of you listening, I made this episode, so you're like, oh my gosh, my baby does not have ARFID.

00:05:18.625 --> 00:05:22.745

<v SPEAKER_1>This is what typically developing children will go through.

00:05:22.745 --> 00:05:25.865

<v SPEAKER_1>And Rosan will teach a little bit about typically developing versus ARFID.

00:05:25.865 --> 00:05:27.405

<v SPEAKER_1>And she talks about late onset ARFID.

00:05:27.405 --> 00:05:32.385

<v SPEAKER_1>And when you really do want to get worried, and if you need resources, she has some wonderful ones for you.

00:05:32.385 --> 00:05:34.365

<v SPEAKER_1>They will all be on the show notes for this episode.

00:05:34.365 --> 00:05:36.945

<v SPEAKER_1>You can find that at plwpodcast.com.

00:05:36.945 --> 00:05:39.325

<v SPEAKER_1>Just search Rosan Meyer, M-E-Y-E-R.

00:05:39.945 --> 00:05:46.005

<v SPEAKER_1>And if you enjoy listening to these interviews with other credential-defeating experts, I would really encourage you to follow this podcast.

00:05:46.005 --> 00:05:47.385

<v SPEAKER_1>I do two new episodes.

00:05:47.385 --> 00:05:50.285

<v SPEAKER_1>Every week, I do a mini solo training episode each Monday.

00:05:50.285 --> 00:05:54.905

<v SPEAKER_1>And every Thursday is a longer interview-style episode like this one with Rosan Meyer.

00:05:54.905 --> 00:06:02.205

<v SPEAKER_1>So with no further ado, I want to introduce you and welcome back Rosan Meyer, who's going to be talking about whether or not this is picky eating or ARFID.

00:06:06.605 --> 00:06:08.625

<v SPEAKER_2>Hey, Katie, it's always a pleasure.

00:06:08.625 --> 00:06:13.485

<v SPEAKER_2>And it's always a pleasure that you find these topics that I love as well to talk about.

00:06:13.485 --> 00:06:15.205

<v SPEAKER_1>Well, this one has been popping up.

00:06:15.205 --> 00:06:18.425

<v SPEAKER_1>So parents, I think they'll think their babies are picky.

00:06:18.425 --> 00:06:21.885

<v SPEAKER_1>And we know that babies don't exhibit food preferences, but they know I have a picky eater.

00:06:21.885 --> 00:06:22.785

<v SPEAKER_1>I know it is.

00:06:22.785 --> 00:06:25.585

<v SPEAKER_1>And then they'll hop online and then they'll learn about ARFID.

00:06:25.585 --> 00:06:27.325

<v SPEAKER_1>And they'll be like, Katie, does my baby have ARFID?

00:06:27.325 --> 00:06:34.405

<v SPEAKER_1>And I was like, I believe it is impossible for a baby to have ARFID, but this is not my zone of genius or my area of expertise, but it is for Rosan Meyer.

00:06:34.405 --> 00:06:36.745

<v SPEAKER_1>So thank you for coming on to talk about ARFID.

00:06:36.745 --> 00:06:39.325

<v SPEAKER_1>Let's start out with what is ARFID?

00:06:39.325 --> 00:06:45.245

<v SPEAKER_2>That's an easy one for me to answer because ARFID, in fact, has a DSM-5 criteria.

00:06:45.245 --> 00:06:47.745

<v SPEAKER_2>Now, what is a DSM-5 criteria?

00:06:47.745 --> 00:06:52.585

<v SPEAKER_2>It is in fact a diagnostic criteria for a mental disorder.

00:06:52.585 --> 00:06:54.525

<v SPEAKER_2>Okay, so what does that mean?

00:06:54.525 --> 00:06:57.345

<v SPEAKER_2>It means that ARFID is an eating disorder.

00:06:57.485 --> 00:07:04.205

<v SPEAKER_2>It falls under the similar broad spectrum of anorexia nervosa, bulimia nervosa.

00:07:04.205 --> 00:07:11.745

<v SPEAKER_2>So that means there is a very specific criteria, and the criteria has four categories.

00:07:11.745 --> 00:07:17.425

<v SPEAKER_2>You can't be diagnosed with ARFID unless you meet those four criteria.

00:07:17.425 --> 00:07:25.985

<v SPEAKER_2>The first criteria is related to an aversion to eating that might be sensory or a lack of appetite with one of the following.

00:07:26.305 --> 00:07:28.305

<v SPEAKER_2>So that's only category one.

00:07:28.305 --> 00:07:30.305

<v SPEAKER_2>Weight loss is the first one.

00:07:30.305 --> 00:07:38.385

<v SPEAKER_2>The second one is that it is impacting on the child's psychological well-being or the way they interact.

00:07:38.385 --> 00:07:45.685

<v SPEAKER_2>For example, the child cannot eat with other children at the table because the smell of food is too much.

00:07:45.685 --> 00:07:50.245

<v SPEAKER_2>The third criteria is they have a vitamin or mineral deficiency.

00:07:50.245 --> 00:07:56.405

<v SPEAKER_2>Fourth criteria is they're dependent on enteral feeding or oral nutritional supplements.

00:07:56.405 --> 00:08:00.245

<v SPEAKER_2>I'm not talking about vitamin or mineral drops as a supplement.

00:08:00.245 --> 00:08:05.105

<v SPEAKER_2>I'm talking about those specialist drinks that you get for older children.

00:08:05.105 --> 00:08:07.345

<v SPEAKER_2>That's only the first category.

00:08:07.345 --> 00:08:17.885

<v SPEAKER_2>The second category is that the current intake is not related to any specific dietary requirements in the family or lack of food.

00:08:18.065 --> 00:08:30.765

<v SPEAKER_2>For example, the family are not believers in a certain, for example, only want to have plants that are growing under the ground and will not have anything else that is above the ground.

00:08:30.765 --> 00:08:38.325

<v SPEAKER_2>You get those types of beliefs and that is the reason why the child's eating is so limited or food insecurity.

00:08:38.325 --> 00:08:52.245

<v SPEAKER_2>Third criteria is that the child's current eating is not better explained by a concomitant mental disorder or by medical diagnosis.

00:08:52.245 --> 00:08:54.345

<v SPEAKER_2>That is a really tough one.

00:08:54.345 --> 00:09:04.825

<v SPEAKER_2>That means, for example, a child that has autism can exhibit symptoms that are similar to aphid but might not have aphid.

00:09:05.805 --> 00:09:07.245

<v SPEAKER_2>That needs to be assessed.

00:09:07.245 --> 00:09:15.025

<v SPEAKER_2>My allergic children might be vomiting all the time and actually don't want the food because they're scared of vomiting.

00:09:15.025 --> 00:09:16.245

<v SPEAKER_2>That's also not aphid.

00:09:16.325 --> 00:09:20.105

<v SPEAKER_2>That's fear of eating because of the vomiting.

00:09:20.105 --> 00:09:25.705

<v SPEAKER_2>The last one, you need to have anorexia nervosa and bulimia as an eating disorder ruled out.

00:09:25.845 --> 00:09:35.565

<v SPEAKER_2>You can see it's a complex criteria and only children that meet that criteria can be having the diagnosis of aphid.

00:09:35.565 --> 00:09:39.625

<v SPEAKER_2>Now, as a dietician, you and me can't make that diagnosis.

00:09:39.625 --> 00:09:41.565

<v SPEAKER_2>It's a mental health disorder.

00:09:41.565 --> 00:09:42.885

<v SPEAKER_1>Who makes the diagnosis?

00:09:44.805 --> 00:09:48.585

<v SPEAKER_2>Psychiatrists, physicians that have had mental health training.

00:09:48.585 --> 00:09:51.585

<v SPEAKER_1>So what do you say to parents who think their babies are picky?

00:09:51.585 --> 00:10:00.185

<v SPEAKER_1>They hop online, they discover arfid, and they're like, Katie, I know my baby has arfid, because they, going through the four criteria, my baby has some sort of, they always talk about sensory.

00:10:00.185 --> 00:10:02.085

<v SPEAKER_1>He doesn't like to touch the broccoli.

00:10:02.085 --> 00:10:06.425

<v SPEAKER_1>And then his intake is less than the mom would think it would be.

00:10:06.425 --> 00:10:15.365

<v SPEAKER_1>And I don't have another medical underlying disorder, and maybe this is the disordered eating, and so they put those four things together, and they're like, my baby has arfid.

00:10:15.365 --> 00:10:17.785

<v SPEAKER_1>How old would one have to be to be diagnosed with this?

00:10:17.785 --> 00:10:19.365

<v SPEAKER_1>Is it true that babies can't have arfid?

00:10:19.365 --> 00:10:23.205

<v SPEAKER_1>And what do you say to parents who are like, hey, I take all four of those boxes for this child?

00:10:23.205 --> 00:10:29.165

<v SPEAKER_2>So we would never make a diagnosis of arfid before two and a half, three years of age.

00:10:29.165 --> 00:10:29.925

<v SPEAKER_2>Why is that?

00:10:29.925 --> 00:10:33.025

<v SPEAKER_2>And Katie, I'm going to take the example you've just given me.

00:10:33.025 --> 00:10:36.365

<v SPEAKER_2>My baby doesn't like broccoli and doesn't like touching food.

00:10:36.365 --> 00:10:49.585

<v SPEAKER_2>You know, that can be any toddler that kind of go goes through the normal neophobic kind of disgust response with green veggies, for example, or exerting their own autonomy.

00:10:49.605 --> 00:10:55.925

<v SPEAKER_2>I want to be eating independently, then it might be a mom that says, my child didn't want to eat independently.

00:10:55.925 --> 00:10:59.345

<v SPEAKER_2>Now, does the sealing of the mouth pushing food away?

00:10:59.345 --> 00:11:01.165

<v SPEAKER_2>That's not arfid.

00:11:01.165 --> 00:11:08.245

<v SPEAKER_2>So the reason we don't make a diagnosis before two and a half, three years of age is, I think, threefold.

00:11:08.465 --> 00:11:18.405

<v SPEAKER_2>The first reason is, you get lots of medical reasons why children may not eat reflux, food allergies, you get children that have developmental delay.

00:11:18.405 --> 00:11:24.965

<v SPEAKER_2>So a child first needs to have those things diagnosed or ruled out or have outgrown it.

00:11:24.965 --> 00:11:46.325

<v SPEAKER_2>Second reason would be that you have the normal toddlerhood feeding, which I think you and me touched on before, picky eating, which often is called picky eating, where I'd spit that food out or it might be my child ate broccoli two weeks ago, now all green veggies, they go yucky, don't like that, that is not our fit.

00:11:47.265 --> 00:11:53.625

<v SPEAKER_2>The third reason we don't do it at that stage is because you get this autonomous behavior that a toddler wants.

00:11:53.625 --> 00:11:57.945

<v SPEAKER_2>I don't want that, I don't want to eat that, I want to push it away, I throw that out.

00:11:57.945 --> 00:11:59.805

<v SPEAKER_2>That's again not our fit.

00:11:59.805 --> 00:12:01.765

<v SPEAKER_2>But what is our fit?

00:12:01.765 --> 00:12:13.565

<v SPEAKER_2>I'm sure you're wondering to all of the listeners to saying, okay, but Rosan, so you've just told me my child who's just doesn't want to have broccoli, doesn't want to have green is not our fit.

00:12:13.565 --> 00:12:19.725

<v SPEAKER_2>So typically children with our fit only have four to 10 different foods that they eat.

00:12:19.725 --> 00:12:22.485

<v SPEAKER_2>And I mean, that's all that they eat.

00:12:22.485 --> 00:12:25.265

<v SPEAKER_2>They will not eat anything different to that.

00:12:25.965 --> 00:12:28.885

<v SPEAKER_2>Secondly, they're brand specific.

00:12:28.885 --> 00:12:34.745

<v SPEAKER_2>So it has to be a specific brand that they have the bread from.

00:12:34.745 --> 00:12:38.965

<v SPEAKER_2>If the bread doesn't come from that brand, they will not eat.

00:12:38.965 --> 00:12:43.045

<v SPEAKER_2>On visualization, they will say to you, that bread looks different.

00:12:43.045 --> 00:12:45.965

<v SPEAKER_2>It has a spot that was not there yesterday.

00:12:45.965 --> 00:12:48.325

<v SPEAKER_2>I don't like it because it's got a spot.

00:12:48.325 --> 00:12:51.645

<v SPEAKER_2>And the other thing is it causes anxiety, huge anxiety.

00:12:51.645 --> 00:12:54.205

<v SPEAKER_1>Hey, we're gonna take a quick break, but I'll be right back.

00:12:59.548 --> 00:13:03.628

<v SPEAKER_1>This episode is sponsored in part by Ritual Prenatal Vitamins.

00:13:03.628 --> 00:13:05.828

<v SPEAKER_1>Are you still taking your prenatal vitamin?

00:13:05.828 --> 00:13:10.648

<v SPEAKER_1>As a dietician, I know I always continued my prenatal even after I gave birth.

00:13:10.648 --> 00:13:16.648

<v SPEAKER_1>In fact, the World Health Organization recommends continuing your prenatal until you start weaning.

00:13:16.648 --> 00:13:28.588

<v SPEAKER_1>But not all prenatals are created the same, and Ritual's Essential for Women prenatal supplements contain science-backed formulas, third-party testing for heavy metals and microbes, as well as traceable ingredients.

00:13:29.228 --> 00:13:48.988

<v SPEAKER_1>Ritual Essential's prenatals support a healthy pregnancy with key nutrients that your body and your baby's body needs, like methylated folate and nature-identical choline that supports your baby's neural tube development, as well as omega-3-DHA for brain and early vision development, and vitamin D that supports fetal bone health.

00:13:48.988 --> 00:13:54.428

<v SPEAKER_1>All Ritual products are rigorously tested and their clean label project certified.

00:13:54.428 --> 00:14:00.608

<v SPEAKER_1>You deserve to know exactly what you're putting into your body, especially when it comes to prenatal vitamins.

00:14:00.608 --> 00:14:05.968

<v SPEAKER_1>And with Ritual's dedication to traceable science and sourcing, you always will.

00:14:05.968 --> 00:14:10.408

<v SPEAKER_1>See for yourself with 25% off your first month at ritual.com/weaning.

00:14:12.388 --> 00:14:17.008

<v SPEAKER_1>Start Ritual or add Essential for Women prenatal to your subscription today.

00:14:17.548 --> 00:14:23.348

<v SPEAKER_1>Again, that website is ritual.com/weaning for 25% off.

00:14:26.988 --> 00:14:29.368

<v SPEAKER_1>Can you talk about the history of the term ARFID?

00:14:29.368 --> 00:14:32.248

<v SPEAKER_1>Was it previously called extreme picky eating?

00:14:32.248 --> 00:14:40.928

<v SPEAKER_1>And is that maybe where some of this confusion in parents are coming up because they start googling really bad picky eating, and then they jump to the conclusion of, oh, my baby has ARFID?

00:14:40.928 --> 00:14:42.868

<v SPEAKER_2>No, it's a great question.

00:14:42.868 --> 00:14:44.568

<v SPEAKER_2>It's a bit more complicated than that.

00:14:44.568 --> 00:14:46.548

<v SPEAKER_2>So the diagnosis is not that old.

00:14:46.748 --> 00:14:51.868

<v SPEAKER_2>It's 11 years old, so it was only started and developed in 2013.

00:14:52.948 --> 00:15:02.768

<v SPEAKER_2>And it didn't come from extreme picky eating because there was a lot of different terminology related to food avoidance.

00:15:02.768 --> 00:15:04.848

<v SPEAKER_2>There were lots of terminologies thrown around.

00:15:04.848 --> 00:15:23.528

<v SPEAKER_2>It was really coming from more the observation that there are children that don't fall into the normal picky eating, which we think spitting out food, not wanting green vegetables, eating only certain varieties that in fact have anxiety around eating.

00:15:23.528 --> 00:15:30.728

<v SPEAKER_2>And I want to reinforce this anxiety, Katie, which you don't see with picky eating.

00:15:30.728 --> 00:15:43.688

<v SPEAKER_2>And what I mean by that, it's a child that really cannot be around you eating, for example, a plate of pasta with yummy food on there that you identify as yummy.

00:15:43.688 --> 00:15:52.488

<v SPEAKER_2>But the food, the smell, the visualization, everything, actually is not only a disgust response, but it's an anxiety response.

00:15:52.488 --> 00:15:54.668

<v SPEAKER_2>So they cannot be around them.

00:15:54.668 --> 00:15:58.288

<v SPEAKER_1>You mentioned before the normal neophobic disgust with veggies.

00:15:58.288 --> 00:16:02.688

<v SPEAKER_1>And I want to touch on that because picky eating is developmentally appropriate.

00:16:02.688 --> 00:16:04.988

<v SPEAKER_1>Picky eating is not a problem to be fixed.

00:16:04.988 --> 00:16:12.108

<v SPEAKER_1>And your child will start to demonstrate as they get a little bit older, this autonomous behavior that you were describing, Rosan.

00:16:12.108 --> 00:16:16.428

<v SPEAKER_1>Could you tell parents what to expect, especially as we cross over into the second year of life?

00:16:16.428 --> 00:16:19.328

<v SPEAKER_1>Parents will be like, Katie, I had a baby that ate everything.

00:16:19.328 --> 00:16:27.068

<v SPEAKER_1>They ate 100 foods from your 100 first foods list, and now they're one or one and a half, and they don't want to eat some of the foods that they used to eat.

00:16:27.068 --> 00:16:30.688

<v SPEAKER_1>And that's typical, but parents think they're doing a bad job.

00:16:30.688 --> 00:16:36.228

<v SPEAKER_1>So could you explain what that normal, I love it, neophobic disgust with foods is all about?

00:16:36.348 --> 00:16:39.028

<v SPEAKER_2>Yeah, and it's literally, they have a disgust response.

00:16:39.028 --> 00:16:47.988

<v SPEAKER_2>So the first thing that parents need to remember, that it's not their fault, it's a normal developmental progression.

00:16:47.988 --> 00:17:04.708

<v SPEAKER_2>And I'm sure you know that as well, the green, I hate green foods, has also a background which is thought to be related to the hunter gatherer time, because the time when child starts walking, so it's supposed to be protective to protect them of having green poisonous plants.

00:17:05.588 --> 00:17:11.048

<v SPEAKER_2>So it's to certain extent, as you know, all toddlers go through that.

00:17:11.048 --> 00:17:15.808

<v SPEAKER_2>Some of them more severe, some of them not as severe.

00:17:15.808 --> 00:17:20.608

<v SPEAKER_2>So they're going through, I don't like it, that looks yucky is normal.

00:17:20.608 --> 00:17:25.288

<v SPEAKER_2>They might have yesterday loved it, and today it's yucky.

00:17:25.288 --> 00:17:28.068

<v SPEAKER_2>So that is also quite normal.

00:17:28.068 --> 00:17:38.448

<v SPEAKER_2>The second aspect to it is that their appetite today might be great, and tomorrow, as you know, can be, I just don't feel like eating.

00:17:38.448 --> 00:17:44.748

<v SPEAKER_2>And where the parents kind of going, but yesterday they ate really well, why is it that they don't eat well today?

00:17:44.748 --> 00:17:48.388

<v SPEAKER_2>So the change is in appetite and not wanting it.

00:17:48.388 --> 00:18:02.628

<v SPEAKER_2>And the third one is pushing the boundaries to say, okay, I had this yesterday, and today I'm taking it from my plate and I'm looking at them going, don't want that, doesn't look nice, don't want that.

00:18:02.628 --> 00:18:05.308

<v SPEAKER_2>That's also very normal.

00:18:05.308 --> 00:18:25.168

<v SPEAKER_2>And very normal, I'm sure you've seen it with your children as well, that there are variations in this and some of them go through it and just have small amounts of, I don't like broccoli or don't like peas and others, all green veggies, but often they like fruit or they like crispy beige brown foods.

00:18:25.568 --> 00:18:30.128

<v SPEAKER_2>So that's very much the range of normality that I see in toddlers.

00:18:30.128 --> 00:18:32.488

<v SPEAKER_1>Can you talk a little bit about nutritional concerns?

00:18:32.488 --> 00:18:44.508

<v SPEAKER_1>When a child is older and is demonstrating all of these criteria and does get a diagnosis of ARFID, what are the potential nutritional and health and growth and developmental impacts long-term?

00:18:44.508 --> 00:18:52.768

<v SPEAKER_1>Because obviously it's something parents are worried about in the day-to-day, but we want to encourage them to seek treatment so that we can help get that child back on track developmentally and nutritionally.

00:18:53.348 --> 00:18:53.768

<v SPEAKER_2>Absolutely.

00:18:53.768 --> 00:19:02.188

<v SPEAKER_2>So before we come to ARFID, I just wanted to say, I mean, any child that cuts out whole food groups would be in theory on a nutritional risk.

00:19:02.188 --> 00:19:15.868

<v SPEAKER_2>And I would always say, if they're cutting out food groups, ideally have a discussion with a pediatric dietician, because often it's not growth that is a concern, but it might be iron or it might be another micronutrients.

00:19:15.868 --> 00:19:34.088

<v SPEAKER_2>When we come into ARFID and if you think about children, or if we take the umbrella term aversive eating, where you have picky eating, which is normal, then a child that has a more severe aversive eating, where they avoid whole food categories, and then ARFID is the severest.

00:19:34.088 --> 00:19:37.068

<v SPEAKER_2>The nutritional concerns are number one growth.

00:19:37.068 --> 00:19:49.628

<v SPEAKER_2>So if you can imagine that you only have, let's say, six to 10 different foods, and by chance, those six to 10 foods are primarily carbohydrates and no protein, and by the way, that's very common.

00:19:49.628 --> 00:19:52.128

<v SPEAKER_2>They have primarily carbohydrates.

00:19:52.128 --> 00:19:54.848

<v SPEAKER_2>Then growth is the first concern.

00:19:54.848 --> 00:20:21.408

<v SPEAKER_2>Micronutrient deficiencies, they have the whole spectrum of deficiencies, and I've seen not only iron deficiency, I've seen the severest versions of B12, zinc, vitamin A, and so it is not just an iron deficiency or vitamin deficiency, it's really the other deficiencies, and I think what we see more with ARFID is that you see the clinical manifestations of that.

00:20:21.408 --> 00:20:31.328

<v SPEAKER_2>For example, eyesight that starts to be reduced as a result of a vitamin A deficiency, as a result of a B12 deficiency, for example.

00:20:31.868 --> 00:20:39.148

<v SPEAKER_1>Rosan, what are the common causes or risk factors associated with ARFID, and is there a genetic or a familiar component here?

00:20:39.148 --> 00:20:48.068

<v SPEAKER_2>That's a great question, Katie, and I first want to say to everybody here, you have to remember that from a scientific perspective, this is a young diagnosis, okay?

00:20:48.068 --> 00:20:52.788

<v SPEAKER_2>So I'm going to give you a bit of hypothesis where we're thinking their origins are.

00:20:52.788 --> 00:20:59.088

<v SPEAKER_2>So I think we all know feeding difficulties has got a genetic background.

00:20:59.208 --> 00:21:01.988

<v SPEAKER_2>So we see it in families, in any case.

00:21:01.988 --> 00:21:13.988

<v SPEAKER_2>There is a wonderful twin study that came about two years ago, where they've looked at genetic assessments, looking at ARFID, and yes, there is also a link, a genetic link with ARFID.

00:21:13.988 --> 00:21:23.448

<v SPEAKER_2>Now, you have to remember, though, the problem here is retrospectively for those parents, the diagnostic criteria for ARFID for those parents did not exist.

00:21:23.448 --> 00:21:30.688

<v SPEAKER_2>So it's a retrospective assessment, but we suspect that that's good data and there is a genetic link.

00:21:30.688 --> 00:21:32.668

<v SPEAKER_2>Then there are other triggers.

00:21:32.668 --> 00:21:41.768

<v SPEAKER_2>First one, we do see children that have had medical diagnosis, in particular, gastrointestinal diagnosis and food allergy.

00:21:41.768 --> 00:21:51.408

<v SPEAKER_2>So for example, we've spoken in the past a little bit of F-P of F-Pi's food protein-induced enterocolitis syndrome, where the hallmark symptom is acute violent vomiting.

00:21:51.408 --> 00:22:04.948

<v SPEAKER_2>So it's almost a traumatic event, where there is the fear of providing foods and widening the variety of foods because of the fear of vomiting, and the child has a traumatic event.

00:22:04.948 --> 00:22:09.988

<v SPEAKER_2>So we see more of it in the population are being documented with F-Pi.

00:22:09.988 --> 00:22:13.628

<v SPEAKER_2>So we, and especially if they don't get the right advice.

00:22:13.628 --> 00:22:21.148

<v SPEAKER_2>The second group of children that we see as a risk factor, those without any medical underlying diagnosis.

00:22:21.148 --> 00:22:28.828

<v SPEAKER_2>But where for some reason, in early childhood, let's between six months and one year, feeding was disrupted.

00:22:28.828 --> 00:22:37.848

<v SPEAKER_2>They didn't manage to progress with textures and tastes and they have lots of sensory issues and you can see by 18 months, those sensory issues still continue.

00:22:38.708 --> 00:22:47.988

<v SPEAKER_2>Then of course, you need to rule out autism, whether autism is at the heart of it or any other similar disorder.

00:22:47.988 --> 00:22:54.648

<v SPEAKER_2>We do seem to have a third group and that's not the group likely that Katie, you'd be exposed to.

00:22:54.648 --> 00:22:57.848

<v SPEAKER_2>We have a late onset of our fit group.

00:22:57.848 --> 00:23:14.128

<v SPEAKER_2>They are nine, 10, 11 years of age and that group, we're not quite sure why we suddenly start seeing them becoming extremely limited in their dietary intake, because many of them, we don't see a traumatic event beforehand.

00:23:14.128 --> 00:23:28.628

<v SPEAKER_2>But I would say to any parents that if they said to me, my child is vomiting and having abdominal discomfort, for any feeding difficulties, that would be a trigger and you want to be seeing somebody and treating that early.

00:23:28.628 --> 00:23:41.968

<v SPEAKER_2>And if by one year of age and after that, the child still can't mess and touch texters you really want to have that reviewed and made sure that they, from a sensory perspective, addressed.

00:23:41.968 --> 00:23:45.248

<v SPEAKER_1>Hey, we're going to take a quick break, but I'll be right back.

00:23:49.308 --> 00:23:50.368

<v SPEAKER_4>Hello, listeners.

00:23:50.368 --> 00:23:55.368

<v SPEAKER_4>This is Anne Bogle, author, blogger, and creator of the podcast, What Should I Read Next?

00:23:55.368 --> 00:23:59.748

<v SPEAKER_4>Since 2016, I've been helping readers bring more joy and delight into their reading lives.

00:24:00.188 --> 00:24:04.988

<v SPEAKER_4>Every week, I take all things books and reading with a guest and guide them in discovering their next read.

00:24:04.988 --> 00:24:08.708

<v SPEAKER_4>They share three books they love, one book they don't, and what they've been reading lately.

00:24:08.708 --> 00:24:12.248

<v SPEAKER_4>And I recommend three titles they may enjoy reading next.

00:24:12.248 --> 00:24:20.128

<v SPEAKER_4>Guests have said our conversations are like therapy, troubleshooting issues that have plagued their reading lives for years and possibly the rest of their lives as well.

00:24:20.128 --> 00:24:31.788

<v SPEAKER_4>And of course, recommending books that meet the moment, whether they are looking for deep introspection to spur or encourage a life change or a frothy page-turner to help them escape the stresses of work, school, everything.

00:24:31.788 --> 00:24:38.988

<v SPEAKER_4>You'll learn something about yourself as a reader, and you'll definitely walk away confident to choose your next read with a whole list of new books and authors to try.

00:24:38.988 --> 00:24:42.528

<v SPEAKER_4>So join us each Tuesday for What Should I Read Next?

00:24:42.528 --> 00:24:49.028

<v SPEAKER_4>Subscribe now wherever you're listening to this podcast, and visit our website, whatshouldireadnextpodcast.com, to find out more.

00:24:53.188 --> 00:25:00.848

<v SPEAKER_1>I wanted to talk a little bit more about this late onset, and I'm actually going to read you a text from a friend, not saying the name of the child, but she says, Hi, Katie, quick question.

00:25:00.848 --> 00:25:05.908

<v SPEAKER_1>Do you know of any registered dieticians, psychologists, or GIMDs who might specialize in ARFID?

00:25:05.908 --> 00:25:12.548

<v SPEAKER_1>We have been having issues with name of child that has gotten a lot worse, and now the child's percentile of weight is too low.

00:25:12.548 --> 00:25:15.528

<v SPEAKER_1>Child says they're not hungry, so it doesn't want to eat.

00:25:15.528 --> 00:25:19.148

<v SPEAKER_1>The pediatrician said that when you don't eat and you're starving, you don't feel hungry.

00:25:19.148 --> 00:25:20.568

<v SPEAKER_1>The child has a lot of anxiety.

00:25:20.568 --> 00:25:22.048

<v SPEAKER_1>We need help.

00:25:22.048 --> 00:25:23.128

<v SPEAKER_1>He's 10.

00:25:23.128 --> 00:25:31.068

<v SPEAKER_2>So I, at the beginning of our discussion, said the biggest and most important aspect to remember is the anxiety that the children have.

00:25:31.068 --> 00:25:39.688

<v SPEAKER_2>And the biggest mistake that many healthcare professionals can make is to say, let's talk about healthy eating.

00:25:39.688 --> 00:25:42.228

<v SPEAKER_2>Every parent knows about healthy eating.

00:25:42.228 --> 00:25:45.908

<v SPEAKER_2>For a child with ARFID, all of that goes out of the window.

00:25:45.908 --> 00:25:53.588

<v SPEAKER_2>We don't talk about healthy eating, we just talk about what can the child eat, and what is the situation the child can eat.

00:25:53.588 --> 00:25:56.548

<v SPEAKER_2>So you in fact try to reduce anxiety.

00:25:56.708 --> 00:25:58.408

<v SPEAKER_2>So let me give you an example.

00:25:58.528 --> 00:26:10.308

<v SPEAKER_2>And if I may, if that child, for example, sits around food, what they often have is their stress response because the food that they see in front of them creates anxiety.

00:26:10.308 --> 00:26:11.868

<v SPEAKER_2>So we have three principles.

00:26:11.868 --> 00:26:21.768

<v SPEAKER_2>The first principle is the division of responsibility, meaning it's the responsibility of the parents to create an environment that's conducive for the child to eat.

00:26:21.768 --> 00:26:38.448

<v SPEAKER_2>If that means for a child with ARFID, and I mean really with ARFID, in front of a television or with an iPad, then that's fine because if that means the anxiety comes down, then that is how you reduce the anxiety.

00:26:38.448 --> 00:26:42.468

<v SPEAKER_2>The second thing is always provide with safe foods.

00:26:42.468 --> 00:26:46.948

<v SPEAKER_2>So a lot of people say, yes, but a child doesn't eat, all of the big variety doesn't matter.

00:26:46.948 --> 00:26:58.088

<v SPEAKER_2>Always provide safe food because if you provide safe food, the anxiety levels are down and because the anxiety levels are down, you actually can get them to visualize new foods.

00:26:58.088 --> 00:27:02.048

<v SPEAKER_2>Second principle is sensory desensitization.

00:27:02.048 --> 00:27:05.588

<v SPEAKER_2>Desensitization is not, oh, I'm smelling food I'm putting in my mouth.

00:27:05.588 --> 00:27:08.908

<v SPEAKER_2>No, desensitization means I visualize.

00:27:08.908 --> 00:27:15.088

<v SPEAKER_2>If that means the food is there, I visualize, I look at the food there, and it comes closer to my plate.

00:27:15.088 --> 00:27:17.208

<v SPEAKER_2>Never contaminate a safe food.

00:27:17.208 --> 00:27:25.968

<v SPEAKER_2>There's so many parents saying, I'm trying to mix in the pasta, some small pieces of vegetables, but then you've lost the pasta.

00:27:25.968 --> 00:27:28.988

<v SPEAKER_2>So you never contaminate safe foods.

00:27:28.988 --> 00:27:35.028

<v SPEAKER_2>New foods are always brought in from the side and never touching safe foods.

00:27:35.028 --> 00:27:39.688

<v SPEAKER_2>So the desensitization takes not months, but often years.

00:27:39.688 --> 00:27:41.968

<v SPEAKER_2>Third principle is food chaining.

00:27:42.748 --> 00:27:46.588

<v SPEAKER_2>So you chain the foods to foods that are sensory acceptable.

00:27:46.588 --> 00:27:49.548

<v SPEAKER_2>And I'm going to give you the simplest example.

00:27:49.548 --> 00:27:53.728

<v SPEAKER_2>One of my children only eats a square vanilla biscuit.

00:27:53.728 --> 00:27:58.788

<v SPEAKER_2>And so I then said, okay, let's try a round vanilla biscuit.

00:27:58.788 --> 00:28:01.128

<v SPEAKER_2>So the parents had to be, but that's not a new food.

00:28:01.128 --> 00:28:02.248

<v SPEAKER_2>A biscuit is a biscuit.

00:28:02.248 --> 00:28:03.288

<v SPEAKER_2>No.

00:28:03.288 --> 00:28:09.588

<v SPEAKER_2>For a child with ARFID, a round biscuit versus a square biscuit is a new food.

00:28:10.288 --> 00:28:17.128

<v SPEAKER_2>So you chain foods that are within a sensory accepted range to current accepted foods.

00:28:17.128 --> 00:28:27.688

<v SPEAKER_2>My first sessions with any child with ARFID, and I wanted to say to you for that mom, is normally just around saying, it's fine.

00:28:27.688 --> 00:28:30.088

<v SPEAKER_2>Let's just reduce the stress situation.

00:28:30.088 --> 00:28:39.208

<v SPEAKER_2>If the weight comes to a critical situation, I often bring in oral nutritional supplements, but those have to fit in with a sensory accepted range.

00:28:39.328 --> 00:28:43.688

<v SPEAKER_2>So a child that doesn't like a vanilla milkshake will not drink a vanilla milkshake.

00:28:43.688 --> 00:28:48.048

<v SPEAKER_2>So you have to introduce what they will have, and that's the same for supplements.

00:28:48.048 --> 00:29:01.028

<v SPEAKER_2>It's hugely challenging to find a supplement of iron, or zinc, or vitamin D, that a child with ARFID will in fact accept, and so we often spend a lot of time with that.

00:29:01.028 --> 00:29:20.168

<v SPEAKER_2>So I would say to this mom, number one, if this child is very anxious, get a psychologist that specializes in ARFID and can deal with anxiety, get a dietician that knows, that is SOS trained, for example, that knows about the sensory sensitivities related to it.

00:29:20.168 --> 00:29:28.348

<v SPEAKER_1>Can you talk a little bit about where you find these people, like an SOS trained psychologist, and I know this is a person in my area, San Diego.

00:29:28.348 --> 00:29:29.928

<v SPEAKER_1>I don't know anyone locally.

00:29:29.928 --> 00:29:32.068

<v SPEAKER_1>Is it something you can do remotely?

00:29:32.068 --> 00:29:37.148

<v SPEAKER_1>Is there an association or an organization for a family who's listening to this, like, oh my gosh, this is my child?

00:29:37.148 --> 00:29:48.188

<v SPEAKER_2>Katie, so before we had our discussion, I quickly just Googled, because just for everybody to know that I work in the UK domain, so I can't give an answer to all different country domains.

00:29:48.188 --> 00:29:54.708

<v SPEAKER_2>But I know that you have the Arford charities or associations that deal with Arford.

00:29:54.708 --> 00:29:58.188

<v SPEAKER_2>They have a lot of times specialists that deal with them that.

00:29:58.188 --> 00:30:03.908

<v SPEAKER_2>You have also SOS, as you know, so specific course, they have the names of those who are SOS trained.

00:30:04.288 --> 00:30:14.048

<v SPEAKER_2>But I do want to say, don't just go for SOS trains or sensory train, but go for somebody that actually understands Arford well, and is pediatric trained if you've got a child.

00:30:14.048 --> 00:30:25.728

<v SPEAKER_2>And for that in your area, Katie, if I'm right, you have lists of pediatric dieticians that I have found online, that puts down if they have got speciality as Arford.

00:30:25.728 --> 00:30:31.208

<v SPEAKER_2>I would strongly recommend not just to go to anybody without knowing.

00:30:31.208 --> 00:30:36.808

<v SPEAKER_2>I think support, the other aspect is, support you can get, of course, from associations.

00:30:36.808 --> 00:30:45.388

<v SPEAKER_2>But not that I want to market the course that we run, but we do run a course within the UK setting that is open for parents.

00:30:45.388 --> 00:30:49.168

<v SPEAKER_2>And that's 10 hours online, so it's remotely.

00:30:49.168 --> 00:31:01.628

<v SPEAKER_2>And if you as a parent know your child has the diagnosis, this course is very much geared, it has psychology, medical, sensory, all of those things, and it's run through University of Winchester.

00:31:01.628 --> 00:31:06.208

<v SPEAKER_2>And I can provide you with the details, but we do absolutely welcome parents.

00:31:06.208 --> 00:31:13.128

<v SPEAKER_2>It's interactive, so I would run, you have your lectures, but you post all of your questions and things like that as well.

00:31:13.128 --> 00:31:18.908

<v SPEAKER_1>Rosan, I will link to the course that you mentioned as well, some of the other resources in the show notes, of course.

00:31:18.908 --> 00:31:21.388

<v SPEAKER_1>You mentioned SOS training, and I wonder if we could just go back to that.

00:31:21.388 --> 00:31:24.208

<v SPEAKER_1>Could you explain briefly what that means and what that entails?

00:31:24.208 --> 00:31:29.208

<v SPEAKER_1>Is that a global qualification or credential, or is it something specific to certain areas of the world?

00:31:29.788 --> 00:31:44.708

<v SPEAKER_2>It's basically a specific sensory training around eating and specifics, and health care professionals, dieticians, speech therapist, occupational therapist, psychologist, all of them can do it.

00:31:44.708 --> 00:31:52.528

<v SPEAKER_2>It is, of course, the origin is the US, but in the meantime, it's become hugely international.

00:31:52.528 --> 00:32:02.348

<v SPEAKER_2>And so I attended it within the UK with a US team, but it's now after COVID, you can do it also remotely from a training perspective.

00:32:02.348 --> 00:32:08.928

<v SPEAKER_2>I want to be clear though here, Katie, I use it as an example from a sensory because there are principles to be applied for it.

00:32:08.928 --> 00:32:21.568

<v SPEAKER_2>But as we are both research trained, there's no specific data to say that the SOS approach specifically helps with ARFID.

00:32:21.568 --> 00:32:30.548

<v SPEAKER_2>It's an approach that is used, but for example, in some of them, you might find that a different approach works better.

00:32:30.548 --> 00:32:40.308

<v SPEAKER_2>But I find that at least somebody that has some sensory training understands the absolute fear a child has, with certain from a sensory perspective.

00:32:40.308 --> 00:32:47.428

<v SPEAKER_1>Rosan, where can our audience go to learn more about the work that you're doing and the resources that you mentioned and to support your work?

00:32:47.428 --> 00:32:49.628

<v SPEAKER_2>That's very kind of you to ask, Katie.

00:32:49.628 --> 00:32:59.708

<v SPEAKER_2>So the first thing I want to say is that, of course, I've got my website, but I am actually a trustee for ARFID Awareness UK which I will provide.

00:32:59.708 --> 00:33:04.568

<v SPEAKER_2>That means anybody can access it and we have international resources there as well.

00:33:04.568 --> 00:33:09.208

<v SPEAKER_2>I will provide you with the detail which is informed by health care professionals.

00:33:09.208 --> 00:33:14.328

<v SPEAKER_2>So that is really the association where I throw my weight in.

00:33:15.208 --> 00:33:27.188

<v SPEAKER_2>Then as I mentioned already, we make sure that we provide the online training for health care professionals and parents on ARFID at University of Winchester, which parents are welcome to as well.

00:33:27.188 --> 00:33:29.768

<v SPEAKER_1>Hey, we're going to take a quick break but I'll be right back.

00:33:35.352 --> 00:33:38.332

<v SPEAKER_5>Do you find it hard to sleep at night?

00:33:38.332 --> 00:33:43.852

<v SPEAKER_5>Then the Calm Cove Podcast can help you sleep deeply all night long.

00:33:43.852 --> 00:33:52.212

<v SPEAKER_5>Calm Cove has deeply relaxing meditation music and ambient sounds like ocean waves and crackling fires.

00:33:52.212 --> 00:33:57.732

<v SPEAKER_5>All of our episodes are designed to help you relax and to fall asleep fast.

00:33:57.732 --> 00:34:08.572

<v SPEAKER_5>Calm Cove is brought to you by the team behind Sleep Cove, the sleep podcast that consists of spoken word hypnosis, meditation and stories.

00:34:08.572 --> 00:34:22.032

<v SPEAKER_5>So if you want to listen to a beautiful soundscape tonight, search for Calm Cove on Apple Podcasts or Spotify and see how we're helping millions of people relax and go to sleep every night.

00:34:30.195 --> 00:34:33.455

<v SPEAKER_1>A final question for you, Rosan, just your personal opinion.

00:34:33.455 --> 00:34:41.175

<v SPEAKER_1>In having this conversation with you, I feel that a lot of parents, other professionals too, are misusing the term ARFID.

00:34:41.175 --> 00:34:42.535

<v SPEAKER_1>They're kind of throwing it around lightly.

00:34:42.535 --> 00:34:57.315

<v SPEAKER_1>You've clearly demonstrated how serious this is and when you would get a diagnosis, but it reminds me of the conversations we've had previously about growth faltering in this term, failure to thrive, or even the term malnutrition, which was in the United States, at least not a generally agreed upon consensus.

00:34:57.415 --> 00:34:59.735

<v SPEAKER_1>And doctors throw that term around.

00:34:59.735 --> 00:35:03.555

<v SPEAKER_1>Like, my friend's pediatrician is the one that told her about ARFID.

00:35:03.555 --> 00:35:09.375

<v SPEAKER_1>And I know the child situation and I would recommend and refer them to an expert as well.

00:35:09.375 --> 00:35:12.295

<v SPEAKER_1>But I see lots of other parents who use these terms loosely.

00:35:12.295 --> 00:35:13.935

<v SPEAKER_1>And I'm just curious what your thoughts are about that.

00:35:13.935 --> 00:35:16.035

<v SPEAKER_1>A lot of this, of course, is proliferated by social media.

00:35:16.035 --> 00:35:18.275

<v SPEAKER_1>Oh, it's not just picky eating.

00:35:18.275 --> 00:35:19.075

<v SPEAKER_1>It's severe picky eating.

00:35:19.075 --> 00:35:20.375

<v SPEAKER_1>Oh, it must be ARFID.

00:35:20.375 --> 00:35:22.035

<v SPEAKER_1>They kind of jump to conclusions.

00:35:22.035 --> 00:35:24.935

<v SPEAKER_1>And as someone working in this space, what are your thoughts on that?

00:35:25.495 --> 00:35:28.135

<v SPEAKER_2>So first of all, we have exactly the same experience.

00:35:28.155 --> 00:35:35.715

<v SPEAKER_2>I am appalled when I get a six-month-old referred to me with a referral and saying this child has ARFID.

00:35:35.715 --> 00:35:36.755

<v SPEAKER_2>That's not possible.

00:35:36.755 --> 00:35:38.355

<v SPEAKER_2>We've missed something.

00:35:38.355 --> 00:35:41.735

<v SPEAKER_2>You and me both know the child is not born with ARFID.

00:35:41.735 --> 00:35:43.235

<v SPEAKER_2>There's an underlying diagnosis.

00:35:43.235 --> 00:35:46.895

<v SPEAKER_2>So I am hugely concerned about the misuse.

00:35:46.895 --> 00:35:58.115

<v SPEAKER_2>So I would say to anybody listening to our discussion today to say, if your child is below two and a half, three years of age, it's unlikely your child has got ARFID.

00:35:58.115 --> 00:36:02.895

<v SPEAKER_2>It's likely your child has got a normal picky eater.

00:36:02.895 --> 00:36:17.275

<v SPEAKER_2>The things that would concern me is if a child is losing weight, and I absolutely concur with you, not just losing weight, but having somebody that really understands about faltering growth and how centile drops really work.

00:36:17.275 --> 00:36:20.835

<v SPEAKER_2>That would be a first sign where I would say you need to get help.

00:36:21.435 --> 00:36:33.215

<v SPEAKER_2>If you find that the specificities around food starts to go, I will only have this brand, I will only have this certain sensory circumstances before I will eat food.

00:36:33.215 --> 00:36:38.115

<v SPEAKER_2>Without that, I would say to you, it's likely just normal picky eating.

00:36:38.115 --> 00:36:41.775

<v SPEAKER_2>But I think social media is not helping, really not helping.

00:36:41.775 --> 00:36:49.315

<v SPEAKER_2>I suppose you've inspired me maybe today again to put some posts out on ARFID and really explain that it's really not just a dive into.

00:36:49.315 --> 00:36:59.535

<v SPEAKER_1>But I so appreciate an expert like yourself coming out and saying that you're not shaming the mom, you're not saying she's doing anything wrong, but also your six-month-old baby does not have ARFID full stop.

00:36:59.535 --> 00:37:03.455

<v SPEAKER_1>But parents need to hear that from experts, not from social media.

00:37:03.455 --> 00:37:18.175

<v SPEAKER_2>I totally agree and I think it creates anxiety because you go on to Google after somebody said to you that, and I think this is here where we as healthcare professionals, and I include myself in all of that, say we need to understand what our limitations are.

00:37:18.175 --> 00:37:22.035

<v SPEAKER_2>I am not trained as a mental healthcare professional.

00:37:22.035 --> 00:37:26.855

<v SPEAKER_2>So I always say to parents, your child has got characteristics of ARFID.

00:37:26.855 --> 00:37:35.315

<v SPEAKER_2>If I'm pretty sure they have, then I refer them on to psychologist, psychiatrist, somebody I trust that I know has been trained, and then they take it from there.

00:37:35.315 --> 00:37:41.235

<v SPEAKER_2>But I don't go and slap a label on there without knowing, because I have had it wrong.

00:37:41.235 --> 00:37:42.375

<v SPEAKER_1>Well, thank you so much for your time.

00:37:42.475 --> 00:37:47.055

<v SPEAKER_1>I really appreciate it, and I know our audience appreciates learning about this from you, the expert as well.

00:37:47.055 --> 00:37:49.735

<v SPEAKER_2>Thank you very much for having me.

00:37:49.735 --> 00:37:52.515

<v SPEAKER_1>Well, I hope you enjoyed that interview with Rosan Meyer.

00:37:52.515 --> 00:38:00.855

<v SPEAKER_1>She has such a knack and a gift for making complicated medical, sometimes confusing diagnoses, very streamlined, very simple.

00:38:00.855 --> 00:38:07.795

<v SPEAKER_1>And I appreciate that you came right out and said, your baby does not have ARFID, but she did a great job of explaining what ARFID is.

00:38:07.795 --> 00:38:27.375

<v SPEAKER_1>And later on in the life cycle, if you're worried about these behaviors, how you can get help and how working with a credentialed expert who specializes in this can really help get your child back on track with regards to their growth and their nutrition and their food, because there is a lot of anxiety around feeding, but not all anxiety around feeding means you have ARFID.

00:38:27.375 --> 00:38:35.215

<v SPEAKER_1>So I'll link to the resources that Rosan talked about, including her website and also that course that she was mentioning about ARFID that parents are welcome to join as well.

00:38:35.215 --> 00:38:39.255

<v SPEAKER_1>That will be on the show notes page for this episode, which you can find at blwpodcast.com/462.

00:38:42.395 --> 00:38:47.495

<v SPEAKER_1>A special thank you to our sponsors and our partners at Airwave Media.

00:38:47.495 --> 00:38:53.435

<v SPEAKER_1>If you like podcasts that feature food and science and using your brain, check out some of the podcasts from Airwave.

00:38:53.435 --> 00:38:56.015

<v SPEAKER_1>We are online at blwpodcast.com.

00:38:56.015 --> 00:38:57.915

<v SPEAKER_1>Thank you so much for listening and I'll see you next time.

00:39:07.333 --> 00:39:22.213

<v SPEAKER_3>At a time when change is constant and we are pulled in far too many directions, we need a way to stay present to life and to increase our ability to remain calm, think clearly and maintain our well-being.

00:39:22.213 --> 00:39:28.553

<v SPEAKER_3>Many studies indicate mindfulness improves our mental, emotional and physical health.

00:39:28.553 --> 00:39:35.153

<v SPEAKER_3>On a mindful moment with Teresa McKee, you can learn how to practice mindfulness and enjoy its many benefits.

00:39:35.533 --> 00:39:44.933

<v SPEAKER_3>Tune in for guided meditations and to hear tips and advice from some of the most respected experts in the fields of mental health and mindfulness.

00:39:44.933 --> 00:39:47.893

<v SPEAKER_3>The world truly can be a better place.

00:39:47.893 --> 00:39:50.153

<v SPEAKER_3>It all starts with a mindful moment.