Avoidant and Restrictive Food Intake Disorder Epidemiology • Begins in infancy and persists into adulthood Risk factors • • • • Temperament e.g. anxiety disorders Environment e.g. familial anxiety Genetic - Esp. a history of GIT diseases Parent-child interactions: - Presenting foods inappropriately interpreting the infant’s behaviour as an act of aggression or rejection - Child abuse - Child neglect Clinical features • • Avoidance based on sensory characteristics of food tends to arise in the first decare of life Infants - Irritable and difficult to console during feeding - Apathetic appearance - Withdrawn - Developmental lads - Feeding difficulties - Irritability Diagnosis • Markers: - Malnutrition - Low weight - Growth delay - Need for artificial nutrition in the absence of any clear medical condition other than poor intake • DSM-V - Eating/feeding disturbances (lack of interest in eating or food) to the extent of persistent failure to meet the appropriate nutritional and/or energy needs resulting in significant weight loss/growth failure and nutritional deficiencies, that is associated with one or more of: ➔Significant weight loss or failure to achieved expected weight gain for faltering growth in children ➔Significant nutritional deficiency ➔Dependence on enteral feeding or oral nutritional supplements ➔Marked interference with psychosocial functioning. - Disturbances is not better explained by lack of available food or bay an associated culturally practice. - The eating disturbance does not happen exclusively during AN or BN AND there is no evidence of disturbance in the way in which one’s body weight or shape is experienced. - The eating disturbance is not attributed to concurrent medical condition or better explained by another mental disorder. When the eating disturbances occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention. Management • • • • Psychoeducation Behavioural modification Psychotherapy Supplementary feeding may be required to sustain adequate intake - E.g. infants with a failure to thrive who need NGT feeding, children with neurodevelopmental disorders who are dependent on nutritionally complete supplements and those who reply on gastrostomy tube feeding or complete oral nutrition supplements in the absence of an underlying medical condition.