The ARFID Clinic: A Co-Treatment Approach in the Outpatient Setting

Avoidant-Restrictive Food Intake Disorder (ARFID) is a feeding and eating disorder. It is defined as an eating or feeding disturbance caused by continuous failure to meet appropriate nutritional and/or energy needs connected to one (or more) of the following:

• Significant weight loss (or failure to achieve expected weight gain or unstable growth in children)
• Significant nutritional deficit
• Dependence on tube feeding or oral nutritional supplements
• Obvious interruption of social interactions and reduced ability or desire to deal with daily activities

This mental health diagnosis is characterized as very selective or picky eating and is related to one or more of the following:

• Lack of interest in eating or a decreased appetite
• Avoidance based on the sensory characteristics of food (taste, texture, smell, etc.)
• Fear of negative consequences from eating (choking, gagging, vomiting, G.I. issues)

Introducing The ARFID Clinic at Nationwide Children’s Hospital

Treatment options for ARFID at Nationwide Children’s Hospital have historically been delivered through the Eating Disorders Program or the Comprehensive Pediatric Feeding and Swallowing Clinic. Treatment would typically consist of a treatment team and outpatient sessions with individual clinicians.

The ARFID Clinic at Nationwide Children's Hospital is an outpatient clinic for youth ages 10 to 14 and their families who are experiencing feeding problems. Our multidisciplinary team supports youth and their families with improving their feeding difficulties. We incorporate multiple disciplines, including a psychologist, a medical provider, and a registered dietitian, to enhance support and improve management of ARFID. These providers will meet your child at the first session and continue to follow them during their time in the ARFID Clinic program. They may also refer to other specialty providers if your child would benefit from additional specialty care to achieve their feeding goals.

Program Overview

• The ARFID Clinic is a 6- to 8-session outpatient program.
• The program is completed over the span of a few months due to appointments being scheduled every 2-4 weeks apart.
• Target population: ages 10-14 years old.
• Each treatment visit is completed with both a psychologist and a dietitian. This co-treatment model allows both behavioral and nutritional problems associated with ARFID to be addressed in each session throughout the program.
• Treatment visits last from 50-60 minutes.
• The ARFID Clinic uses a treatment plan that is based on Cognitive Behavioral Therapy (CBT) for ARFID, which is an evidence-based treatment for youth with ARFID. CBT for ARFID involves education and practicing skills during treatment visits in addition to exercises that youth and their families complete at home. It is vital to complete outside-of-session exercises to support the work completed during treatment visits.

Could your child be appropriate for the ARFID Clinic?

• If you have concerns or are interested in your child participating in the ARFID Clinic, please discuss your concerns with your primary care provider who can place a referral.
• You can also call to place a self-referral by contacting Behavioral Health Intake at 614-355-8080.
• Referrals are reviewed by providers to assess their appropriateness.
• If appropriate, patients will be scheduled for an initial evaluation meeting (90 minutes in length) with all team members present (psychology, medical, and nutrition) to review goals and determine if ARFID is present and if the program is an appropriate fit for your child.