Back to school with ARFID!

September is always the busiest month for those working with children with ARFID.

The anxiety of returning to school nearly always results in a reduction in the range of foods that a child with ARFID will accept. Many children will just ‘regress’ to a few safe foods.

Any progress that had been made over the holidays will seem to have been lost.

This anxiety increases sensory reactivity and hyper-vigilance to detail, and leads to food rejection.

This ‘regression’ is likely to be worse of course:

• where this is the first time at school

• where children are changing schools

• when children have ASD or traits of autism

• when children have contamination fears (COVID!)

What to do?

First take a deep breath and remember that, when all settles down, the dietary range will usually increase again. That is until we get to the disruption caused by the Christmas play!

Remember that growth is more important than dietary range at this point in time; let them eat cake, (and chocolate, crisps, biscuits, dry cereal!)

Then prepare:

The primary/nursery school should know that:

• It is of primary importance that your child eats and drinks throughout the day.

• Reasonable accommodation should be made to allow them to do this.

• Your child will bring their own packed lunch, snacks and drinks into school where necessary.

• They cannot eat the fruit snack provided.

• Your child should not be encouraged to eat the fruit snack provided.

• Although their packed lunch and snack seems ‘unhealthy’, no-one should ever. comment on this (foods might be lost from their dietary range).

• Care should be taken when discussing ‘healthy and unhealthy’ foods as part of the curriculum.

• Your child might not be able to be near other children when they are eating.

• Reasonable accommodation should be made to allow them to do this.

The secondary school should know that:-

• It is of primary importance that your child eats and drinks throughout the day.

• Reasonable accommodation should be made to allow them to do this.

• Your child will bring their own packed lunch and snacks into school where necessary.

• Choosing food from a cafeteria style display is stressful.

• Your child might not be able to sit in the dining hall because of the smell.

• They might not eat their lunch because they are slow and want to get outside with their friends.

• Any food preparation courses that are on the curriculum might be difficult to handle.

Get all of these points agreed beforehand with the school.

Write out the plan that you have agreed for your child to see and approve.

General anxiety reduction

Remember the higher the worry the fewer the foods!

The rule is to plan, plan, and then plan again.

Children with ARFID, because of the usual co-morbid ASD/traits, are not good at forward planning or problem solving. Most of us know that we can work out:

• What to do in a new situation

• Where to go

• Who to ask if we don’t know, and we can think about what we did before in a similar situations

Children with ARFID are less likely to be able to do this.

So write it all down, and put the plan on the wall. Think about everything that will be new for your child, where to go what to expect, what they should do if they ‘don’t know’.

When you have planned, then practice (e.g.).

• Do they have a new uniform, different clothes to wear?

Try them on, then cut the labels out!

• Is there a different route to travel to school, a different method of transport?

Drive the route, catch the bus, until everyone is happy.

• Is there a new door to go into, a new coat peg?

Go and look at the door, find the coat peg, do this, if possible before school starts.

• Is there a new teacher, (hopefully they will have met the new teacher last term)?

Get a photo, write out his/her name.

Finally

Think about your own stress levels.

Do you have to start the breakfast, school run, work, treadmill once again?

If you are flustered in the morning then this will increase your child’s stress levels.

Think - what can you control?

Work on that; leave everything else until later.

And remember:

The higher the uncertainty, the higher the worry > the higher the hyper-vigilance > the greater the panic > the lower the appetite.

Written for ARFID Awareness UK by Dr. Gillian Harris, BA, MSc.PhD, CPsychol, AFBPsS.