Assessing growth in children and adolescents with Avoidant/Restrictive Food Intake Disorder

Background Although growth delays and disruption are a well described medical complication of restrictive eating disorders in children and young adolescents, this complication has received less attention in patients with Avoidant/Restrictive Food Intake Disorder (ARFID). Patients with ARFID have challenges with adequacy of food volume and variety that are not related to body image but are instead related to lack of interest in eating, sensory concerns, and/or fears of aversive consequences. Because onset of ARFID is commonly before puberty, concerns regarding growth adequacy may present an additional treatment challenge and a unique opportunity for support.Review Child and adolescent patients with other restrictive eating disorders are at risk of irreversible deleterious impact on growth and development, particularly when onset is before or around puberty. Although faltering growth is a defining feature of ARFID, less attention has been paid to methods for examining growth concerns in young patients with ARFID and training providers to assess growth adequacy when prepubertal and peripubertal patients present with this diagnosis. Providers working with patients under 18 years of age with eating disorders will benefit from the tools discussed in this narrative review to adequately assess growth and development against genetic potential, recognize alterations in growth that are a result of nutritional deficiencies, and support and maximize catch-up growth and development when it has been impaired.Conclusion Established pediatric growth monitoring tools and techniques to assess adequacy of growth can be applied to child and adolescent patients presenting with ARFID. These tools can improve long term outcomes in linear height for these patients and allow for monitoring during and after treatment until growth and development is complete. Medical providers caring for patients presenting with ARFID will need to establish best practices for assessing and monitoring growth. Providers caring for younger patients with eating disorders must remember that children should be growing, and adolescents must progress through puberty. Linear height gain, as well as bone and brain development, hinge upon adequate nutrition. Patients with Avoidant/Restrictive Food Intake Disorder (ARFID) are at risk for inadequate nutrition and will need an assessment of growth at presentation, as well as ongoing medical support to assure that growth is on track to achieve predicted adult height. Lack of attention to these developmental concerns in a critical window may allow growth to be lost. For medical providers, additional skills will be needed to assess young patients with ARFID and assist them in resuming and achieving growth that matches their genetic potential.