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by GlenTheMachine 501 days ago
So my kid has ARFID. I am not a doctor, but what I have learned is that eventually, anything that causes nausea associated with eating can progress into ARFID, even if the original underlying cause resolves. ARFID is technically an eating disorder, like anorexia, but it isn't related to poor body image; it is, basically, a food aversion to, well, food. All food, or nearly all. This is what happened to my kid; there’s an underlying disorder that can be treated with meds, but when not treated causes nearly constant nausea. Once we diagnosed and treated the underlying cause, the nausea didn’t go away. My kid's brain had learned to associate eating with being sick, and that association persisted even when the original illness resolved.

My kid at one point was admitted to the hospital for two weeks because said kid had lost so much weight. They inserted a gastric tube, and kid discovered that kid did not become nauseous when fed through the tube. We knew kid had ARFID, but this was ah “a-ha” moment for kid, because it showed kid irrefutable proof that the problem was not a physical issue with kid's gut. It was very clearly related to the experience of eating. Kid has subsequently learned to “eat through the nausea” as described in the post.

That's what this sounds like. There was likely an underlying physical cause of the nausea; that cause may or may not have resolved, but the nausea is now it's own thing. The OP indicates a series of consults with a behaviorist; I would imagine being screened for eating disorders is what that was about, but ARFID is not a common eating disorder, and may or may not have been considered.

4 comments

Fwiw: Strenuous winter activities (eg mountain hiking and camping) can more than double baseline calorie demand. Sitting down to a base camp meal afterward can be a body-has-a-mind-of-its-own saliva-gushing "FEED ME NOW!!!" experience of really-need-to-pee intensity. Normally unappealing food commonly becomes just fine - uncooked pasta, blocks of lard, whatever. So I wonder... what happens if food-is-nauseating is repeatedly hit with a hammer of the "are you going to eat that vomit, or can I please have it? - it looks quite yummy" of extreme calorie appeal?

Another thought is the breastfeeding maternal-diet envelope expansion drill, of working outward from some one bland safe thing, experimentally adding a thing at a time, and backing off upon problems.

I haven't ever had a real eating disorder, but a lot of my childhood food aversions were finally broken during times of extreme hunger.
The absolute best meal I've ever had was a cup of clear chicken broth: my first meal after a month in the ICU without eating. As the old saying goes, hunger is the best seasoning, and as I always say, when you're hungry -- I mean really hungry -- nothing satisfies like... food.
As plausible as this might sound, it's kind of "just man up and power through it" advice. They stated they often don't feel well enough to leave their house.
Drinking pasta water is another thing that becomes totally appealing during calorie deficit.
Your son’s serotonin in his gut may still be high. Please do not assume that the nausea is related to a psychological disorder. My parents did this with me and it turns out my case was a lot more complicated.

I don’t know if you tried antinausea medication that blocks the serotonin HT3 receptor but if you try that and the nausea goes away, I would look ant increased serotonin release as a culprit instead.

https://www.ncbi.nlm.nih.gov/books/NBK603710/

"Research regarding ARFID is still emerging; the role of serotonin in sensory processing and anxiety suggests a potential mechanism through which neurotransmitter dysregulation could influence the disorder. Moreover, sensory processing issues, which are not exclusive to ARFID but are also present in other conditions (eg, autism), may be associated with abnormal serotonin function, further supporting the need to investigate serotonin's role in ARFID"

https://pmc.ncbi.nlm.nih.gov/articles/PMC305267/

Another parent with an ARFID kid here, though it sounds like our case is somewhat different. My kid, almost 16 now, has always had an extremely limited diet repertoire, starting at a failure to switch to non-smooth baby food as a toddler. Early on he exhibited extreme fear reactions to being presented with new foods. Nausea has never really been a huge issue, other than gagging if we tried to force him to try something new.

As he's matured, the reactions are less intense, and with a lot of therapy sessions, most recently with a dietician who also has ARFID, we've made real progress. In our case, that means he's (enthusiastically!) eating cheese pizza, scrambled eggs, and chocolate (but not white) milk, along with the bacon which has been his main protein source since age 3 or so.

Not sure what we'll do when he heads off to college in 2.5 years.

Anyway, if you want to compare notes with another ARFID parent, my email's in my profile.

Sounds rough. I wonder if a prolonged fast would reset things, either the gut, brain or both?