FBT for ARFID: Parent Guided Treatment for Restrictive eating in Children

Family-Based Treatment for Avoidant/Restrictive Food Intake Disorder (ARFID)

Parents empowered and helping their child move past their restricted eating

FBT stands for Family-Based Treatment, which is a therapeutic approach often used in the treatment of various eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in young people. ARFID is a complex eating disorder characterized by a persistent and severe restriction of food intake, often resulting in significant weight loss, nutritional deficiencies, and interference with psychosocial functioning.

In Family-Based Treatment (FBT) for ARFID, caregivers play a central role in the treatment process. The main goal of FBT-ARFID is to help the individual with ARFID gradually expand their range of acceptable foods (and the quantity of food, too, in some cases) and improve their overall nutritional intake. This is achieved through a structured approach where parents or caregivers take an active role in meal planning, preparation, supervision and home support in expanding food repertory.

Main interventions in FBT for ARFID

1. Psychoeducation: Parents are educated about ARFID, including its symptoms, causes, and potential consequences. They also learn about the principles of FBT and their role in the treatment process.

2. Weight restoration (if necessary): If the individual with ARFID is underweight or experiencing nutritional deficiencies, the focus may initially be on restoring weight and addressing any immediate medical concerns.  Usually during weight restoration, we’re not working too much on expanding food repertory; weight restoration typically needs to happen first.

3. Meal support and supervision: Parents or caregivers are responsible for planning and preparing meals according to a plan coordinated in collaboration with the FBT provider. They provide encouragement and support to help the individual gradually increase their food intake and overcome their fear or aversion to certain foods.

4. Exposure and desensitization: The individual is gradually exposed to a wider variety of foods in a supportive environment, allowing them to become more comfortable with trying new foods and expanding their diet.  This is the heart of FBT for ARFID and the intervention that moves the needle towards normalized eating. The provider gives parents the tools to engage the child between sessions in exploring new textures and flavors.

5. Transition of control: As the individual progresses in treatment, they gradually take on more responsibility for their own eating behaviors, with the support and guidance of their family and FBT provider.

FBT for ARFID is typically delivered by a therapist with the oversight of a pediatrician (typically the patient’s established provider).  The length and intensity of treatment may vary depending on the individual's needs and progress but most often, sessions are weekly. This may not sound like much but the work continues between sessions at home - so the treatment moves.