🍽️ Understanding Pica and ARFID: A Parent's Guide

⚕️Important Note

This guide provides educational information and support strategies. Both pica and ARFID are serious medical conditions that require professional diagnosis and treatment. Always consult with healthcare providers, registered dietitians, and mental health professionals for proper care.

🧩What is Pica?

Pica is the persistent eating of non-food substances for at least one month. It's considered inappropriate for the person's developmental level and not part of cultural practices.

Common items eaten: Paper, starch, ice, cornstarch, paint chips, dirt, clay, hair, fabric, metal objects

🥄What is ARFID?

ARFID (Avoidant/Restrictive Food Intake Disorder) involves limited food intake that results in significant weight loss, nutritional deficiency, dependence on supplements, or interference with social functioning.

Not the same as: Picky eating, anorexia nervosa, or typical childhood food phases

Emergency Action Plans

🚨Pica Emergency Protocols

If Child Eats Something Dangerous:

  1. Stay calm - Your child will mirror your reaction
  2. Remove any remaining item from mouth/area
  3. Don't induce vomiting unless specifically told to by poison control
  4. Call your local poison control/emergency line:
    • USA: 1-800-222-1222
    • UK: 111 (NHS) or 999 (emergency)
    • Canada: Contact your provincial poison centre or 911
    • Australia: 13 11 26 (Poisons Information Centre)
    • New Zealand: 0800 764 766 (National Poisons Centre)
  5. Have ready: Child's weight/mass (kg/lbs), age, what was eaten, how much, when
  6. Follow their instructions exactly
  7. Call emergency services if: Child is unconscious, having seizures, difficulty breathing (911/999/000/111 as appropriate for your country)

🏥 Emergency Room Kit

  • Insurance cards
  • List of current medications
  • Emergency contacts
  • List of known allergies
  • Recent medical history
  • Sample of item eaten (if safe/available)
  • Phone charger
  • Comfort items for child

📋 Information to Collect

  • Exactly what was eaten
  • Approximate amount
  • Time it happened
  • Any symptoms appearing
  • Recent food/drink intake
  • Current behavior changes
  • Photos of item/packaging (if helpful)

⚠️ARFID Warning Signs - Seek Immediate Help If:

  • Severe dehydration: No wet diapers/urination for 8+ hours, lethargy, dry mouth
  • Dramatic weight loss: Losing weight rapidly or consistently
  • Signs of malnutrition: Hair loss, extreme fatigue, delayed healing
  • Refusing all fluids for extended periods
  • Extreme behavioral changes around food (panic, aggression)

Understanding by Condition

🔍Signs and Symptoms of Pica

  • Regularly eating non-food items for a month or longer
  • Seeking out specific non-food textures or materials
  • Continuing to eat inappropriate items despite redirection
  • May occur alongside developmental disabilities, autism, or intellectual disabilities
  • Can happen at any age but often starts in toddlerhood
  • May be secretive about eating non-food items

⚠️Safety Risks of Pica

  • Poisoning: From paint chips, cleaning products, or toxic substances
  • Choking: From small objects or inappropriate textures
  • Intestinal blockage: From indigestible materials
  • Dental damage: From hard objects or abrasive materials
  • Infections: From contaminated soil, feces, or unsanitary items
  • Nutritional deficiency: When non-food items replace nutritious foods

🔍Signs and Symptoms of ARFID

  • Extremely limited food choices (may eat fewer than 10 different foods)
  • Significant weight loss or failure to gain weight appropriately
  • Nutritional deficiencies requiring supplements
  • Dependence on feeding tubes or nutritional supplements
  • Social impairment - difficulty eating with others or in social settings
  • Strong reactions to food textures, smells, colors, or temperatures
  • Fear or anxiety around trying new foods
  • Gastrointestinal issues that lead to food avoidance

🧠Understanding Why These Conditions Happen

Pica Reasons

  • Sensory seeking: Specific textures/oral stimulation
  • Nutritional deficiencies: Iron, zinc deficiencies
  • Self-soothing: Calming behavior
  • Developmental differences: Understanding of edible vs. non-edible
  • Communication: Expressing needs
  • Medical conditions: Some conditions increase likelihood

ARFID Reasons

  • Sensory: Texture, smell, temperature sensitivities
  • Medical: GI issues, swallowing difficulties
  • Psychological: Anxiety, trauma, autism differences
  • Lack of interest: Low appetite, medication effects
  • Past experiences: Choking, vomiting associations

Age-Specific Guidance

👶Toddlers (1-3 years)

Pica Considerations

  • High supervision needs - Constant vigilance required
  • Environmental safety priority - Baby-proofing everything
  • Simple redirections - "That's not food, here's a snack"
  • Safe alternatives readily available
  • Medical evaluation for nutritional deficiencies

ARFID Considerations

  • Distinguish from normal pickiness - Look for extreme limitations
  • Growth monitoring critical - Regular weight/height checks
  • Sensory exploration encouraged - Food play without pressure
  • Milk/formula often primary nutrition
  • Early childhood intervention may be available

🎒School Age (4-12 years)

Pica Considerations

  • School communication essential - Teachers need to know
  • Peer awareness - May be teased or misunderstood
  • Portable safety tools - Safe alternatives for outings
  • Building self-awareness - Help them recognize urges
  • Social situations challenging - Playground, parties need planning

ARFID Considerations

  • School meal accommodations - Educational support plans may be needed (504/IEP in US, SEN support in UK, IPP in Canada)
  • Social eating challenges - Birthday parties, field trips
  • Involving child in solutions - Age-appropriate participation
  • Building food skills - Cooking, grocery shopping
  • Peer relationships - Education about differences

🌟Teens (13+ years)

Pica Considerations

  • Privacy concerns - May hide behaviors
  • Self-advocacy skills - Teaching them to communicate needs
  • Independence building - Gradual increase in self-management
  • Transition planning - Preparing for adult services
  • Mental health support - Addressing any depression/anxiety

ARFID Considerations

  • Body image concerns - May develop alongside eating disorder thoughts
  • Social independence - Managing eating in social situations
  • College preparation - Dorm life, meal plans, independence
  • Self-advocacy crucial - Speaking up for accommodations
  • Relationship impacts - Dating, social functions

Practical Tools & Checklists

🏠Home Safety Audit for Pica

Kitchen Safety:

  • □ Cabinet locks on cleaning supplies
  • □ Knives and sharp objects secured
  • □ Small objects (magnets, twist ties) removed
  • □ Trash cans with tight lids or locked
  • □ Pet food stored securely

Bathroom Safety:

  • □ Medications locked away
  • □ Cleaning products secured
  • □ Toilet paper/tissues monitored
  • □ Small toiletries removed
  • □ Toilet locks if needed

General Home:

  • □ Paint chips scraped/covered
  • □ Craft supplies locked away
  • □ Coins, buttons, small objects secured
  • □ Plants researched for toxicity
  • □ Electrical outlet covers
  • □ Safe alternatives readily available in each room

📊ARFID Food Tracking Template

Weekly Food Log:

Week of: ___________

Child's Name: ___________

Day Foods Accepted Foods Refused New Exposures Notes
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

💬Communication Scripts

For Schools/Educational Settings:

"My child has [condition] which means they [brief explanation]. This requires [specific accommodations]. I'd like to set up a meeting to discuss how we can work together to keep them safe and supported. We may need to create a formal support plan."

For Family/Friends:

"[Child's name] has some special eating needs due to a medical condition. They're not being difficult or 'naughty' - this is how their brain processes food/eating. Here's how you can help..."

For Babysitters/Carers:

"[Child's name] has specific safety needs around eating. Please do not offer any foods not on this list. If they try to eat something inappropriate, here's what to do... This is a medical condition, not behavioural."

Specific Product Recommendations

🛡️For Pica - Safe Alternatives by Common Cravings

Ice/Hard Items:

  • Nugget ice makers - Soft, safe ice
  • Frozen fruit pops
  • Hard candies (supervised)
  • Frozen teething toys
  • Ice chips in controlled amounts

Paper/Cardboard:

  • Edible paper (rice paper, fruit leather)
  • Seaweed snacks
  • Rice crackers
  • Communion wafers
  • Paper-thin crackers

Dirt/Gritty Textures:

  • Crushed ice
  • Coarse salt (small amounts)
  • Poppy seed crackers
  • Sesame seed snacks
  • Everything bagel seasoning

Safety Products:

  • Cabinet locks: Magnetic locks (brands like Safety 1st, Munchkin, or local pharmacy brands)
  • Outlet covers: Sliding plate covers (available at most hardware/baby stores)
  • Toilet locks: Adhesive strap locks or latch systems
  • Medication lockbox: Small locking storage boxes (pharmacy/medical supply stores)
  • Portable safety kit: Small bag with safe alternatives for outings

🍴For ARFID - Sensory-Friendly Tools

Eating Utensils:

  • Weighted utensils - Good Grips or Therapro
  • Textured handles - Bumpy or ridged grips
  • Different materials - Bamboo, silicone, plastic options
  • Size variations - Toddler to adult sizes
  • Specialty spoons - Flat, deep, or angled

Plates and Bowls:

  • Divided plates - Prevent food mixing
  • Different colors - Some prefer white, others need color
  • Various depths - Shallow vs. deep bowls
  • Silicone options - Easy to clean, different texture
  • Temperature-sensitive plates - Show food temperature

Food Play Materials:

  • Sensory bins - Rice, beans, pasta for exploration
  • Play kitchen foods - Realistic looking items
  • Food-safe Play-Doh - For creating food shapes
  • Cookie cutters - Make familiar shapes
  • Food painting supplies - Brushes for food exploration

Nutritional Supplements:

  • Complete nutrition drinks - Pediasure/Boost (US), Fortisip/Complan (UK), Ensure (widely available)
  • Breakfast drinks - Carnation Instant Breakfast or similar malted drinks
  • Gummy vitamins - More appealing format (check with pharmacist for age-appropriate options)
  • Protein powders - Mix into accepted foods (consult dietitian first)
  • Smoothie ingredients - Hide nutrition in familiar textures

Technology and Apps

📱Recommended Apps and Technology

Note: App availability varies by country. Check your local app store for alternatives if specific apps aren't available.

Food Tracking Apps:

  • MyFitnessPal - Nutrition tracking (widely available)
  • Fooducate - Food education and tracking
  • See and Learn - Visual food schedules
  • Choiceworks - Visual scheduling app
  • First Then Visual Schedule - Meal routine support
  • Local equivalents - Search "visual schedule" or "food diary" in your app store

Communication Apps:

  • Proloquo2Go - AAC for communication needs
  • PECS IV+ - Picture exchange communication
  • TouchChat - Symbol-based communication
  • GoTalk NOW - Simple communication tool
  • Local alternatives - Ask speech therapists for country-specific recommendations

Safety and Monitoring:

  • Family locator apps - For wandering concerns (varies by country)
  • GPS watches - Available internationally, brands vary
  • Baby monitor apps - Extra supervision when needed
  • Medication reminder apps - For supplements/medications

Educational Resources:

  • National autism organization apps - Digital resources by country
  • ARFID awareness apps - Search your local app store
  • Feeding therapy videos - YouTube channels by speech-language pathologists
  • Social stories apps - Explaining food rules and safety

Share Your Family's Journey

💙Real Stories from Real Families

We believe that authentic experiences from other families are the most valuable resource for parents navigating pica and ARFID. Your story could provide hope, practical tips, or comfort to another family going through similar challenges.

We'd love to hear about:

  • What strategies worked for your family (and what didn't)
  • Breakthrough moments or gradual progress you've seen
  • Challenges you've overcome and how you managed them
  • Resources or professionals that made a difference
  • Daily life tips that other families might find helpful
  • School or social situations you've navigated successfully

📝Share Your Story

Help other families by sharing your experience:

⚠️ Important: This form is for sharing experiences and support, not for emergency situations. If you or someone you know is at immediate risk of harm, please contact emergency services (999/911/000) or your local safeguarding services immediately.

All stories are reviewed before publishing. We respect your privacy and will never share personal information without permission.

🔒Privacy & Safety

  • You control your story - share only what you're comfortable with
  • No identifying information required - anonymous submissions welcome
  • Medical privacy respected - don't feel pressured to share specific diagnoses or details
  • Focus on helpful strategies rather than personal medical information
  • You can withdraw your story at any time if circumstances change

Practical Daily Strategies

🏠Creating a Supportive Environment

For Both Conditions:

  • Remove pressure: Avoid forcing, bribing, or punishing around food/eating
  • Stay calm: Your reaction affects their comfort and safety
  • Consistent routines: Regular meal times and predictable food experiences
  • Medical team: Work with doctors, dietitians, and therapists
  • Document patterns: Keep food diaries and track behaviors

🍎Specific ARFID Strategies

  • Start where they are: Accept current safe foods without judgment
  • Tiny exposures: Place new foods near (not on) their plate
  • Food play: Let them touch, smell, or play with food without eating pressure
  • Bridge foods: Find slight variations of accepted foods (different brand of crackers)
  • Involve them: Let them help with grocery shopping and food preparation
  • Social modeling: Eat together when possible, show enjoyment of varied foods
  • Sensory supports: Provide preferred utensils, plates, or eating environments

🔒Specific Pica Strategies

  • Safe substitutes: Provide similar textures that are edible (ice, gum, crunchy snacks)
  • Increase supervision: Monitor during high-risk times
  • Environmental control: Secure dangerous items, provide appropriate alternatives
  • Address underlying needs: If it's sensory, provide other sensory input
  • Medical evaluation: Check for nutritional deficiencies
  • Redirect, don't just restrict: Give them something appropriate to do instead
  • Communication support: Help them express needs in other ways

⏰What NOT to Do

  • Don't force eating - This increases anxiety and resistance
  • Don't use food as reward/punishment - Creates unhealthy relationships with food
  • Don't make eating a battle - Keep mealtimes as positive as possible
  • Don't compare to other children - Each child's needs are unique
  • Don't ignore safety risks - Take pica seriously and get professional help
  • Don't blame yourself - These conditions aren't caused by parenting

When to Seek Professional Help

🚨Seek Immediate Medical Attention If:

  • Child has eaten something toxic or dangerous
  • Signs of poisoning or illness after eating non-food items
  • Choking or difficulty breathing
  • Severe weight loss or dehydration
  • Signs of intestinal blockage (severe pain, vomiting, no bowel movements)

👨‍⚕️Professional Team Members

For ARFID:

  • Paediatrician/Family Doctor - Overall health monitoring
  • Registered Dietitian/Nutritionist - Nutritional assessment and planning
  • Feeding Therapist - Speech therapist/pathologist or occupational therapist with feeding specialization
  • Occupational Therapist - Sensory and motor aspects
  • Psychologist/Child Psychiatrist - Anxiety and behavioural support
  • Gastroenterologist - If GI issues suspected

For Pica:

  • Paediatrician/Family Doctor - Medical evaluation and safety
  • Behaviour Analyst/Psychologist - Understanding function and interventions
  • Occupational Therapist - Sensory alternatives
  • Gastroenterologist - If GI complications occur
  • Dietitian/Nutritionist - If nutritional deficiencies suspected
  • Toxicologist - If dangerous ingestion occurs (available at major hospitals)

💰Healthcare System Navigation & Advocacy Tips

  • Document everything: Keep records of all appointments, treatments, and communications
  • Get proper diagnoses: Official medical diagnoses help with accessing services and support
  • Know your healthcare system:
    • UK: Work through GP to access specialist services (NHS) or consider private options
    • Canada: Provincial health plans vary - check coverage for feeding therapy/behavioural services
    • Australia: Medicare covers some services, private health insurance may cover others
    • USA: Insurance coverage varies - appeal denials and know your rights
  • Educational support: Request assessments for formal support plans (IEP/504 in US, EHCP/SEN in UK, IPP in Canada)
  • Know your rights: Familiarize yourself with disability laws and accommodations in your country
  • Join support groups: Connect with other parents who can share successful strategies for accessing services
  • Advocate persistently: Don't accept "no" as final - many services require multiple requests

Supporting Your Family

💚Self-Care for Parents

  • Connect with others: Find support groups for families dealing with feeding challenges
  • Take breaks: These conditions can be exhausting - arrange respite care when possible
  • Educate family: Help siblings and extended family understand the conditions
  • Celebrate small wins: Acknowledge any progress, no matter how small
  • Professional support: Consider counseling for yourself to manage stress and anxiety
  • Stay hopeful: With proper support, many children make significant improvements

👨‍👩‍👧‍👦Supporting Siblings

  • Explain the condition in age-appropriate ways
  • Ensure they get attention and support too
  • Help them understand it's not their fault or their sibling's fault
  • Include them in solutions when appropriate
  • Watch for signs of stress or behavior changes
  • Consider sibling support groups or counseling if needed

Resources and Support

📚Helpful Organizations and Resources by Region

International/Multi-Country Resources:

  • ARFID Awareness - International information and support
  • Feeding Matters - Global resources for pediatric feeding disorders
  • International Association of Eating Disorder Professionals (IAEDP)
  • SOS Approach to Feeding - Evidence-based feeding therapy (available internationally)

Country-Specific Resources:

🇺🇸 United States:
  • NEDA - National Eating Disorders Association
  • Early intervention services (0-3 years)
  • School district services - Special education support
  • Children's hospitals - Often have feeding clinics
🇬🇧 United Kingdom:
  • BEAT - Eating disorders charity
  • NHS Speech and Language Therapy
  • SENDIASS - Special educational needs support
  • Local authority early years services
  • ARFID Awareness UK
🇨🇦 Canada:
  • NEDIC - National Eating Disorder Information Centre
  • Provincial early intervention programs
  • Children's treatment centres
  • School board special education services
🇦🇺 Australia:
  • Butterfly Foundation - Eating disorder support
  • Early childhood intervention services
  • Speech Pathology Australia
  • National Disability Insurance Scheme (NDIS)
🇳🇿 New Zealand:
  • Eating Disorders Association NZ
  • Ministry of Health disability services
  • Enable New Zealand

Universal Resources:

  • Your local children's hospital or paediatric centre
  • Community health centres
  • Autism organizations - Many children with pica/ARFID are also autistic
  • University-based feeding clinics - Often available in larger cities
  • Online support communities and forums

🌟Remember

Both pica and ARFID are real medical conditions that require patience, understanding, and professional support. You are not alone in this journey, and with the right team and strategies, children can make progress. Focus on safety first, seek professional help, and remember that small steps forward are still progress. Your love and advocacy for your child makes a tremendous difference in their journey toward healthier eating and safety.

Most importantly: Every child is unique, and what works for one may not work for another. Stay flexible, keep trying different approaches, and celebrate the victories along the way. With time, support, and the right interventions, improvement is possible.