Feeding difficulties: Difficulty swallowing and the fear of aversive consequences
This chapter provides a detailed understanding of the emergence of fears of aversive consequences broadly and more specifically in youth with avoidant/restrictive food intake disorder (ARFID), practice guidance on differentially assessing ARFID from other related psychiatric disorders, and guidance on tools to address these fears in youth. ARFID is characterized by a pattern of restrictive or avoidant eating resulting in malnourishment, a low body weight, dependence on enteral feeding or supplements, and/or a significant impact on their psychosocial functioning. The chapter explores the role of maladaptive fear-learning in the context of eating challenges in pediatric gastrointestinal disorders. Assessment of fears in children ideally should integrate data from multiple reporters including youth and parents. Treatment of somatic fears typically aims to create new learning experiences that demonstrate the safety of a previously feared stimulus. For some youth, food restriction is so severe that they must be placed on supplemental or replacement tube feeding.
