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Nutritional blindness from avoidant-restrictive food intake disorder – recommendations for the early diagnosis and multidisciplinary management of children at risk from restrictive eating
  1. Sarah Schimansky1,
  2. Haneen Jasim1,
  3. Lucy Pope2,
  4. Philippa Hinds3,
  5. Daphin Fernandez4,
  6. Paraskevi Choleva1,
  7. Arundhati Dev Borman1,
  8. Peta M Sharples5,
  9. Todd Smallbone5,
  10. Denize Atan1,6
  1. 1 Bristol Eye Hospital, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
  2. 2 Department of Paediatric Nutrition and Dietetics, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  3. 3 Community Child Health Partnership, Sirona Care and Health CIC, Bristol, UK
  4. 4 General Paediatrics, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  5. 5 Department of Paediatric Neurology, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  6. 6 Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  1. Correspondence to Dr Denize Atan, Bristol Eye Hospital, University Hospitals Bristol & Weston NHS Foundation Trust, Lower Maudlin Street, Bristol, BS1 2LX, UK; denize.atan{at}bristol.ac.uk

Abstract

Avoidant-restrictive food intake disorder (ARFID) is an eating disorder characterised by limited consumption or the avoidance of certain foods, leading to the persistent failure to meet the individual’s nutritional and/or energy needs. The disordered eating is not explained by the lack of available food or cultural beliefs. ARFID is often associated with a heightened sensitivity to the sensory features of different types of food and may be more prevalent among children with autism spectrum disorder (ASD) for this reason. Sight loss from malnutrition is one of the most devastating and life-changing complications of ARFID, but difficult to diagnose in young children and those with ASD who have more difficulty with communicating their visual problems to carers and clinicians, leading to delayed treatment and greater probability of irreversible vision loss. In this article, we highlight the importance of diet and nutrition to vision and the diagnostic and therapeutic challenges that clinicians and families may face in looking after children with ARFID who are at risk of sight loss. We recommend a scaled multidisciplinary approach to the early identification, investigation, referral and management of children at risk of nutritional blindness from ARFID.

  • Ophthalmology
  • Micronutrients
  • Paediatrics
  • Child Development
  • Child Health

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Footnotes

  • Contributors DA conceived the idea for this article. SS coordinated the writing of the manuscript and wrote the initial draft with written contributions from HJ, LP, PH, DF, PC, ADB, PMS, TS and DA. All authors reviewed and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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