Schwalen ARFID Treatment (SAT) Protocol

Often known as “extreme picky eating,” the consistent and constant avoidance of foods results in nutritional deficits and lack of energy. Aversions to certain foods can be based on sensory sensitivity (texture or specific preparation of a particular food), traumatic experience (choking or vomiting), general aversion (little or no interest) in food, and secondary to a medical diagnosis (Crohn’s disease, etc.). Improving the food repertoire and/or weight restoration are the benefits for seeking treatment for this disorder.

ARFID/Extreme Picky Eating can occur in children and adults no matter your body structure or weight. Many people never outgrow extreme picky eating because it is an actual disorder – which sometimes remains untreated for long periods of time. Trauma and other medical conditions can induce anxiety with certain types of food, as can sensory or aversion to different textures of food. If meal times are a struggle because of a limited palate or as a parent you sense that your child’s picky eating is not being taken seriously, we understand the psychological complexity of the disorder. It is better to get early intervention than to delay and face serious health risks.

If your child is rejecting nutritional food regularly and you fear this issue, consider our Schwalen ARFID Treatment Protocol. Unique to the RED Clinic and based on Dr. Schwalen’s extensive experience and expertise with ARFID, clients from around the world are overcoming ARFID through The RED Clinic’s implementation of the Schwalen ARFID Treatment Protocol.

ARFID/Picky Eating can cause serious health issues that can last a lifetime. Besides malnutrition, young clients who have a limited food repertoire can experience developmental delays, significant weight loss or failure to achieve expected weight gain/faltering growth, significant nutritional deficiency, dependence on enteral feeding or nutritional supplements, as well as brain damage, due to lack of appropriate nutrients. Other health issues associated with ARFID include bone density loss, low blood pressure, low heart rate, endocrine changes, anemia, leukopenia, thrombocytopenia, dehydration, constipation, elevated liver enzymes, organ failure and even death. 

One of the key components of the SAT Protocol is the mechanism for change regarding food and eating. Through empowerment, improved family functioning, and increased parent confidence positive changes regarding food begin. This means force feeding is never part of the treatment. In fact, if force feeding is a part of your family’s history, we address any past instances where choice was removed and offer hope for healing from those occurrences.

The SAT Protocol changes are incremental and implemented weekly. The whole family must be part of the treatment process. Parents or caregivers, essentially, become the at-home staff as they implement small changes over time for a lasting impact. Behavior within the environment – the home – begins to change for the client and their caregivers. These small adjustments, such as eating at the table, to timeframes, like completing a meal or snack in a set time period, can feel large to a family who has a member struggling with ARFID. Self-discipline and routine are established in the first five weeks. Food variety and/or weight restoration are addressed after the foundation for the child to become more psychologically minded is established. Food exposures build on this foundation as children are able to handle anxiety and learn how to eat a wide variety of food.

The SAT Protocol also embraces a multidisciplinary approach, which means that registered dietitians and all clinicians regularly complete treatment team meetings about clients to ensure that the diagnoses, treatment plan, and followup care are in sync for relapse prevention and recovery. This incorporation of the treatment team can sometimes include a speech therapist, occupational therapist or psychiatrist when needed.

The entire family unit is part of the SAT Protocol. The family is foundational regarding feelings and behavior patterns towards food. Despite cultural and social norms regarding eating, the family unit is where knowledge and a new relationship with food can be constructed and adopted.

Some parents and caregivers experience the following “lightbulb” moments during the SAT Protocol:

1. The eating disorder has taken away your confidence. We are going to build you up. You know how to feed your child.
2. It will take practice to feed your child and regain your confidence. Practice needs to happen first.
3. When you place an appropriate variety and quantity of food in front of your child, you are doing your job as a parent or caregiver.
4. Now that you know what you know about ARFID you can let go of the guilt and shame that has weighed you down regarding your child’s eating.
5. Your child can start to trust you again. The ED has led to control and anxiety around food. Your child will begin to understand that you aren’t making decisions to hurt them. You have their best interest in mind. As you take the lead as the parental authority, you are building the trust mechanism in your children.

In conjunction with their SAT clinician, children meet with a play therapist weekly at The RED Clinic. The play therapist aids in the client’s development of coping skills to adjust to environmental changes within the home regarding food, emotions, and the parent/child relationship. Nutrition sessions and family therapy also occur weekly for clients and parents to maximize success.

In conjunction with their SAT clinician, adolescents meet with a therapist weekly at the RED Clinic. The play therapist aids in the client’s development of coping skills to adjust to environmental changes within the home regarding food, emotions, and the parent/child relationship. Nutrition sessions and family therapy also occur weekly for clients and parents to maximize success.

For adults, we continue to take a support system approach. The treatment team will include your spouse, best friend and/or parent – any other adult who is part of your close support system – in the recovery process.

Adults who struggle with ARFID, may have started to experience this ED as a child but remain undiagnosed until now. Other adults seek treatment for a child with ARFID in their care, and then they themselves experience a lightbulb moment when their own issues with food are recognized. Sometimes adults eat normally their entire lives until a surgery or event impacts their confidence in consuming more than a few foods. Sudden onset from a secondary event can occur, as well as sensory issues that are re-agitated after having been coped with successfully in the past.

Besides including the support system and talk therapy, the SAT Protocol includes registered dietitians, food exposure therapy, meal plans, and restaurant and grocery store experientials in its multidisciplinary approach. Accountability between the treatment team and the client along with communication amongst the clinical team help facilitate real life implementation of new thoughts and feelings about food. Adults are given the tools to empower them to change through the SAT Protocol.

At the RED Clinic, Dr. Schwalen and her clinical team have a 90% success rate in relapse prevention and complete recovery from ARFID. Our team of therapists, registered dietitians and cooperative families achieve this level of success together.