Ep. 281: Avoidant/Restrictive Food Intake Disorder (ARFID) & Food Allergies

Safe eating is at the heart of managing food allergies—but what happens when that vigilance starts to feel overwhelming, and food becomes a source of fear instead of nourishment? For many families, the line between necessary caution and something more serious can be hard to recognize. We are diving into the intersection of food allergies and Avoidant/Restrictive Food Intake Disorder, or ARFID. Joining us is Dr. Brian Vickery, Division Chief of Allergy & Immunology at Children’s Healthcare of Atlanta and Emory University, and Kaitlin B. Proctor, PhD, Assistant Professor at Emory School of Medicine Department of Pediatrics, and board-certified psychologist at Children's Healthcare of Atlanta to unpack what this means for families and share insights from Dr. Vickery's latest research. 

Resources to keep you in the know:

• Psychology Today
• AAAAI's People with Food Allergies May Be Susceptible to Avoidant/Restrictive Food Intake Disorder
• FAACT's Behavioral Health Resource Center
• "When Medically Required Food Avoidance Goes Awry: A Conceptual Framework of ARFID as an Underrecognized Clinical Complication of Food Allergy" - Research paper

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Thanks for listening! FAACT invites you to discover more exciting food allergy resources at FoodAllergyAwareness.org!

Transcript

Caroline: Welcome to FAACT's Roundtable, a podcast dedicated to navigating life with food allergies across the lifespan. Presented in a welcoming format with interviews and open discussions,

each episode will explore a specific topic, leaving you with the facts to know or use.

Information presented via this podcast is educational and not intended to provide individual medical advice.

Please consult with your personal board certified allergist or healthcare providers for advice specific to your situation.

Hi everyone. I'm Caroline Moassessi and I am your host for the FAACT Roundtable podcast. I am a food allergy parent and advocate and the founder of the Grateful Foodie Blog.

And I am FAACT's Vice President of Community Relations.

Before we start today's podcast, we would like to take a moment to thank Genentech for being a kind sponsor of FAACT's roundtable podcast. Also, please note that today's guest was not paid by or sponsored by Genentech to participate in this specific podcast.

Today we're diving into the intersection of food allergies and Avoidant Restrictive Food Intake Disorder or ARFID. Joining us is Dr. Brian Vickery, Division Chief of Allergy and Immunology at Children's Healthcare of Atlanta and Emory University,

and Kaitlin  B. Proctor, Ph.D. assistant professor at Emory School of Medicine, Department of Pediatrics and a board certified Psychologist at Children's Healthcare of Atlanta, to help us unpack what this means for families and to share insights on latest research.

Welcome Dr. Vickery and Dr. Proctor to FAACT's Roundtable podcast. We're absolutely thrilled and excited to have you on because we have never discussed this topic and I think it's the new thing that we should be talking about and we should be exploring.

So this is very exciting for us today.

Dr. Vickery: Well, thanks Caroline, for having us. This is a great opportunity and I'm excited that Dr. Proctor has agreed to join us.

Dr. Proctor: Yes, thank you so much for the invite to join. Thrilled to be with you.

Caroline: You're very welcome and we do appreciate your time. We know you're very busy and you've squeezed us into your busy schedules.

So before we dive in, please,

if each of you can share your backgrounds. And so we'll start with Dr. Vickery.

Dr. Vickery: So I'm a pediatric allergist by training. I see patients two days a week. I'm also the Division Chief of Allergy and Immunology and I run a food allergy research program here at Emory University and Children's Healthcare of Atlanta.

Caroline: And he's on our podcast quite a bit, which we're very happy about. And then how about you, Dr. Proctor?

Dr. Proctor: Great. Yes, I'm a pediatric psychologist by training, which for those who might be a little less familiar with pediatric psychology as a specialty, it's an area of clinical psychology focused on supporting kids and their families at this intersection of chronic or acute medical conditions and psychosocial well being.

So within my practice, I have worked with families with food allergy as well as feeding concerns consistent with avoidant restrictive food intake disorder, or arfid that we're going to talk a lot about today.

So I'm a psychologist in our multidisciplinary feeding program where we see kids with a wide range of levels of severity with ARFID concerns. And I also do research on this intersection of ARFID and food allergies.

Caroline: Now, let's just jump right in.

ARFID is a term many families may be hearing more often now.

Can you help us understand what avoidant restrictive food intake disorder really is and give us a bit of background on how it became recognized?

Dr. Proctor: Yeah, this is a great question. ARFID is,

you know, relatively new. I think at the popular level, we're starting to hear the term more often.

But it really represents a diagnosis that gets at the person's experience with eating.

So I'm going to contrast that to other eating disorders that we might be more familiar with, like anorexia nervosa or bulimia, where the fears or negative experiences around eating really relate to the outcomes of eating.

So within anorexia nervosa, for example, we're worried about weight gain or concerns about body image as a result of eating. ARFID is different from that. So ARFID really gets at this negative experience or feelings about the process of eating.

So it's a negative, hedonic or physiological experience of food and eating that has three neurobiological drivers based on what we currently understand.

So ARFID can come about, or a person can experience 1, 2, or 3, all of the following.

The first being low appetite or low interest in eating.

This is a kid who, if you didn't remind them to eat, would just forget. They don't think about it. They're not very interested in it.

They just don't present with a lot of desire for food or eating. Or maybe they have food that they like, but they wouldn't be classified as a kid who's really excited, loves their food, or can't wait to eat.

So that would be one driver. Another driver would be sensory sensitivity. So having a lot of a very strong perception around the different properties of food, like their smell or their texture or their flavor.

And then the third mechanism would be a fear or strong worries, panic, fear of a negative outcome associated with eating. So for some that could be things like worrying about vomiting or as it applies to allergies, could be fear of a reaction.

Right.

So a person can have one, two or three of these drivers that then create a highly restricted food intake that leads to one of four criteria.

So this, we have four clinical criteria which would be poor growth, failure to grow as expected, or significant weight loss,

nutrient deficiency,

formula or supplementation dependence and or psychosocial impairment. And really that psychosocial impairment piece that we're getting at is related to having these concerns about eating get in the way of being able to meet our needs in the day to day.

Caroline: Well, thank you so much for just helping us understand the basics. And just a quick question on that. What's the prevalence of ARFID right now, just in the general population?

Dr. Proctor: Yeah, another great question. So ARFID is estimated to affect about 6% of kids. So if you were looking at a classroom prevalence, that would be about one in every 30 kids might be estimated to have ARFID.

So it's estimated to be quite prevalent and something that I think a lot of kids and families are recognizing and struggling with,

it's quite a bit, it's really increasing in terms of the recognition of it. I think this is something that has probably been around for a long time and in the pediatric feeding space.

It's something that we've been treating for over 30 years, but now we have this unifying name for it, something that we can handle that we can grab on to recognize it.

The prevalence estimate increases significantly if we're talking about introducing either neurodiversity or chronic medical conditions.

Caroline: And so now I know we're focusing on pediatric, but so now when these children are growing up and they go into adulthood, what do they do? How do they get diagnosed or what is the next step for them?

Dr. Proctor: Yeah, this is a lifespan diagnosis, actually. So a lot of folks may have experienced food in this way for a very long time and not be identified until adulthood. Or there may be different psychosocial stressors that maybe a person's been able to string together enough that they aren't experiencing weight loss and they have a stressor and a big episode of weight loss.

But yes, this is a lifespan diagnosis that could be diagnosed at any point across at any age.

Caroline: So now, Brian, we're going to turn to you to connect the dots for us. So where do food allergies and ARFID begin to overlap. And then what should families understand about how these two can intersect?

Dr. Vickery: Well, so when we think about a patient diagnosed with food allergy,

a medically recommended avoidance diet is required as part of the management of the condition. And so to some extent,

vigilance around what you're feeding your child and what your child is willing to eat is part of living with food allergy and is an adaptive skill to learn that keeps you safe and healthy and keeps you away from the foods that could trigger a reaction.

But what we see and what we sometimes get concerned about is when that level of vigilance or self restriction extends beyond the medically recommended foods and into foods that would be considered allergen safe.

And so we see this in clinic all the time that we're recommending based on the outcomes of our careful testing and workup, sometimes, which requires food challenges to really clarify a diagnosis, but that we might recommend avoidance of, you know, 1, 2, 3, just a small number of foods.

Usually once somebody's had a good comprehensive workup, as we know in food allergy, they tend to be, across the population, one of a handful of food groups, milk, egg, wheat, soy, fish, shellfish, nuts, peanut, sesame, and so on.

So that the classic major food allergens. But what we often see is that children are avoiding a long list of foods that are generally considered allergen safe, that there's no really reason to suspect the child is allergic to, that they just simply don't consume.

And when this happens, this can really affect the family's daily functioning, well above the already impacted daily functioning based on the food allergy alone. Right. This makes it really hard to shop and travel and go to school and do all the things that are hard enough to do with food allergy.

And so it's this overly broad,

overgeneralized,

excessive self restriction,

especially as it pertains to foods that are not candidate food allergens. This is intuitive to understand. It makes sense that a child who's had a reaction is going to kind of close ranks and be careful about eating new things.

Those are generally going to tend to be behaviors that help keep them safe. But when this is pervasive, extensive really starts to affect daily functioning. And when you know, you can really think about the number of foods that a child child eats being a small number,

then you start to think about, is there something else going on here? And so Kate's work has shown that the rate of ARFID in the food allergy clinic is quite high, higher than that 6% number you heard across the general population.

And so we can sort of think about it from the standpoint of like, you know, feeding disorders are overrepresented in the allergy clinic. Or you could think about it like, allergies are overrepresented in the feeding clinic compared to what they would be in a general peds clinic.

Think about a Venn diagram with the two intersecting components in the midd of ARFID and food allergy. That really is Kait's area of interest and expertise.

That's what's led us to collaborate extensively, both in the clinical care of these patients and increasingly in research, because there's still a lot that we don't understand. I mean, I should also point out that this is important in the allergy context, especially for your listeners, but it can happen after a noxious experience that has nothing to do with allergies.

So I've learned that, for instance, if a child has like a near choking episode,

then they can have ARFID as a consequence of that. So an allergic reaction is one type of mechanism that can lead to this. But there are others as well when it relates to the noxious stimuli.

Caroline: And, you know, Kait, can we pick your brain just a little bit? What does it look like in real life? So for someone listening today and they're saying, okay, so my child has food allergies, but they just won't go near the berries and green beans.

And when we're traveling, they only want to stick to chicken nuggets. Like, can you give an example of just a real life situation?

Dr. Proctor: Yeah, absolutely. I think about this as a. I'm going to start with a metaphor that I used to think of this and then frame it into what it looks like in the day to day.

So I think about a car dial, volume dial in the car, you get in,

you turn on the radio.

Let's say it's a good time to listen to some music. It's a great day out. You roll on the windows, you turn on the volume.

When you get somewhere, you're ready to talk, you need to do something different. You can turn that volume back down. It's kind of within the drivers or passengers ability to change that when we start to get concerned about ARFID is a time when we feel like that volume dial isn't as sensitive or isn't working in the way that we need it to.

So,

for example, Brian made a great point about we need to be careful as part of food allergy management. We need to be attentive when we're in a new social setting or a restaurant, we need to be asking questions about their food preparation.

And if we're providing our kiddo with a new food, we need to be confident that the food has been prepared correctly and that it's safe. And once we've checked those boxes, then we can comfortably and confidently move forward with that meal.

The radio dial comes in when we've checked those boxes and we want to be able to turn the volume down,

but we're not able to yet. Our kiddo is still super distressed. They're not reassured.

We've done all the checkpoints. We know that this is safe or we know that this was prepared at home by us. We know that it's prepared correctly and safely and our child isn't responding to that reassurance that it is safe.

Or they're super, super distressed when we go around new food, regardless of their allergies, like regardless of knowing that those could be safely consumed.

So when we think about ARFID in the food allergy population, we're not talking here about a peanut allergic child who's avoiding all peanuts and tree nuts because their physician has advised that that's the right level of avoidance.

Caroline: Here.

Dr. Proctor: This is more akin to, or what we would more commonly see is a kiddo who really eats a very restricted range of foods that's more restricted than it needs to be.

So not only do we not eat peanuts and tree nuts, that's important, we can't do that because that's unsafe. But we also aren't eating sun butter because it looks like peanut butter.

We're not able to go to school confidently because kids around us might be eating things that make us feel afraid. So we've seen kids come into our clinic who are only eating a very small handful of foods,

who aren't eating outside the home. And if we are in a situation of traveling or needing to eat somewhere that the parent objectively feels like could be done safely,

there's anxiety, fear, meltdowns or just kind of that non participation. I'm not going to eat.

Caroline: I think you've described what so many of us experience and see, but now to see a name for this and this intersection, I mean, this could be very life changing. I think for our community to really start to recognize this and to dive into this.

Listeners, before we even came online, Brian and I were talking about. The nice thing is there are treatments for this, there are solutions. So please stay with us, listeners. Kate, we're gonna go even deeper with you to talk about the recent publication that you and Brian participated in called when medically required food avoidance goes a conceptual framework of ARFID as an under recognized clinical complication of food food allergy.

Okay, what sparked this work? And then what were you and your team hoping to better understand or uncover with this work?

Dr. Proctor: Yeah, so we've been alluding to this appreciation that we think ARFID is highly prevalent in the food allergy population. That estimation of one to 30 goes up to as many as one in three.

We believe kids potentially with food allergy suffering from.

From some. From ARFID or something akin to it or something related. Right.

And so with this paper, we really wanted to start to pull out why,

because if we understand the why,

we can better understand what to do about it and how to help. So Caroline, to your point, there are great treatments for ARFID working in the pediatric feeding world.

We've been doing this type of treatment for 30 plus years. But I think what we hope to bring to the food allergy space is an understanding, first of all, a recognition that ARFID is present and prevalent and then getting people connected with treatment, but probably recognizing as well that we need to make some tweaks or adaptations to current treatment to be optimized for kids with food allergies as well.

So with this paper we wanted to put forth a framework that said, you know, here's how we understand arfid, here's how we understand food allergy. And we think there are three potentially unique aspects of food allergy management that really would account for or drive the relationship between allergy and ARFID

One of those being the specifics of allergic reactions and medical treatment, that need for strict avoidance, that need for vigilance,

the ability to be prepared and respond to a reaction in real time.

We think there are probably impacts of chronic vigilance and avoidance on a child's approach to eating and parents mealtime leadership, mealtime management,

you know, needing to monitor food processing practices. There's that common moniker, every label, every time,

monitoring for symptoms, continuously avoiding unlabeled foods, having just this persistent chronic vigilance. And then finally how a person responds to the learning that happens and the physiological process of having allergies and having an allergic reaction.

It's a high burden on kids and their parents to have a real time interpretation of the interoceptive cues that we think about associated with a reaction versus a related internal, potentially feeling like anxiety.

So if we're getting butterflies in our tummy, does that signal impending reaction? Or does that signal I'm nervous because I'm trying something new so having to make that decision in real time can be very challenging.

Having that noxious experience like Brian labeled, I had a reaction and it was uncomfortable or it was scary. I'm afraid to have that again. What if that happens? And really just ultimately the setup of food as threat and so that these are the three unique aspects of allergy that we've proposed increased risk for ARFID and we hope will really spark conversation within the kind of research and clinical spaces to better describe this and then again more sensitively

inform treatment.

Dr. Vickery: I was going to jump in there. I mean, if I could just add to that. I mean, I think that I agree with what Kait said.

From my standpoint as an allergist,

there's a big need to spread awareness still. There are many people in everyday allergy world who have not yet heard the term or don't yet quite understand. But even among those that have, number one, spread awareness, number two is recognize that there's a lot of work that needs to be done still.

Right. Fortunately,

you know, we don't really have a lot of ARFID patients in food allergy that meet the growth failure requirements. There are, you know, nutritional impacts related to food allergy. But in general,

most kids consume enough calories to grow. You have very few that are actually tube fed. I'll occasionally meet one who has that sort of anhedonic, just don't really care about eating.

Could take it or leave it and gyna would forget if unless you reminded me. We occasionally see that, but for the most part a lot of the ARFID that we see in the allergy clinic is that fourth component of psychosocial impact.

And so really trying to understand where is this arfid, where is this anxiety,

where is this just part and parcel of everyday food allergy? How could we distinguish between them reliably?

What are the mechanisms at play here? So some of this is also just a call to action, to research because there might be listeners who are hearing this and thinking like I'm confused, like I thought this was food allergy, I thought that was anxiety when my child did that.

So I just, I think that that psychosocial component or the psychosocial impact, that fourth criterion is beyond what would be expected by the underlying medical condition. Right. And so Kate's doing a lot of work with others to try to really understand how we distinguish between these conditions.

And that's an area that, you know, needs a lot of further development. It's interesting, there's actually some preclinical or basic work that's being done right now in animals because you can actually see behavioral changes in animals when they're exposed to allergen.

And so there's. There's a lot of work that needs to be done,

you know, to sort of really kind of flesh out,

like, how is this actually working? What we're doing right now is just sort of observing it and calling it out that it is happening. And I think by spreading awareness and putting a name to it, my hope is that that will help people a little bit with their distress.

To be like, ah, okay, this seems like it's more than I expected.

Maybe that's because there's something else. Maybe I need to talk to my doctor or, you know, somebody else about this.

Caroline: When we first started the conversation, my mind just started blowing,

thinking of how many people I know that can fall into this category and even within my own family.

So then how does food allergy PTSD play into this? And I don't even know if food allergy PTSD is a proper term, but, you know, I've heard it being used around.

So then is ARFID an element of it, or is it truly maybe ARFID?

Dr. Proctor: This is where the nuance really comes in. I think when we think about ptsd, we're thinking about an identified event,

right? That create ongoing distress. And that distress can come back to a person at times when they don't want it to. It can be hard not to think about it.

You can have kind of intrusive thought,

physiological upregulation or that, like jittery, that kind of hairpin trigger for that anxiety response.

You know, I think when it might cross over into ARFID is when that distress changes from thinking about the event that happened, thinking about the reaction, symptoms, and what that feels like into restricting our food intake.

So the question that I usually ask on that differential is in the presence of anxiety or trauma, if where that is present, is there also restricted eating? So you can have distress without the restricted eating?

And those are some of the ways we start to tease this apart.

You know, I would also ask typically about, are there anxiety or behaviors that we're engaging in to reduce anxiety that are outside of eating? So is it. This is, I think, where it gets murky.

But do we worry about going social events in general,

do we worry about being in physical proximity to our allergen, but not the process of ingesting it? So this is where we get into the fine tooth comb area here of trying to parse these apart.

And ultimately all of these things have good treatments. So if you're working with your doctor, your child's doctor, if you,

and get connected with a pediatric psychologist who can help to maybe navigate some of these nuances,

I think that can be really helpful because there are lots of different interventions. They often go hand in hand or are complementary.

There can be help in all of those, all of these ways. It's just really getting a good understanding of the layers of what we're working towards.

Caroline: From my position, it just feels so hopeful when both of you are saying there are solutions, there are ways. We just have to suss it out and really nail it. And it really starts, starts with the allergist, right?

It really starts with our physician.

Now let's put on our protective hats for just a moment. And if a parent or listener is hearing this and thinking this might be us,

what should they do next? What steps can they take to get the right support if they suspect ARFID and their child or even themselves as an adult, or if an adult's listening?

And so, Brian, we'll start with you from your perspective as the allergist.

So it's very nice to have the two perspectives here and it's really fascinating and inspiring to see how you two are collaborating and bringing these worlds together.

So Brian, what would you suggest?

Dr. Vickery: Well, I think you're right in that, you know, some of this is going to start with the allergist, although, because it's unlikely that somebody's going to necessarily present to the trained pediatric psychologist that knows how to manage or refer from the get go, it's likely that they're going to bring these concerns up to their pediatrician who notices,

who takes a dietary history or an allergist first. And although the concept of ARFID and its impact and relationship to food allergy is starting to kind of permeate,

it's possible that interested listener may have to actually educate their allergist a little bit about this because it's very likely that some allergists have still not heard about this. So I think, unfortunately, advocacy is still a big part of what parents have to do.

It adds to their burden, like that's part of managing a kid with food allergy and that that may be the case here. I would invite them to kind of review the things that you'll have in the show notes and connect with others.

There's always obviously peer support and others as they find resources that may be helpful. But ultimately, at the end of the day, what you need is a referral to a pediatric psychologist or dietitian or,

you know, some other allied health professional. And I'll. I'll let Kate flesh this out even more. Who is trained in this and who can manage that? I mean, I do think that at the end of the day,

there is reason to be optimistic. There are solutions that are available. I think that compared to maybe some other populations that are affected by arfid, you know, the feedback I get from our team is that patients with food allergies respond quite well to treatment and usually,

you know, have the opportunity to really improve.

But that's when you're already in the hands of a skilled team. And access to this kind of care is hard to come by, I'm sure, for many patients. Right. Like, not everybody knows exactly what to do with this situation.

You know, we were talking before the show started, like, I came from a major medical center before I got to Atlanta, and the feeding program was very small and that other institution and really not focused on this kind of problem.

So we have probably one of the bigger places that have both food allergy clinical care, food allergy research, and,

you know, a multidisciplinary feeding program and recognize that not everybody has those kinds of resources. Part of what we also need to do, we, meaning Kate and I and others in the allergy world, is to do what we can to train people and promote access to this care.

There's not enough to meet the need as it currently is.

Caroline: Thank you. And Kait let's get your weigh in now.

Dr. Proctor: Yeah. I think Brian hit on a lot of the big points there in terms of communication and access.

Sometimes in the ARFID space, we talk about looking beyond the growth chart. So I think relating to advocacy,

parents have a really good pulse on how their kids are doing. And so we hear from a lot of families that I've expressed concerns about my child's restricted intake, and I'm told they're growing fine.

Just keep going. But if you suspect there's more there, more, more to this challenge, I would encourage parents to continue talking to their allergist, to their pediatrician to engage or get referral to a dietitian or a psychologist in the community.

If you're looking for a psychologist or counselor, you can look on platforms like Psychology Today. And really what I would recommend looking for is a psychologist or counselor who's trained in evidence based treatments like cognitive behavioral therapy, behavioral parent training for younger kids,

and pediatric psychology, because those folks are at least going to be a good starting point for supporting families and some of these listeners and some of these challenges. And then at the higher level, if we find that we need more multidisciplinary support,

multidisciplinary feeding programs like the one here at Children's Healthcare of Atlanta would have all of those specialists at the same table talking to one another about child's care. So you can look for multidisciplinary eating or eating disorder programs for higher level of support.

Caroline: Thank you. It was really good information.

And honestly, this conversation is amazing and just what our community needs.

I mean, this is a new conversation that I think is going to continue to get bigger and bigger and bigger.

So before we say goodbye today,

do each of you have one last thing you want to make sure our listeners are hearing from you? And so we can start with Brian, what is that one last parting word you want to leave with everybody?

Dr. Vickery: Well, I think we covered a lot of really important points and thanks for having us on, Caroline, because I think this is an important discussion and we have lots left to learn about it, which I sort of talked about.

I would just say that, look, when is your kid just sort of a picky eater and when are they experiencing normal food allergy and when might this be a concern?

I mean, I think one of the kind of rules of thumb that Dr. Proctor and Dr. Sharp taught me early on was if it's reasonably easy for you to count the number of foods that your child eats and that really affects your daily functioning every day, you know, you might want to look into that a little bit further.

And the other thing I also would say is it really depends on the child's development and, you know, other things that might be going on. So for example,

you know, if your child has autism, that's a separate issue. Right. If you're, we know that orphan is more common in kids that have autism. If your child is a toddler, incident food allergy presents often 6, 8, 9, 12 months of age.

Right.

So 2 year olds, it's developmentally normal for 2 year olds to drop foods that they were eating, you know, last week or to really,

you know, back to that sort of chicken nugget. Thing is chicken nuggets are safe. It's like chicken nuggets every day because they're 2 years old. Like that's normal. That's not arfid yet.

You know, when you've got a school aged child or a teenager where their diet's really restricted so that it's almost easy for you to just count the number of things that they will eat and that's really affecting their ability to travel, go to school, you know, have a productive daily life.

Those are kind of rules of thumb where you might want to look into it more.

Caroline: Thank you. And how about you, Kait?

Dr. Proctor: I think in addition to the points that Brian just raised, I'm going to flip it a little here and encourage families and listeners. If there is psychology support available,

please feel free to avail yourselves of it. So I think we are trying to increase the provider availability, the, the access to psychologists in the food allergy community. When we're talking about ARFID today, we're really talking about kind of the tail ends of that normal distribution.

But pediatric psychologists or embedded mental health professionals can support families across their journey in food allergy. And so if you're thinking about things like an upcoming oral food challenge, for example, as an ARFID provider, we talk about food challenges all the time because those require a child to ingest,

to actually eat the thing that maybe they've been avoiding for allergy reasons and now also might have some, some feelings about eating that new food from an ARFID perspective or from a sensory or kind of taste perspective.

I think I would just make the plug for there doesn't have to be a capital B problem for us to be able to work together and support a child all along their food allergy journey, or a parent or a teen or a young adult.

So definitely I would encourage folks to reach out where that is available because there are a lot of different areas that a psychologist can support in addition to ARFID.

Caroline: Well, thank you both for your time. This has been such a critical conversation and I do look forward to having more because I have a feeling this is the tip of the iceberg and we're going to start to see more research and more information and a lot more questions.

So thank you both very, very much for giving us the time today and spending it with our listeners.

Dr. Proctor and Dr. Vickery: Well, thanks for having us on, Caroline.

Caroline: You're welcome.

Before we say goodbye today, I just want to take one more moment to say thank you to Genentech for their kind sponsorship of FAACT's Roundtable podcast.

Also, I want to note that today's guest was not paid by or sponsored by Genentech to participate in this specific podcast.

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