Avoidant Restrictive Food Intake Disorder (ARFID) Simple Suggestions Series – Strategies for planning and managing a holiday away from home

Produced in collaboration with:

• Bedfordshire and Luton Mental Health and Wellbeing Services provided by East London NHS Foundation Trust
• InsightEating and InsightHealth
• North East and North Cumbria Mental Health, Learning Disability and Autism Partnership

1. For most people, going on holiday feels like a relaxing treat. For a person with ARFID it can feel overwhelming, full of uncertainty and anxiety. If you/your child takes nutritional supplements it is advisable that you take these with you. Include any necessary medical notes for travel. If possible, also pack safe foods and snacks to take with you. If suitcase space is tight, you may need to take an extra case with you. Consider also taking safe plates/ cutlery/ drinking containers. This can make a big difference to food and fluid intake.
   
   These steps can feel like an unnecessary and unwelcome expense or sacrifice to those of us who don’t have ARFID. But for those who do and their families, it could be the key to enjoying a holiday away from home.
2. It can seem logical to assume that if you don’t take safe foods with you, then you/your child will eat the local variety. We assume this will happen because there are no other options. With ARFID this is not the case and is likely to lead to a deterioration in mental health and wellbeing. Any restriction of food and fluid may also require medical attention away from home. It is therefore strongly recommended that you do not try this strategy.
3. Think about your journey and have a plan of what to eat and when, whether this is a car journey, a boat, train or plane. If you are flying, consider what you can take with you through an airport. Think about whether you need a medical note or need to contact your airline. This may be necessary to take foods or fluids through with you. Jetlag or time-zone differences can pose a problem. If this is likely and you or your child eats at very fixed and specific times, think about how best you will manage this. Keeping to your/their usual food routine whilst away can reduce anxiety. Even if this doesn’t fit with the local timescales for meals, it could be helpful to stick to your/their routine.
   
   Your journey should also include preparation of what to expect. For example, thinking through all the steps involved in an airport and flight. this would include understanding unpredictable events like traffic and turbulence. Where possible, use visual aids (like images of the airport) to help. It may also be helpful for your journey to include items which help you to manage in new environments. For example, using headphones, screen devices or games, or using fidget toys.
4. It is important to remember that even small taste changes can mean that a usual food or fluid is not accepted. Therefore, consider working towards planning these in advance. For example, can bottled water be tolerated instead of tap? Could cordial be used to keep the flavour the same? Could UHT milk be a goal that is worked towards instead of fresh milk? It may be appropriate for you to practice some local cuisine before you go.
5. Think about the safest and easiest foods that can be managed. These should be ones which have as little variation as possible. This can mean that for one or two weeks it will be ok if the same few foods are eaten across all meals and snacks. This is something we call ‘minimally safe’. However, make sure there is a plan to come out of this very restrictive pattern again once you return home.
   
   Try to change how your think. Safe food could be seen as something you feel defeated or disappointed by. Instead, consider safe food as fuel that allows you to enjoy the holiday.
6. Plan ahead. If possible, discuss your needs with your hotel or any restaurants you plan to visit. This could mean asking to reserve a quieter or less public table. Or it could mean requesting permission to bring your own food to a restaurant. You may be able to try similar foods at home prior to going or gain an understanding of the hotel/restaurant menu. This can help you to plan what you will eat and when (including dates and times), in advance.
7. Discussing your/your child’s ARFID needs can be a difficult experience. Where possible, writing these needs down so that you have something you can give to those who ask can be helpful. It may be helpful to try and source this in the language of your destination if this is different.
8. Whilst you should not assume that it will be possible to eat local foods, it can be a good opportunity for variety. Holidays can feel more relaxed and are outside the usual environment. In novel environments some people do better with eating. However, this only works if the pressure is low and safe foods remain available.
   
   Create opportunities to partake in other foods or social food experiences. During these, keep pressure and expectations low and allow yourself/them to go at your/their own pace. Choosing to stick to the safe foods isn’t a failure. Just being around new foods and experiences is a positive challenge.
9. Sometimes, despite all your planning and preparation efforts, something can still go ‘wrong’. This often causes lots of emotion or distress. When this happens, having a toolkit of basic strategies to reduce arousal can be helpful. These will be different for each person. Try to think about what sensory input/strategies relaxes you and work with this. Some examples might include dimming the lights or finding a quiet space. It could mean using tactile objects like fidget toys. Engaging in kinetic movement is helpful for some. This includes going for a walk or moving your arms/legs in a way which aids relaxation (known as stimming). Abdominal breathing and using strong/grounding smells (like essential oils) can also help.
10. As a person with ARFID or a carer for a person with ARFID, try to adjust your expectations of what a holiday ‘should be’. Reasonable adjustments to support the needs of someone with ARFID still makes for an enjoyable holiday for all.

If helpful, ARFID awareness cards in English (which explain the difficulties of ARFID to settings such as restaurants) can be found from their shop at: www.ARFIDawarenessuk.co.uk

C.Ellison, RD, P.Falcoski RD and U.Philpot (February 2024)