Evaluating Mirtazapine and Citalopram Prescription for a Child with ARFID
Is it typical for a pediatric gastroenterologist and psychiatrist to prescribe mirtazapine and citalopram, albeit separately, for a 10-year-old boy diagnosed with Avoidant/Restrictive Food Intake Disorder (ARFID) who maintains a healthy body weight? After conducting some investigation, we've found that these medications are primarily administered to adults and are not generally the first-line treatment options for children. At present, our son is enrolled in an intensive outpatient feeding program at a hospital, where the physicians initially suggested mirtazapine. However, we felt uneasy about him starting this medication, leading to the recommendation of citalopram next, with both being dosed at 20 mg. We firmly believe that therapeutic intervention is the most essential focus, and all efforts should be directed towards that. To date, we have not administered any medication to him. To give you a better understanding of his situation, he has a limited selection of foods he considers safe, which includes cheese pizza, toast with Philadelphia cream cheese, original-flavored Goldfish crackers, simple desserts, grilled cheese sandwiches, vanilla yogurt, and cheese strings. His primary meal consists of a blended combination of vegetables, chicken, and rice, which he refuses to eat unless it's pureed. He will not feed himself this meal and must be assisted by someone else. He shows resistance to trying new foods and becomes very upset, often crying, when presented with anything unfamiliar. For instance, if a yogurt flavor other than vanilla is offered, he will react with distress. We aspire to make informed decisions regarding his treatment and would greatly appreciate any insights or advice on this matter.
Answers (1)
8/26/2025, 4:55:26 AM
OpenHealth AI
It's understandable to be concerned about the medications suggested for your son with Avoidant/Restrictive Food Intake Disorder (ARFID). The use of mirtazapine and citalopram in children can raise questions, especially since these medications are more commonly prescribed to adults.
Overview of ARFID Treatment
ARFID is often addressed through behavioral therapies and supportive interventions rather than medications. The primary goal should be to reduce anxiety around food and improve dietary variety and intake.
Understanding the Medications
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Mirtazapine: This medication can sometimes help with appetite and anxiety. However, it is typically considered when other treatments have been ineffective, particularly for anxiety or depressive symptoms that impact eating behavior.
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Citalopram: This selective serotonin reuptake inhibitor (SSRI) is used to treat anxiety and depression. While it may help with anxiety symptoms related to ARFID, its use in children is not as established, and careful monitoring is essential.
Next Steps for Your Situation
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Focus on Therapy: Ensure that the intensive outpatient feeding program is your first line of intervention. Behavioral approaches, such as exposure therapy or cognitive-behavioral therapy (CBT), can be effective in addressing the anxieties associated with ARFID.
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Communication with Providers: Discuss your concerns openly with the gastroenterologist and psychiatrist involved in your son's treatment. Ask about the reasoning behind prescribing these medications, what their expectations are, and the plan for monitoring and adjusting treatment.
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Consider Second Opinions: If you feel uneasy about the medication approach, seeking a second opinion from a child psychologist or a specialist in pediatric nutrition may provide more insights into non-pharmacological treatment options.
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Track Dietary Changes: Keep a food diary to note your son’s reactions to various foods and any changes in his willingness to try new foods. This can help inform your treatment team and track progress.
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Give Yourself Time: You’re already on the right path by prioritizing therapeutic interventions. Monitor how his engagement with the feeding program evolves, and be open to adjusting strategies as needed.
By focusing on therapy and maintaining open communication with your healthcare team, you’re laying a solid foundation for your son’s progress. It's okay to take time to explore the best treatment options that align with your family's values and his individual needs. Let me know if you would like further details or have any more questions!
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