Many parents struggle to feed picky eaters and worry their kids aren’t getting their nutritional needs met with only a small selection of their favorite foods. But some children’s aversion to eating is not a typical part of growing up – and could be a sign of avoidant/restrictive food intake disorder (ARFID), a type of eating disorder that can affect young children.
“Picky eating and ARFID are not the same thing,” says clinical psychologist Kim Anderson, PhD, the executive director at Pathlight Mood & Anxiety Center. “Fussy eating is a very normal thing for children to experience. They only like certain colors of food or want their foods in certain shapes. They’ll eat a certain food every day for a week and then refuse to eat it again.” ARFID, on the other hand, is much more serious. It is “not a stage or a normal part of development. It’s not even ‘extreme picky eating.’ It’s a diagnosable and treatable eating disorder,” Dr. Anderson explains.
Below, learn more about the details of ARFID, including causes, symptoms, and treatment options. Knowing how to spot the signs can be particularly helpful in getting your child the care they need.
What Is ARFID?
“ARFID is an eating disorder characterized by a pattern of eating that is limited in volume and variety,” says Dr. Anderson. “For patients with ARFID, the avoidance of certain foods and restriction of the amount of food they eat is associated with serious medical, nutritional, and psychosocial consequences.”
However, unlike other eating disorders, ARFID has more to do with aversion to food, sensory sensitivities, or a negative experience with food (such as choking, vomiting, or an allergic reaction) than wanting to lose weight or obsessing over thinness or body image, says Dr. Anderson.
Anyone can develop ARFID at any time in their life. However, very little is known about ARFID in adults and there are no estimates as to how common this condition is in older patients.
In children, while estimates of prevalence vary, a 2015 study in the journal European Child & Adolescent Psychiatry screened 1,444 children aged 8 to 13 in Switzerland and found that 3.2 percent “reported features of ARFID in the self-rating” screening. A study published in the European Eating Disorders Review in December 2022 noted, “Psychiatric comorbidity [with ARFID] was common, especially anxiety disorders . . . and autism spectrum disorder.
With ARFID, it’s important to know that symptoms usually start younger than in eating disorders like bulimia or anorexia, says Dr. Anderson. And the risk of developing ARFID as a child is higher if by 6 years of age a child does not grow out of the “picky eating” phase and continues to eat only from a small range of foods, she adds.
What Are ARFID Symptoms?
Dr. Anderson notes that the symptoms of ARFID usually include:
- Restrictive eating
- Lack of interest in food
- Avoiding foods due to texture or consistency
- Refusing to try new foods
- Requiring food to be prepared a specific way
- Feeling afraid to eat due to fear of a possible allergic reactions, choking, or vomiting
- Very low bodyweight or malnutrition
How Is ARFID Different From Picky Eating?
Picky eating is something kids grow out of and does not typically put children at serious risk for malnutrition or low bodyweight. Meanwhile, ARFID is not a typical part of development and can result in “a variety of emotional, behavioral, and cognitive problems such as low mood, irritability, anxiety, reduced concentration, cognitive inflexibility, and social isolation,” says Dr. Anderson.
Additionally, restrictive eating can lead to interpersonal difficulties for people with ARFID. Some people develop anxiety and fear in regards to social eating, as “they often express concerns about being embarrassed, unable to eat what is offered, and faced with uncomfortable questions about their eating,” Dr. Anderson says. “As a result, social eating situations are often avoided.”
This can lead to isolation and loneliness and can even interfere with social development, causing both children and adults to miss out on important experiences.
What to Do If You Suspect Your Child Has ARFID
If your child or loved one is displaying signs or symptoms of ARFID and you feel concerned about their well-being, it’s important to know there are resources to support you and your family.
“Your first step is to find a qualified professional who can assess your child’s behavior,” says Dr. Anderson. Your primary care doctor will be able to refer you to a specialist like a psychologist, dietitian, or eating-disorder-focused physician or therapist. From there, your doctors will help create “an individualized treatment plan that will meet the unique needs your child has when it comes to their physical, emotional, and mental well-being,” Dr. Anderson says.
What Are ARFID Treatment Options?
According to the Child Mind Institute, treatment depends on the individual’s needs – especially because ARFID is a relatively new diagnosis with limited research available on treatment.
For underweight or malnourished kids, regaining weight and maintaining a healthy body will likely be of great importance, reports Child Mind Institute, but addressing sensory issues, possible fears of choking, and anxiety through cognitive therapy methods are equally important to make sure the child can learn to cope with their symptoms.
