No one tells you how much of parenting will revolve around feeding your kids. Providing three meals a day plus snacks is a big ask under normal circumstances, but for parents whose children are struggling with ARFID, it can be particularly daunting. You might be wondering, what is ARFID? Read on to learn about this relatively new eating disorder diagnosis, how to identify ARFID in children and teens, and more.

ARFID vs. picky eating

Eating seems like it should be such an intuitive thing—until it isn’t. If you have a child who doesn’t like to eat, then you know how quickly feeding concerns can overwhelm your life. And while some picky eating is developmentally appropriate and goes away on its own, for some, it's a sign of a full-blown eating disorder known as Avoidant Restrictive Food Intake Disorder (ARFID). Unfortunately, many families with “finicky” or “picky” eaters spend years of their lives trying to investigate, cope with, and resolve their child’s struggles with food without getting a proper diagnosis.

Historically, young children who struggled with extreme picky eating had been labeled as having a feeding disorder and were treated primarily by pediatric feeding experts, occupational therapists, or speech and language pathologists. However, older children, teens, and adults with similar eating problems struggled to be diagnosed and receive treatment.

Then in 2013, the diagnosis ARFID was introduced into the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-V). ARFID is defined as a disturbance in eating or feeding behaviors that's not accompanied by the fear of weight gain or body dysmorphia that accompanies other eating disorders. In layman's terms, this means eating very little and a very small variety of food without any body image issues or desire to lose weight. The diagnosis captures a wide variety of feeding and eating challenges related to limiting food intake, and is not limited to children.

Understanding symptoms of ARFID in children

So how do you know if someone’s picky eating is “normal” or if it's a medical or mental health problem? After all, when it comes to food, all of us have some strong preferences: flavors, temperatures, level of spice, etc. It is also common for toddlers to go through a developmental period where their range of preferred foods narrows for a while and they may eat less as a consequence. Many people may also temporarily change their eating habits following an illness or an incident of choking, and there are medical conditions and allergies that can cause us to make changes to our diet and become more cautious about our food intake.

It can be tough to tell when these behaviors tip from being "normal" to signs of an eating disorder, but a general rule is that if someone's eating habits start to affect their physical or mental health, they may be dealing with something serious. Some more specific ARFID symptoms to look out for include:

• A general lack of interest in food and eating
• Being repulsed by specific aspects of foods (texture, smell, etc) and avoiding specific food groups
• A small list of "acceptable" foods that grows smaller over time
• Fear of something bad happening when they eat (vomiting, choking, allergic reaction)
• Rigid habits or rituals around eating (for instance, eating in a certain order, foods being a certain distance from one another, etc)
• Impaired social functioning
• Anxiety around mealtimes
• Eating very slowly
• Low weight or weight loss, or, for growing kids, faltering growth
• Nutritional deficiencies
• Delayed puberty
• Dizziness/lightheadedness

In general, if intense food preferences, loss of appetite, aversions, or fears start to interfere with a person's ability to live life fully, that means it’s time to get help.

The three subtypes of ARFID

ARFID is generally understood as having three main types, known to professionals as ARFID “presentations,” and many patients experience symptoms or behaviors of more than one presentation. These subtypes are:

• Low interest in food and low appetite. Many individuals with ARFID may have struggled with feeding from birth, sometimes being designated as having a “failure to thrive” by their pediatrician. They may lack hunger cues, get full easily, and tend to avoid eating. Sometimes this low appetite stems from another medical condition or from a medication; for instance, having ADHD can make it hard to stay in tune with hunger cues, and stimulant medications to treat ADHD can blunt appetite.
• Selective eating due to sensory sensitivity. You may have heard the phrase "selective eating disorder"; that phrase refers to this ARFID presentation. Here, selective eating is driven by intense aversions to or strong preferences for certain textures, colors, smells, and tastes. This high level of sensitivity is common among individuals who are on the autism spectrum but can also be present in those who are not. These individuals will have a very limited number of foods they feel safe eating. Often, pre-packaged foods from a specific brand or items from a particular fast food restaurant are the only acceptable foods, as they are consistent, predictable, and easy to eat.
• Avoiding foods because of a specific feared outcome. Common food-related phobias include fears of vomiting, choking, allergic reaction, illness, or pain. Symptoms of this presentation may suddenly appear after a traumatic eating-related incident, or the fear may grow slowly over time after experiencing multiple upsetting events. This presentation is most often associated with a sudden and significant drop in weight that may lead to hospitalization.

Finding treatment for ARFID in children

If your loved one has ARFID symptoms, your family may have been struggling with feeding challenges for a while. You may have been given the common advice to “ignore it” or told it’s a phase your child will grow out of, or you may have even been blamed or shamed for the way you or your child eats. It's important to understand that ARFID is not your fault, nor is it your child's fault. Eating disorders are not a choice, and parents do not cause eating disorders.

The good news is that ARFID is treatable. If your loved one is exhibiting any of the warning signs of ARFID, you deserve the right support. With Family-Based Treatment (FBT) and cognitive behavioral therapy (CBT), recovery can happen at home. It's important to seek help promptly, as these problems get worse—not better—when ignored. Talk with your medical provider or schedule a consultation with our team to discuss your concerns and possible next steps.

Getting an evaluation and a treatment plan is the first step in healing a fraught relationship with food and helping your whole family find more peace and connection—during meals and beyond the dinner table.