As parents, one of our constant daily tasks is feeding our kids. This is challenging enough on its own, but it can be extra difficult and complex for children struggling with an eating disorder known as avoidant restrictive food intake disorder, or ARFID. Picky eating is a common theme in childhood, but when that picky eating becomes progressively more and more restrictive, it’s cause for concern. ARFID can occur at any age, but ARFID in kids is particularly common. According to one recent study, ARFID can affect up to 3.2% of kids ages eight to 13 years old.

ARFID is different from other eating disorders like anorexia nervosa or bulimia nervosa, in that the restrictive eating behaviors don’t stem from body image distress or a desire to lose weight. Children with ARFID eat a very limited amount of food and/or very limited types of foods, due to sensory issues, a lack of interest in eating, or a fear of something bad happening when they eat (like vomiting or choking). Kids with ARFID usually have a very short list of foods they will eat, and this can have serious physical consequences, leading to malnutrition and impairing development and growth.

Signs and symptoms of ARFID in kids

How do you know if your kid might be dealing with ARFID? Warning signs can include:

• Limited food variety. Your child might stick to a very small list of foods they’re comfortable with. This list often gets progressively shorter. To them, foods on this list are “safe” foods.
• Sensory sensitivity. Some kids with ARFID eat a very limited variety of food because they are particularly sensitive to textures, tastes, or smells. This might look like avoiding anything too mushy or too crunchy, foods that have a strong smell, or foods that aren’t the right brand.
• Fear of an adverse event. Your child could avoid eating due to a fear that something bad will happen if they do, like choking, vomiting, or becoming ill. This is often related to a past traumatic incident involving food, and can lead them to avoid specific foods as well as food in general.
• Lack of interest in eating. Some children with ARFID have a hard time eating simply out of a lack of interest. Eating doesn’t seem appealing to them and therefore it’s difficult for them to eat enough.

Risks of untreated ARFID in kids

ARFID isn’t just about being a picky eater. It’s a serious eating disorder that comes with serious long-term and short-term consequences for kids’ physical and mental health. Some of the issues ARFID can cause include:

• Nutritional deficiencies. By limiting their diet, your child may not be getting all the nutrients they need. This can lead to deficiencies that can impact their growth and health, as well as cognitive function.
• Weight loss or lack of expected growth. Limited eating can lead to weight loss or decreased growth, which can also have a negative impact on children’s physical development. Losing too much weight can lead to many other health side effects, like fatigue or a weakened immune system.
• Social isolation. ARFID can make social situations tricky for both kids and their family members. ARFID can cause your child to experience anxiety, and make them want to avoid gatherings that involve food. Going to parties or restaurants or eating meals with friends becomes impossible, leading to social isolation.
• Impaired cognitive function. Poor nutrition can hinder your child’s cognitive function, having a negative impact on their ability to concentrate and learn.
• Emotional distress. ARFID can take a toll on your child emotionally. Their ARFID may go hand in hand with anxiety, depression, or other mental health concerns, all of which can be addressed alongside ARFID.

What can cause ARFID in kids?

Like all eating disorders, ARFID doesn’t usually have one single cause. It can result from a mix of genetic, environmental, and psychological factors. Here are some possible contributors:

• Sensory sensitivities. Some kids are particularly sensitive to textures or smells. This can influence what they’re willing to eat.
• Traumatic events. Having a bad experience with food, like choking or food poisoning, can play a role in the development of ARFID in kids.
• Autism spectrum disorders. ARFID is common in kids who are on the autistic spectrum: up to 23% of people with autism also have a diagnosis of ARFID.

How is ARFID in kids diagnosed?

Drawing the line between developmentally normal picky eating and ARFID can be tricky. But by consulting with a team of eating disorder-informed providers, you’ll be able to get an accurate assessment for your child. The process of diagnosing ARFID in kids often goes as follows:

• Medical evaluation. Your pediatrician will check for any underlying health issues that may be causing your child to have eating difficulties.
• Psychological assessment. A mental health professional will assess your child’s mental health to understand whether or not they’re dealing with anxiety, trauma, or other factors that can have an impact on their eating.
• Nutritional evaluation. A dietitian can take an expert look at your child’s nutritional intake. This can help them determine any deficiencies and their potential impact on your child’s health.
• Parental input. As the parent, you’ll also play a vital role by providing the information about your child’s eating habits, behaviors, and possible triggers.

ARFID can often be misdiagnosed or undiagnosed. It might be dismissed as mere picky eating, either by providers or by loved ones. It might also be mistaken for other eating disorders, like anorexia nervosa, due to a lack of awareness among health care professionals. Improved awareness, specialized training, and the development of targeted screening tools can help improve early identification and intervention in affected children. Our team are all well-versed in diagnosing and treating ARFID, and you can schedule a free assessment if you’re concerned about your child.

How is ARFID in kids treated?

Just like the diagnosis process, treating ARFID in kids is a team effort. Research shows that eating disorders are best treated through a multidisciplinary approach, so it’s important to support your child with a team that can help to address the physical, psychological, and nutritional aspects of the disorder on their road to recovery.

Some aspects of ARFID treatment for kids include:

• Nutritional rehabilitation. Your child’s dietitian can help gradually broaden their food choices. They can help fill any nutrition gaps with supplements if needed.
• Exposure and response prevention (ERP). This form of exposure therapy is an effective and safe way to help your child expand the variety of food they’ll eat and face and conquer their fears about certain foods.
• Family-based treatment (FBT). FBT involves the whole family and can be a game changer by helping to create a supportive environment in which to try new foods. It also helps to deal with any family dynamics that may be tied to your child’s ARFID. FBT-AR is a specific form of FBT designed particularly for ARFID.
• Sensory integration therapy. If your child has sensory issues, this approach focuses on sensory integration to help ease their aversions.

ARFID is a serious but treatable eating disorder. With the right expertise and resources alongside your love and support, your child can conquer these challenges and build a healthier relationship with food that allows for the full, joyful life they deserve.

At Equip, our personalized and empathetic approach gives your child the tailored support they need. Our virtual, evidence-based treatment model ensures that your family has the tools you need to navigate and overcome this challenging journey. Every step of the way, you and your child will be supported by a multidisciplinary team that provides collaborative and comprehensive treatment.

Get in touch with our team today for more information or to schedule a consultation.