Almost every kid goes through a picky eating phase at least once in their childhood. But when a child's range of acceptable foods becomes very narrow—to the point where they’ll only eat one brand of chicken nuggets and only if Dad makes it—and this persists for some time, it may be more than picky eating.

Avoidant/restrictive food intake disorder (ARFID) can seem like an extreme form of picky eating, but it’s actually a serious eating disorder that can have significant negative consequences. Luckily, evidence-based treatment can effectively address the different forms of ARFID and prevent any negative consequences for your kid’s mental and physical health. Here’s what parents of picky eaters need to know.

What is ARFID?

Avoidant/restrictive food intake disorder is defined as a disturbance in eating or feeding behaviors that's not driven by the fear of weight gain or body dysmorphia that accompanies other eating disorders.

In layman's terms, this means people with ARFID eat very little and a very small variety of food, but it’s not due to any body image issues or a desire to lose weight. The diagnosis captures a wide variety of feeding and eating challenges related to limiting food intake, and while it’s most commonly seen in young people, it’s not limited to children.

ARFID is less commonly known than other eating disorders. This is likely in part because it was only introduced into the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-V) in 2013, and partly due to the fact that it doesn’t fit the mold of more stereotypical eating disorders.

ARFID vs. picky eating: What’s the difference?

“This is the number one question I get from parents and other providers,” says Jessie Menzel, PhD, VP of Program Development for Equip. So let’s break down ARFID vs. picky eating.

“Picky eating is a developmental phase that's very much common for children to go through,” Menzel says. She explains that for a period of time, a child with picky or selective eating will refuse to eat certain foods. They may also be particular about:

• Which brands of foods they eat
• How the foods they eat are packaged
• How the foods they eat are prepared

On the surface, ARFID may resemble picky eating. After all, people with ARFID are selective about what they eat. However, “the extent to which they narrow what they eat and the persistence with which they narrow is what differentiates picky eating from ARFID,” Menzel explains.

With ARFID, a child limits the amount and variety of food they’ll eat to the point where:

• They are nutritionally deficient or are at risk of being nutritionally deficient
• Their growth (height and weight) has started to flatten
• It affects their day-to-day life (and the life of their family)

“The child is not only limited in terms of what they eat, but also in the number of circumstances and situations in which they'll eat or accept food,” Menzel says. “All of a sudden, the child will only eat boxed Kraft macaroni and cheese, they won’t eat macaroni and cheese served in the cafeteria at school or at a restaurant. Or they only like how mom makes it and not how dad or their grandparents make it.”

The three subtypes of ARFID

ARFID is generally understood as having three main types, known to professionals as ARFID “presentations.” Many people affected by ARFID experience symptoms or behaviors of more than one presentation. These presentations are:

• Low interest in food and low appetite. Many of those 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 or get full easily, and tend to avoid eating. Sometimes this low appetite stems from another medical condition or 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. This presentation 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. People with this ARFID presentation 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 (like choking or getting food poisoning), 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.

Symptoms of ARFID in children and teens

It can be tough to tell when picky eating behaviors cross the line from "normal" to being signs of an eating disorder. 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. Below are some more specific ARFID symptoms to look out for in children and teens.

Physical symptoms

• Low weight or weight loss, (or, for growing kids, faltering growth)
• Fatigue
• Nutritional deficiencies
• Delayed puberty
• Dizziness/lightheadedness
• Eating very slowly
• Stomach cramps
• Irregular menstrual cycles

Psychological symptoms

• 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 after eating (vomiting, choking, allergic reaction)
• Rigid habits or rituals around eating (for instance, eating foods in a certain order, keeping foods a certain distance from one another, etc)
• Impaired social functioning
• Anxiety around mealtimes

Anxiety and fear in particular play a significant role in ARFID. Children may be nervous to eat, especially when new foods are served. Although many kids are resistant to trying new foods or foods they don’t like, someone with ARFID becomes especially upset or worked up at the prospect. “This might look like anything from a lot of arguing with their parent to having a full-blown tantrum,” Menzel says.

Identifying ARFID in your child

Even if you familiarize yourself with the symptoms of ARFID, it’s challenging to determine if your child’s eating habits are “normal” or not. 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.

Here are other warning signs to look for:

• Your child’s growth: Every child grows at a different rate. Ordinarily, kids should continue to become taller and gain weight as they mature. If your child’s growth curves have flattened out, talk to their pediatrician.
• The situations in which your child will accept food: Are you able to eat out at restaurants? Can your child play at friends’ houses and attend birthday parties, or do their eating restrictions cause them to stay home? If your child becomes increasingly rigid about where and how they’ll eat, it’s a red flag.
• What foods your child eats: Do they only eat certain brands of foods, prepared specific ways, or only by one person? Have they cut out entire food groups? For example, even if a child doesn’t eat fruit and vegetables, they often enjoy juice and French fries—but many children with ARFID wouldn’t. This intense narrowing of food preferences puts a child or teen at risk of becoming nutritionally deficient or impairing their growth and development.

Menzel emphasizes the importance of parents trusting their gut. “You know as a parent if something feels like it's harder than it should be and if eating in general is harder than it should be for your kid,” she says.

Causes and risk factors of ARFID

At this time, we still don’t fully understand what causes avoidant/restrictive food intake disorder. Like all eating disorders, ARFID rarely has one single cause, but rather emerges out of a complex mix of different factors. Some factors that could contribute to the development of ARFID include:

• A family history of eating disorders
• Differences in sensitivity and perception of taste
• Differences in brain regions that regulate appetite
• A traumatic experience, such as choking, vomiting, or having a bad allergic reaction to a food

Treatment options for ARFID

As with any eating disorder, early intervention is important when it comes to ARFID. “The sooner you can jump in and try to change course, the better,” Menzel says. “If you wait and see if your child will grow out of it, by that point in time, the behavior may be so entrenched that you may have a much harder battle to fight.”

The good news is that ARFID is treatable, and lasting recovery is possible for everyone affected. The most common ARFID treatments are family-based treatment (FBT) and cognitive behavioral therapy (CBT).

FBT vs. CBT: similarities

Both FBT and CBT take a staged approach to treating ARFID. They break down the different treatment goals and targets, and prioritize what to focus on. In the beginning, the focus is always on addressing any nutritional deficiencies and issues with weight and growth. After that, treatment gradually moves on to address other symptoms or maintaining factors for ARFID, Menzel says.

FBT vs. CBT: differences

In family-based treatment, parents take a central role in treatment, helping to stop disordered behaviors and renourish their child. This approach leans into parents’ knowledge and instincts of their child. “FBT is a collaboration between experts, who really know and understand eating disorders, and parents, who really know and understand their child,” Menzel explains. “Therapists rely on the parents to think, ‘How can we apply the knowledge from FBT to our kid, our household, and our family?’” Many parents find FBT to be empowering during a time when they may feel helpless in the face of their child's eating challenges, Menzel adds.

On the other hand, cognitive behavioral therapy is more structured, with prescribed interventions and approaches to address the thoughts and behaviors of ARFID. Different modules address the various presentations of ARFID, including picky eating driven by sensory sensitivity, food-based fears, and problems with appetite and enjoyment of food.

Learn more about the evidence-based treatment approaches used at Equip.

How to find professional help

ARFID is fully treatable, but it requires working with a team of eating disorder experts who are knowledgeable about ARFID. Your pediatrician can be a great support in finding ARFID treatment, or you can schedule a consultation with our team to discuss your concerns and possible next steps.

It can also be helpful to learn more about ARFID so that you feel prepared to discuss what you’re noticing with your child and what you think may be going on. There are a number of online resources— like Equip, Feeding Matters, F.E.A.S.T., and the National Eating Disorders Association—that can provide more in-depth education about ARFID.

Supporting your child through recovery

If your child 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—but they are central to recovery. Helping your child get started with treatment is an essential first step toward helping them get better.

Once you begin treatment, you can further support your child’s recovery by keeping in mind these tips:

• Be patient: “ARFID can be really slow moving to recover. It can feel like you’re doing a lot of work for very little gain at the start of treatment,” Menzel says. So celebrate the smallest wins, and understand it might take a while to change behaviors.
• Remain open: It’s very difficult for a child who eats only 10 to 15 foods to turn into a foodie. However, you have no idea what this journey and the outcome may look like for your child. Move forward with no expectations.
• Foster a non-judgmental environment: Your child’s experience with food is probably very different from your experience with food, Menzel says. Just because you enjoy apple pie doesn’t mean everyone does. Your best plan? Help your child be willing to explore new foods, rather than being invested in them liking foods.
• Build a support system: Before your child’s ARFID diagnosis, you may never have heard of this eating disorder, let alone known someone who has it. Because ARFID is so little-known, dealing with it can be very isolating. Luckily, peer support groups exist and can help you feel less alone. “I’ve seen how impactful it is for families to meet others who have a child with ARFID,” Menzel says. There are a number of free, online support groups you can join today.

The Equip takeaway: moving forward with hope

Avoidant/restrictive food intake disorder is more than picky eating—it is a diagnosable eating disorder that requires professional help to overcome.

This type of restrictive eating impacts a child’s ability to function and enjoy their daily life, and it can impair their growth. So if you suspect your child’s picky eating is more than just a phase, don’t wait for them to grow out of it. Talk about your concerns with your pediatrician, or seek out an experienced eating disorders expert.

With the right professional and peer support, recovery from ARFID is possible—and worth it.

FAQ

What is ARFID and how is it different from picky eating?

Avoidant/restrictive food intake disorder (ARFID) is when a person eats very little food and a small variety of food, without any body image issues or desire to lose weight. These eating behaviors persist for a long time and impair a person’s growth and ability to take part in everyday life. On the other hand, picky eating is a developmental phase that many children go through. During picky eating, a child may only eat certain foods or foods prepared in certain ways, but this eventually goes away and the child still grows and can enjoy a typical social life.

What are the signs and symptoms of ARFID in children?

ARFID symptoms in children include:

• A small list of "acceptable" foods that grows smaller over time
• Rigid habits or rituals around eating
• Anxiety around mealtimes
• A plateau in growth in both height and weight
• A general lack of interest in food and eating
• Avoiding specific food groups
• Being repulsed by specific aspects of foods
• Fear of something bad happening when they eat
• Impaired social functioning

How can parents identify ARFID in their child?

Parents can identify ARFID in their child by observing their child’s eating behaviors and growth. If a child has cut out entire food groups or has eating rituals that persist, and this causes them anxiety at mealtime and has caused their height and/or weight to slow or stop, it may be ARFID. Additionally, children with ARFID may be fearful to attend social events that involve food, such as eating out at restaurants, going to parties, or playing at friends’ houses.

What causes ARFID and who is at risk?

It’s unclear what causes ARFID. A combination of genetics and differences in brain function may play a role. Anyone who’s had a traumatic event involving food (such as choking, an allergic reaction, or vomiting) may be at risk of developing ARFID. A family history of eating disorders also increases the risk of ARFID.

What treatment options are available for children with ARFID?

The most common ARFID treatment options for children are family-based treatment (FBT) and cognitive behavioral therapy (CBT). FBT empowers parents, who know their child best, to take charge of the recovery process and support their child at home. CBT works to change the child’s thoughts and behaviors. Both FBT and CBT prioritize weight stabilization and addressing nutritional deficiencies first.

How can parents support their child through ARFID recovery?

Parents can support their child through ARFID recovery in many ways. This includes being patient, as recovery can take a while, and remaining open to how this journey will go. It also helps to remain non-judgmental about your child’s behaviors and preferences. Instead, help your child be willing to explore new foods.