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What to Know About ARFID, a Condition That Makes Kids Extreme 'Picky Eaters'

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If you’re a parent of a child who is a “picky eater,” you probably know the struggle of trying to make foods your child will eat.

Maybe your child refuses to eat kid-friendly favorites like boxed mac and cheese. Maybe your child doesn’t want any of their foods to touch, and if they do, they will go on a hunger strike. Or maybe your child doesn’t like boiled brussels sprouts (but really, who does?).

There are a lot of reasons a child might reject the food you present them. For example, some kids have sensory issues that make them especially sensitive to textures and tastes. Though most kids tend to grow out of picky preferences, for some kids, “picky eating” isn’t just a phase. It’s actually indicative of a deeper struggle that can affect their ability to get the nutrients they need for healthy growth and functioning.

If any of this sounds familiar, you’re not alone. If you suspect your child’s “picky eating” is something more, they may be struggling with avoidant restrictive food intake disorder (ARFID), a feeding disorder characterized by food avoidance. 

What Is Avoidant Restrictive Food Intake Disorder (ARFID)?

Avoidant restrictive food intake disorder (ARFID) is a feeding disorder characterized by eating very little food and avoiding certain foods entirely, sometimes leading to disturbances in growth and weight. Adults and children with ARFID are often referred to as “picky eaters” because of their selectivity when it comes to food. However, ARFID is more than “just” picky food preferences. 

ARFID is a fairly new diagnosis that replaced the previous diagnostic category called “feeding disorder of infancy and early childhood” in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. This change reflected a growing body of research validating the reality that food avoidance and restriction can affect people of any age, though it is still most common in children.

According to the National Eating Disorders Association (NEDA), people on the autism spectrum, those with ADHD and people with intellectual disabilities are more likely to develop ARFID. Children diagnosed with ARFID often have a co-occuring anxiety disorder as well.

It’s important to note ARFID is not caused by lack of available food or refusing to partake in certain foods due to cultural traditions. It can be hard to distinguish from typical “picky eating,” but there are some signs that set ARFID apart. 

Symptoms of ARFID

Most symptoms of ARFID are related to the fact that selective eating can lead to a diet of poor nutritional value. While adults with ARFID have autonomy in choosing what they eat, children with ARFID may struggle because they only have access to the foods presented to them and may have limited vocabulary to express what they need.

“Every child’s food preferences are unique. However, the food groups that children with ARFID seem to struggle with the most are vegetables, protein and fruits,” Nancy L. Zucker, Ph.D., an eating disorders specialist and associate professor in psychiatry and behavioral sciences at Duke University, told The Mighty. “Carbohydrates seem to be the easiest group for most children with ARFID. Many children also struggle with dairy, though in my clinical experience this is the food group with the most variability.”

Adults and children who struggle with severely selective eating typically can experience symptoms related to malnourishment. Symptoms of ARFID can also include:

  • Disturbances in growth and weight
  • Lack of appetite or interest in food
  • Limited range of preferred or “safe” foods
  • Fear of choking or vomiting
  • Bowel movement pain
  • Difficulty taking part in social activities, especially when food is present

Though some symptoms of ARFID may present like those of eating disorders like anorexia, for example, ARFID is distinct because it doesn’t involve distress about body shape or size or fears about body size.

“ARFID is different than anorexia nervosa in that the food avoidance in ARFID is not thought to be motivated by a fear of weight gain,” Dr. Zuker explained, adding: 

While this is true, it gets a little tricky. Many children with ARFID are very sensitive to sensations in their body and don’t like change. Thus they may be uncomfortable with changes in their bodies due to food. Though this is [technically] due to a fear of getting fat, it’s a nuanced difference.

Mighty contributor Vi Synster knows what it’s like to struggle with ARFID symptoms. In her piece, “What I Want Others to Know About Avoidant/Restrictive Food Intake Disorder,” she wrote:

Every single time I’m faced with trying a new food, this internal dialogue runs through my head. I’m hypersensitive to the taste and texture of foods. It is paired with my eating disorder known as selective eating disorder, also known as avoidant/restrictive food intake disorder. The short version is ARFID. Those who have ARFID can’t just ‘try new food.’ A dialogue, similar to the one I described above, might play through their heads. Imagine going to a restaurant with a five-page menu and finding none of your safe foods. Safe foods are foods people with ARFID feel comfortable with eating because they are familiar with them.

ARFID Treatment

Like most health experiences, ARFID exists on a spectrum and can vary from person to person. In some cases, a child with a severely selective diet may continue to achieve growth milestones with the help of supplements and significant support from medical professionals, parents or guardians. If your child is struggling with severe “picky eating” or exhibits any of the symptoms mentioned above, please reach out to your child’s doctor for medical support.

In critical situations, hospitalization may be required for folks with ARFID who are extremely malnourished. But usually symptoms are addressed before emergency intervention is needed. 

Cynthia Martin, Psy.D., who specializes in assessing young children with developmental concerns, told The Mighty both selective eating and severe selective eating in children are becoming more and more common. With the help of a nutrition or eating/feeding disorder specialist, adults and children with ARFID can overcome their food aversions and get on track for recommended growth and weight.

“You can work with a provider to expand the repertoire of foods your child will accept and also to get guidance on improving mealtime behaviors,” Dr. Martin said.

If you are struggling to find foods your child with ARFID will eat, you’re not alone. In her work with clients, Zucker encourages parents to begin to associate eating with fun, non-judgmental experiences.

“Usually when a parent has a child with ARFID, there have been years of conflict and struggle. Thus eating has become associated with negative emotions and circumstances,” she explained. “The first task is to change this association so that eating is associated with positive experiences.” 

One of her tips is instituting “food adventures” with your child. For example, rather than asking your child to accompany you to the store to pick out new foods, she recommends reframing the request as a statement like this:

“Today we are going to go on a food adventure to the grocery store. How many ‘maybe’ foods [do] you think we can find? Let’s see who’s closer in our guesses, you or me.”

Children who tend to be food-avoidant will avoid experiences that feel triggering and will likely immediately say no if they are given a “yes” or “no” choice to an experience that feels difficult. Suggesting activities in a confident and playful way (as well as providing flexibility to the child in the new context) can help a change-averse child adjust.

When trying new strategies for introducing food, Zucker said it’s important to stay focused on making the experience positive, rather than focusing on the end result.

“A key factor of any food adventure with a new food is to be process-focused. Focus on the experience — not the outcome,” Zucker said. “If you go into an experience expecting that your child will complete a portion, the pressure of that performance may thwart a positive memory you are trying to build.”

For more tips on finding foods a child with selective eating struggles will eat, we encourage you to check out the articles below. For support from parents who understand, we encourage you to reach out to community by posting a Thought or Question on the site with the hashtag #Parenting. Our community wants to rally around you, no matter what you’re facing today.

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Getty Images photo via Dina Damotseva

Originally published: January 7, 2020
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