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ARFID in Children: A Picky Eating Disorder

An aversion to food can be challenging to parent in the home. Find out about ARFID in children and whether you have a child with extreme picky eating.

Eight year-old Ben had been a picky eater his whole life. His family didn’t know him any other way.

In fact, they’d learned to live with Ben’s idiosyncrasies around food…only liking one particular chicken finger from a summertime favorite restaurant, refusing all vegetables, and preferring many sweets and snacks.

Sure, these tendencies weren’t easy to live with–and frankly they sometimes caused quite a bit of drama in the family–but Ben’s parents had learned to skip the vegetables, not bother to offer other types of chicken, and learned to live with meals that included cheese, crackers and strawberries nearly every day.

Did they feel guilty? Of course. But they were doing the best they knew how.

Plate of fruit and veggies - Does My Child Have a picky eating disorder?

Does My Child Have ARFID? (Avoidant Restrictive Food Intake Disorder)

When Ben started to grow more anxious at social events involving food with his peers and his growth started to fail, they started searching for more help.

It was then they learned Ben had an extreme form of picky eating called Avoidant Restrictive Food Intake Disorder, or ARFID.

Ben’s parents had never heard of this term. They just thought they were dealing with a picky eater.

But deep down they knew Ben wasn’t your average picky eater.

After all, he was eight years old and still picky.

He couldn’t spend the night at a friend’s house because there was nothing for him to eat.

He was anxious, tearful, or argumentative at the meal table if his usual dinner wasn’t there.

Picky eating had taken over, leaving Ben’s parents to morph into short-order cooks, masters of bribery, and enforcers of more bites.

Parents of picky eaters morph into short-order cooks, masters of bribery and enforcers of more bites. Click To Tweet

ARFID Disorder Symptoms in Children

ARFID is characterized by a persistent disturbance in eating leading to weight loss or growth disturbances, nutrient deficiencies, dependence on supplements, and impaired psychosocial functioning.

The general signs are:

  • food refusal (the child refuses to eat anything!)
  • poor eating or feeding skills
  • underweight or slowed growth
  • anxiety
  • texture sensitivities
  • aversion to food

What Causes ARFID in Children?

Kids with ARFID typically have an underlying reason for their food refusal, including early negative associations with eating (choking, gagging, vomiting), medical conditions that inhibit eating like food allergy or constipation, co-existing conditions such as autism or ADHD that include texture or other food characteristic sensitivity, or a combination of these.

They are generally not motivated to lose weight.

In my own practice, I have seen a multitude of reasons for ARFID, from enlarged tonsils and adenoids inhibiting eating to sensitivities around the sensory components of food (flavor, texture, appearance, odor, etc) and even dysfunctional parenting.

Read: Eosinophilic Esophagitis (EoE) in Children

How Food Parenting and Restrictive Eating Disorder Interact

Having a picky eater in the home is challenging enough, but add in years of food refusal and negotiations, and it’s easy to see the role of short-order cook evolve.

You may cater to your child’s food preferences and fail to challenge him with new foods.

Ultimately, a limited diet of liked or acceptable foods results, possibly compromising your child’s nutritional status.

Alternatively, you may use pressure or force your child to try new food before she is ready or willing.

This can leave a negative association with trying unfamiliar foods and make your child unwilling to eat.

Other tactics like bribery further limits your child’s diet, and even encourages unhealthy foods.

Unfortunately many families get stuck in unproductive, negative dynamics around food when they have an extremely picky eater.

[Read] How to Help Your Child Try New Food and How to Prevent Picky Eating

Feeding Therapy: Does a Child with a Selective Eating Disorder Need More Help?

If you’re a parent of an extremely picky eater, there are certain red flags that may indicate more help is needed.

I generally tell my clients if picky eating isn’t getting better by the end of the fourth year, it’s time to look deeper and consider professional intervention.

Help may include learning about new techniques around positive food parenting and boosting growth and nutritional status in children with ARFID.

Or, it could mean one on one intervention to help your child overcome his sensitivities to food, learn to chew and swallow, or develop coping skills to manage anxiety.

[Watch Picky Eating vs. ARFID on YouTube!]

Common Characteristics of Avoidant Restrictive Food Intake Disorder

Kids with a picky eating disorder are complex and they don’t all present with the same signs.

I’ve outlined some of the common signs I’ve seen, but know that kids may have a variety of them.

Typical Signs of ARFID

  • A short list of foods they will eat
  • Eating foods of similar characteristics, such as crunchy in texture, or colorless
  • Preferences for particular food preparation methods
  • Avoidance of vegetables, protein sources (meat, beans, etc), fruit
  • Eliminates foods and never gains them back into the diet
  • Poor weight gain and growth (child may also be of normal weight and growth)
  • Nutrient deficiencies (iron, vitamin A, and vitamin C most common)
  • Skips one or more entire food groups
  • Becomes emotional or demonstrates stress around unfamiliar foods
  • Food limitations negatively impact normal social behaviors
  • Won’t try new food

A Word on Anxiety and ARFID

Anxiety is an underlying component to ARFID for many kids. In fact, some research has shown that 21% of kids with ARFID also have anxiety, and up to 58% may have an anxiety disorder.

It’s hard to be brave and try new foods when you experience a significant amount of stress at the table, whether it stems from the food itself or from the family dynamic at mealtime.

In the older child, social engagement around food may become a source of angst and is often the trigger for getting more help.

What the family has been able to deal with in the home becomes much more limiting to the child’s social life.

Equally challenging is the embarrassment the child may feel about his diet and eating around his friends.

[Watch Picky Eating vs. ARFID on YouTube!]

ARFID Treatment Using Food Therapy

As a new diagnosis, ARFID and its management is still in its infancy. We are learning what is effective and beneficial for the child. There are a few things you should know, however, about ARFID treatment.

Each child will be different in his reasons for ARFID, and therefore, the approach to treat it.

For example, children with sensitivities to the sensory components of food will likely need food desensitization and exposure-based food therapy with a feeding specialist.

Kids who are anxiety prone will need help with coping skills, food exposure therapy and confidence-building around new food and eating in social situations.

Children who have experienced pressure to eat, bribery or even punishment for not eating will benefit from parent-centered positive feeding education, as well as other treatment approaches.

And, children who are nutritionally compromised will need nutrition therapy.

Fortunately, there are teams who can treat children with a picky eating disorder, as well as single providers who can help.

The ARFID Guide booklet

ARFID Treatment at Home

Some parents are able to get started with helping their child at home.

This is best guided by a healthcare provider and involves systematically trying one or more new foods each day.

It’s important to keep this a positive experience and not overwhelm the child.

Other Names for ARFID

ARFID can be called or referred to by several different names, including

  • selective eating disorder
  • picky eating disorder
  • food aversion disorder
  • restrictive eating disorder

Need More Help? Nutrition Resources for ARFID in Children

If you know your child needs more help, then you’ll want to read my booklet, The ARFID Guide: How to Get Help When Your Child is Extremely Picky.

I also have a DIY class called Nutrition for Extremely Picky Eaters.

Listen: The Best of Extreme Picky Eating

And don’t forget about my newsletter, The Munch, where I answer parent questions about picky eating and so much more!

Do you know a child who may have ARFID? Share this article if you know a family who is struggling with a long-term picky eater!

Be sure to check out The Ultimate Guide to Feeding the Picky Eater!

Is it ARFID or PICKY EATING? | The SYMPTOMS of EXTREME PICKY EATING (According to a Kids Dietitian)
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