5 Things to Know About Feeding Your Child with ARFID

Is it ARFID or picky eating? As a dietitian mom, here are 5 things you should know when feeding your child with ARFID.

Feeding your child can be tough, but for some families, mealtimes are more than just challenging—they can feel impossible. If your child struggles with a very limited range of foods and intense anxiety around eating, they may be dealing with something called ARFID (Avoidant Restrictive Food Intake Disorder). 

ARFID goes beyond “normal” picky eating and can have a big impact on your child’s health and your family’s life. Let’s dive into five things you should know about ARFID.

1. What is ARFID and where does it start?

ARFID or Avoidant Restrictive Food Intake Disorder is a type of eating disorder, but while it is characterized by restricting foods it isn’t motivated by body image concerns. There is no one single cause of ARFID because it is often a combination of factors. There are three subtypes of ARFID that are characterized by the common causes of ARFID.

ARFID- Restrictive 

• A lack of interest in food: A general disinterest or lack of motivation towards eating where kids don’t find eating enjoyable and might have reduced appetite leading to insufficient volume of food and nutritional deficiencies.

ARFID- Aversive

• Sensory adverse: Strong aversions to the sensory characteristics of food like taste, texture, smell or colour are too overwhelming and lead to eating a limited variety of food.  

ARFID – Avoidant 

• Fear-based reactions: Having a deep fear of having a negative reaction to eating such as choking, vomiting or gastrointestinal discomfort leading to avoiding certain foods and food groups. 

It’s important to note that ARFID isn’t anyone’s fault. It’s not caused by bad parenting or by being too lenient with a picky eater. It’s more than just picky eating. It’s a complex disorder that needs professional support. Kids with ARFID might struggle to eat enough to grow properly, get the nutrients they need, have a dependence on nutrition supplements and see an impact on their social development. This can lead to isolation, undernourishment or more severe malnutrition, poor growth, and other health issues if not addressed.

2. ARFID vs. Picky Eating: What’s the Difference?

All kids can be picky eaters at times. Maybe your child refuses to eat vegetables or only wants chicken nuggets for dinner. This is frustrating, but it’s usually temporary and doesn’t affect their growth or health.

ARFID, however, is different. A child with ARFID has a much more extreme reaction to food. Trying new foods or even foods that look slightly different than safe foods can cause anxiety, fear, or a total refusal to eat. This fear of eating often includes such an intense response in their body that it is physically preventing them from eating a variety of foods.  

Unlike a typical picky eater who may respond to interventions and see an improvement over time, kids with ARFID aren’t just being stubborn or picky. It is much more complex where their eating may be affected by trauma, which can then lead to feelings of embarrassment, guilt, shame and anxiety. 

Key Differences:

• ARFID often leads to weight loss, poor growth, or nutritional deficiencies.
• Children with ARFID might feel anxious about eating and avoid mealtimes.
• Picky eating usually improves with time, while ARFID often requires treatment.

3. How ARFID Manifests Differently in Children, Teens, and Adults

ARFID can affect people of all ages, but it often starts in childhood. The way it shows up can change as children grow older:

• In young children: It often looks like very picky eating, but more extreme. Children might avoid whole food groups or have intense reactions to trying new foods.
• In teenagers: They may start to avoid social situations where food is involved (like parties or eating at school). The anxiety around food might become more noticeable as they grow older and more independent.
• In adults: ARFID can persist into adulthood. Adults with ARFID may struggle with the same fears around food and may have a limited diet that impacts their health. 

Recognizing ARFID early can help prevent health complications with long-term effects, but treatment support is possible at any age. 

4. Symptoms and Red Flags of ARFID

Recognizing ARFID can be tricky because it can look like extreme picky eating at first. However, there are several red flags to be aware of:

• Extreme restriction: Your child will only eat a very small number of foods and refuses others, even ones they used to like.
• Fear or anxiety around food: Some children with ARFID have a fear of choking, vomiting, or gagging when eating.
• Sensory sensitivities: Texture, smell, or even the appearance of foods can lead to refusal to eat.
• Growth problems: Not eating enough can result in weight loss or slow growth in children and teens.
• Nutritional deficiencies: A diet limited to just a few foods may lead to vitamin and mineral deficiencies.

If you notice these symptoms, it might be time to seek help from a pediatrician or a registered dietitian with experience in ARFID.

5. Treatment Approaches for ARFID

It is important to note that ARFID is still a newly recognized disorder and we are continuing to learn more from the lived experiences of individuals with ARFID and to include different perspectives on ways to support them. A treatment plan should be developed considering a neuro-affirming and trauma-informed perspective. When we consider looking at the whole person including, the risk or degree of malnutrition, their lived experiences, the eating environment, their support systems and family experiences. 

Many treatment plans will include one or more of the following treatment pathways:

• Exposure therapy: This type of therapy is very individualized and helps to gradually get used to new foods. It’s done in a supportive way to reduce fear and anxiety.
• Cognitive Behavioral Therapy (CBT): CBT can help manage any anxiety and stress response around food by supporting them in changing the way they think about eating.
• Dietary interventions: Creating a balanced and nourishing eating plan that works within an individual’s current abilities, comfort and sense of safety.
• Family-based treatment: Involving the whole family in treatment can help create a positive eating environment at home and overall support.

Depending on a child’s medical status, treating ARFID may require a team of professionals. A team may include a registered dietitian, an occupational therapist and a psychologist or therapist trained in eating disorders. Practitioners with experience in ARFID can support children (and families) in living well with ARFID while minimizing the risk of health complications along the way. 

How a Dietitian Can Help with ARFID

As registered dietitians at Centred Nutrition Collective, we work closely with families to help children overcome ARFID. We offer guidance on:

• Looking at the big picture and the experience of the individual including any harm they may have experienced.
• Developing a nutrition plan that addresses any signs of malnutrition and ensures they are getting the nutrients they need, even with a limited range of foods
• Creating a structured and supportive eating environment 
• Introducing new foods in a way that feels safe and manageable.

We recognize that there is no one-size-fits-all all approach to managing ARFID and it is important to look at individualized needs of every person or child.

With patience, empathy and the right approach, ARFID is manageable. The goal is to help your child feel more comfortable with eating and to expand their range of safe foods over time to be able to meet their nutrition needs in a way that works for them.