About avoidant restrictive food intake disorder (ARFID)

Avoidant restrictive food intake disorder (ARFID) is an eating disorder and a mental health condition.

Children and teenagers with ARFID eat only a small range or amount of food. This can affect their weight, growth, nutrition and physical health, because they’re not getting all the nutrients they need. Children with ARFID might also feel very upset while eating or find it hard to eat in social situations.

Children and teenagers with ARFID might restrict what they eat because they:

• have a low appetite or aren’t interested in eating
• are highly sensitive to the sensory aspects of eating – for example, the colour, smell, texture or taste of food
• fear that something bad will happen when they eat – for example, pain, nausea, vomiting or choking.

Unlike children with other eating disorders, children with ARFID aren’t trying to lose weight. They aren’t unhappy with their bodies either.

Some children might develop ARFID in early childhood. In other children, it might develop at a later age after a stressful or bad experience with food. ARFID can continue into adulthood.

Fussy eating and ARFID: what’s the difference?

It’s common for younger children to be picky or fussy eaters.

Most children gradually eat more types of food and explore new foods as they get older. This happens as children see you and other people enjoying different foods. But it’s common for children to try new foods 10-15 times before they accept and enjoy them.

ARFID is more than just fussy eating. Children with ARFID need a lot more support than other children to try new foods and eat larger amounts of food.

ARFID is a serious illness that can significantly affect children’s health and development.

Signs and symptoms of avoidant restrictive food intake disorder (ARFID)

The signs and symptoms of avoidant restrictive food intake disorder (ARFID) can vary a lot among children and teenagers. Here are some common signs and symptoms.

Physical signs and symptoms
Children with ARFID might:

• lose weight, not gain weight as expected, or not weigh enough
• grow and develop poorly
• look pale or unhealthy
• lack energy
• be late starting puberty
• have a slow heart rate
• feel sick or have stomach pain when they eat
• feel full after eating only small amounts.

Blood and other tests might also show nutritional deficiencies or poor bone strength.

Behavioural signs and symptoms
Children with ARFID might:

• eat very slowly or not finish meals
• eat only a very small range of foods
• be easily disgusted by different foods
• not eat with others or avoid social events or school because they don’t want to eat with others
• avoid school camps because they’re worried about the food they’ll be offered.

Psychological signs and symptoms
Children with ARFID might:

• feel afraid or upset when trying new foods
• feel upset by the sight and sound of others eating
• feel very worried about pain, nausea, vomiting or choking when eating
• have a lot of trouble eating in unfamiliar places
• get very upset if food isn’t prepared and presented in a certain way
• worry if food packaging changes
• have depression or anxiety.

What to do if you notice signs of avoidant restrictive food intake disorder (ARFID)

If you’re worried about the amount or range of food your child eats, or you’ve noticed a recent change in your child’s eating habits, mood or behaviour, get help from your GP as soon as you can.

It’s best to get early professional help for your child. Early assessment from a health professional might help your child avoid more intensive treatment and reduce their recovery time later.

Diagnosing avoidant restrictive food intake disorder (ARFID)

There’s no single test that can diagnose avoidant restrictive food intake disorder (ARFID).

Your GP will talk with you and your child about eating behaviour, habits and thoughts. Your GP might also do a full physical examination and tests including a blood test, a urine test, an X-ray or an ECG.

Your GP might then refer you to a paediatrician, a mental health professional like a psychologist, or a dietitian to confirm your child has ARFID and to recommend appropriate treatment.

Treatment for avoidant restrictive food intake disorder (ARFID)

Treatment for avoidant restrictive food intake disorder (ARFID) will depend on your child’s needs.

Psychological therapy
If your child has ARFID, your child might need psychological therapy. This can include family therapy sessions or one-on-one sessions with your child. This therapy aims to:

• create pleasant mealtime experiences and family eating environments
• gradually introduce new foods into your child’s diet
• help your child learn to cope with their emotions while eating
• help your child understand how it feels when they’re hungry or full.

Medication
There are no medications for treating ARFID. But if your child has depression or anxiety as well as ARFID, there are some medications that can help with these conditions.

Your doctor or dietitian might prescribe nutritional supplements if your child has nutritional deficiencies.

Hospital
Sometimes children with ARFID might need to go to hospital to be treated for the physical effects of the disorder. This will depend on children’s weight, symptoms and other health issues.

Hospital treatment usually focuses on providing support at regular mealtimes to encourage children to eat and gain weight. Your child might also be given nutritional supplements.

With treatment, children and teenagers with ARFID can recover. They need a lot of love and support to get better and maintain healthy eating habits, and they sometimes relapse. If you notice your child is showing symptoms of ARFID again, contact your doctor as soon as possible.

Causes of avoidant restrictive food intake disorder (ARFID)

Experts are still trying to work out what makes some children more likely than others to develop avoidant restrictive food intake disorder (ARFID).

Some children might have genetic factors that make them more sensitive to certain tastes. Other children might have medical conditions that put them at risk for ARFID. These include conditions that affect the digestive system or conditions that require children to be on special diets.

Children with ARFID are also more likely than other children to experience anxiety disorders.

Avoidant restrictive food intake disorder (ARFID) and autism

Some autistic children have fussy eating habits. There’s a lot of overlap between fussy eating and autism and avoidant restrictive food intake disorder (ARFID), but more research is needed to understand the relationship between these two eating issues.