What Is Avoidant/Restrictive Food Intake Disorder (ARFID)?
Avoidant/restrictive food intake disorder (ARFID) is an eating disorder
characterized by eating very little food or avoiding eating certain foods. It’s
a relatively new diagnosis that expands on the previous diagnostic category of
feeding disorder of infancy and early childhood, which was rarely used or
Individuals with ARFID have developed some type of problem with feeding
or eating that causes them to avoid particular foods or consuming food
altogether. As a result, they aren’t able to take in enough calories or
nutrients through their diet. This can lead to nutritional deficiencies,
delayed growth, and problems with weight gain. Aside from health complications,
people with ARFID may also experience difficulties at school or work due to
their condition. They might have trouble participating in social activities,
such as eating with other people, and maintaining relationships with others.
ARFID usually presents in infancy or during childhood, and may persist into
adulthood. It may initially resemble the picky eating that’s common during
childhood. For example, many children refuse to eat vegetables or foods of a
certain odor or consistency. However, these picky eating patterns usually
resolve within a few months without causing problems with growth or
Your child may have ARFID if:
- the eating problem isn’t being caused by a
digestive disorder or other medical condition
- the eating problem isn’t being caused by a food
shortage or cultural food traditions
- the eating problem isn’t being caused by an
eating disorder, such as bulimia
- they aren’t following the normal weight gain
curve for their age
- they’ve failed to gain weight or have lost a
considerable amount of weight within the last month
You may want to schedule an appointment with your child’s doctor if
your child is showing signs of ARFID. Treatment is needed to address both the
medical and psychosocial aspects of this condition.
When it’s left untreated, ARFID can lead to serious long-term
complications. It’s important to get an accurate diagnosis right away. If your
child isn’t eating adequately but is at a normal weight for their age, you
should still make an appointment with their doctor.
What Are the Symptoms of ARFID?
Many of the signs of ARFID are similar to those of other conditions
that may cause your child to become malnourished. Regardless of how healthy you
think your child is, you should call a doctor if you notice that your child:
- appears underweight
- doesn’t eat as frequently or as much as they
- often seems irritable and cries frequently
- seems distressed or withdrawn
- struggles to pass bowel movements or seems to be
in pain when doing so
- regularly appears tired and sluggish
- vomits frequently
- lacks age-appropriate social skills and tends to
shy away from others
ARFID can sometimes be mild. Your child may not show many
signs of malnourishment and may simply appear to be a picky eater. However, it’s
important to tell your child’s doctor about your child’s eating habits during their
The absence of certain foods and vitamins in your child’s
diet can lead to more serious vitamin deficiencies and other medical conditions.
Your child’s doctor may need to perform a more detailed examination so they can
determine the best way to make sure your child receives all of the important
vitamins and nutrients.
What Causes ARFID?
The exact cause of ARFID isn’t known, but researchers
have identified certain risk factors for the disorder. These include:
- being male
- being under age 13
- having gastrointestinal symptoms, such as
heartburn and constipation
- having food allergies
Many cases of poor weight gain and malnutrition are due to an
underlying medical condition related to the digestive system. In some cases,
however, signs can’t be explained by a physical medical problem. Possible nonmedical
causes for your child’s inadequate eating habits may include the following:
- Your child is fearful or stressed about
- Your child is afraid to eat due to a past
traumatic incident, such as choking or severe vomiting.
- Your child isn’t receiving adequate emotional responses
or care from a parent or primary caregiver. For example, a child may feel
afraid of a parent’s temper, or a parent may have depression and be withdrawn from
- Your child just doesn’t like foods of certain
textures, tastes, or smells.
How Is ARFID Diagnosed?
ARFID was introduced as a new diagnostic category in the new edition of
the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is
published by the American Psychiatric Association and helps doctors and mental
health professionals diagnose mental disorders.
Your child may be diagnosed with ARFID if they meet the following
diagnostic criteria from the DSM-5:
- They have a problem with feeding or eating, such
as avoiding certain foods or showing a lack of interest in food altogether
- They haven’t gained weight for at least one
- They’ve lost a significant amount of weight within
the last month
- They depend on external feeding or supplements
for their nutrition
- They have nutritional deficiencies.
- Their eating problem isn’t being caused by an
underlying medical condition or mental disorder.
- Their eating problem isn’t being caused by cultural
food traditions or a lack of available food.
- Their eating problem isn’t being caused by an
existing eating disorder or poor body image.
Schedule an appointment with your child’s doctor if your child appears
to have ARFID. The doctor will weigh and measure your child, and they’ll plot
the figures on a chart and compare them with national averages. They may want
to do more testing if your child weighs much less than most other children of
the same age and gender. Testing may also be necessary if there’s a sudden
change in your child’s growth pattern.
If the doctor determines that your child is underweight or
malnourished, they’ll run various diagnostic tests to screen for medical
conditions that may be restricting your child’s growth. These tests may include
blood tests, urine tests, and imaging tests.
If the doctor doesn’t find an underlying medical condition, they’ll
likely ask you about your child’s feeding habits, behavior, and family
environment. Based on this conversation, the doctor may refer you and your
- a dietitian for nutritional counseling
- a psychologist to study family relationships and
possible triggers for any anxiety or sadness your child may be feeling
- a speech or occupational therapist to determine
whether your child has delayed oral or motor skill development
If your child’s condition is believed to be due to neglect, abuse, or
poverty, a social worker or child protection official may be sent to work with
you and your family.
How Is ARFID Treated?
In an emergency situation, hospitalization may be required. While
there, your child may need a feeding tube to receive adequate nutrition.
In most cases, this type of eating disorder is addressed before
hospitalization is necessary. Nutritional counseling or regular meetings with a
therapist can be very effective in helping your child to overcome their
disorder. Your child may need to go on a specific diet and take prescribed
nutritional supplements. This will help them catch up to a recommended weight
while undergoing treatment.
Once vitamin and mineral deficiencies are addressed, your child may
become more alert and regular feeding may become easier.
What Is the Outlook for Children with ARFID?
Since ARFID is still a new diagnosis, there’s limited information on
its development and outlook. In general, an eating disorder can be resolved
easily if it’s addressed as soon as your child begins to show signs of
persistently inadequate eating.
When it’s left untreated, an eating disorder can lead to delayed
physical and mental development that may impact your child for life. For
instance, when certain foods aren’t incorporated into your child’s diet, oral
motor development may be affected. This can lead to speech delays or long-term
problems with eating foods that have similar tastes or textures. You should
seek treatment right away to avoid complications. Talk to a doctor if you’re
concerned about your child’s eating habits and suspect they have ARFID.