ARFID, or Avoidant Restrictive Food Intake Disorder, goes beyond typical picky eating—it’s a significant challenge that can affect a child’s growth and development. But with the right knowledge and support, families can overcome these obstacles, helping their children thrive and enjoy a healthier, more nourishing life.
What Is Avoidant Restrictive Food Intake Disorder (AFRID)?
Avoidant Restrictive Food Intake Disorder is an eating disorder characterized by a significant limitation in the types and quantities of food consumed. It’s estimated that between 0.3 and 11 percent of children and adults in the general population have ARFID.
Unlike other eating disorders, such as anorexia nervosa or bulimia nervosa, ARFID is not driven by concerns about body image or weight. Instead, it’s marked by a strong aversion to certain foods and eating behaviors, which can lead to severe nutritional deficiencies that negatively impact a child’s health.
Who Does ARFID Affect?
ARFID can affect people of any age but is most commonly diagnosed in children and adolescents. In fact, it used to be called “Feeding Disorder of Infancy or Early Childhood.” In some cases, ARFID continues into adulthood, especially if not properly addressed, and some individuals develop ARFID symptoms for the first time in adulthood
This disorder often begins in early childhood, and while it can affect any child, it is more common among those with certain risk factors.
Risk factors for ARFID can include:
- Sensory sensitivities: Children with heightened sensory sensitivities can be more prone to ARFID. They might react strongly to the texture, smell or appearance of certain foods.
- Neurodevelopmental Disorders: There is a notable overlap between ARFID and neurodevelopmental disorders such as Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). Children with ASD sometimes have a limited range of acceptable foods and rigid eating habits. Additionally, children with ASD or ADHD may experience sensory sensitivities that lead to food aversions. Children with ADHD may also be more distractible during mealtimes, which can impact eating behaviors.
- Anxiety disorders: Children with anxiety disorders may develop ARFID as a way to cope with their anxiety, particularly if they associate eating with distress or discomfort.
- Trauma or negative experiences: A history of traumatic events related to food, such as choking incidents or severe food poisoning, can contribute to the development of ARFID.
- Family history: There’s evidence that a person’s chance of having ARFID is greatly influenced by their genetics and their parents’ eating patterns and level of anxiety.
Signs and Symptoms of ARFID
ARFID symptoms can vary but generally include:
- Severe restriction of food intake and eating a very limited variety of foods
- Strong aversions to foods with specific textures, smells or appearances
- Only being willing to eat certain textures of food
- Fears of choking or vomiting
- Weight loss, stunted growth in children or nutritional deficiencies
- Significant distress or anxiety when eating
- Anxiety over social interactions, family meals and daily activities that involve eating, leading to withdrawal and isolation
- Lack of interest in food or eating
- Physical symptoms caused by low nutrient intake, including stomach pains, cramps, changes in menstrual cycles, fatigue, weakness, dry skin, trouble concentrating and frequently feeling cold
How is ARFID Treated?
Effective treatment for ARFID requires collaboration between medical professionals, including pediatricians, dietitians, psychologists and sometimes occupational therapists.
Treatment strategies for ARFID can include:
- Nutritional counseling: Registered dietitians work with patients to develop balanced meal plans that address nutritional deficiencies and gradually expand the range of acceptable foods. They may use techniques to make new foods more palatable and less intimidating.
- Cognitive-Behavioral Therapy (CBT): Exposure and Response Prevention is a CBT based intervention for ARFID that helps the child establish a regular pattern of eating and monitoring their food intake and then gradually introduces new foods in a non-threatening way to slowly add more variety to the diet. This type of therapy exposes patients in a gradual way to bodily sensations that prevent them from eating enough and learning additional coping skills to help manage anxiety around food and eating. For younger patients family members play an important role in this treatment.
- Family therapy: This type of therapy involves providing education to the child’s family about ARFID and initially has the child’s parents take charge of the child’s eating . The therapist also works with the family members to identify and address family dynamics that might impact eating behaviors and then, over time, the child is given more and more control over their eating. Involving family members in the treatment process can create a supportive home environment and address any family dynamics contributing to the disorder.
- Medical monitoring: Regular check-ups are necessary to monitor growth, weight and nutritional status, and address any physical health issues resulting from ARFID.
When to Seek Help for Your Child’s Picky Eating
If you notice that your child is exhibiting signs of ARFID, talk to your pediatrician or adolescent medicine specialist as early as possible. Early intervention can help prevent the disorder from worsening and improve the likelihood of successful treatment.
Consulting with a specialist in pediatric eating disorders, in particular, can provide guidance and support in managing ARFID and ensure your child is getting enough variety in their diet for growth and development.
At Stony Brook Children’s Pediatric Specialties and Adolescent Medicine, we are committed to providing comprehensive care for children with ARFID and other eating disorders. Our team of specialists work collaboratively to address the unique needs of each patient by integrating medical care, nutritional counseling, and therapeutic support to help children overcome ARFID and achieve a healthier, more balanced relationship with food.
