Feeding Disorder Of Infancy And Early Childhood
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Avoidant/Restrictive Food Intake Disorder

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 studied.

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 development.

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?

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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 should
  • 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 next checkup.

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?

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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 something.
  • 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 a child.
  • Your child just doesn’t like foods of certain textures, tastes, or smells.

How Is ARFID Diagnosed?

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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 month
  • 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 child to:

  • 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?

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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?

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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. 

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