What is ARFID?

ARFID is avoidant restrictive food intake disorder. It’s an eating disorder and a serious mental health condition.

Children 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. They might also feel very upset while eating or find it hard to eat in social situations.

Children with ARFID might restrict what they eat because they:

• have a low appetite or aren’t interested in eating
• are highly sensitive to the colour, smell, texture or taste of some or most foods
• fear that something bad will happen when they eat, like pain, nausea, vomiting or choking.

Unlike young people with other eating disorders, children with ARFID aren’t trying to lose weight or thinking about their body shape. They aren’t unhappy with their bodies, and they might seem to be at a healthy weight.

Sometimes ARFID develops in early childhood. And sometimes it develops at a later age after a stressful or bad experience with food. ARFID can continue into adulthood.

What’s the difference between fussy eating and ARFID?

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 enjoying different foods and start trying these foods themselves. But it’s common for children to try new foods 10-15 times before they accept and enjoy them. And it’s common for children to continue to dislike a few foods, but this won’t affect their growth or development.

ARFID is more than just fussy eating. Children with ARFID need a lot of support to try new foods and to eat enough food for healthy development.

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

ARFID symptoms and signs

ARFID symptoms and signs can vary a lot.

Physical symptoms and signs

Children with ARFID might:

• lose weight or not gain weight as expected
• grow and develop poorly
• have poor nutrition
• 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 development.

Behavioural symptoms and signs

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 symptoms and signs

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 childhood depression, teenage depression, childhood anxiety or teenage anxiety.

What to do if your chid has ARFID symptoms

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, it’s important to talk with your child and your GP as soon as you can.

It might be a difficult conversation with your child, but it will help you understand more about what’s going on. Try to stay calm and non-judgmental. Focus on your child’s health and wellbeing.

If you’re not sure how to talk with your child about these issues, you could ask your GP or a mental health professional for help. You can also contact the Butterfly Foundation by calling the free national helpline on 1800 334 673 or using the Butterfly Foundation webchat.

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.

How is ARFID diagnosed?

There’s no single test to diagnose 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 your child to a paediatrician, a mental health professional like a psychologist, or a dietitian. These professionals can confirm your child has ARFID and recommend appropriate treatment.

How is ARFID treated?

If your child is diagnosed with ARFID, their ARFID treatment will depend on their needs.

Psychological therapy

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 emotions, stress and sensory sensitivities while eating
• help your child understand how it feels when they’re hungry or full
• help your child develop healthy eating behaviour
• improve your child’s physical health.

Medicines

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

Your doctor or dietitian might prescribe nutritional supplements if your child needs them.

Hospital

Your child might need to go to hospital to be treated for the physical effects of ARFID. This will depend on their weight, symptoms and other health issues.

Hospital treatment usually focuses on supporting children at regular mealtimes and encouraging them to eat and gain weight. Children might also be given nutritional supplements.

With treatment, love and support, your child can recover from ARFID and maintain healthy eating habits. But they might get ARFID again. If you notice your child is showing ARFID symptoms again, contact your doctor as soon as possible.

How to help your child with ARFID at home

One of the most important things you can do to support your child with ARFID is to show that you love and care for them. This can be as simple as:

• stopping to listen when your child wants to talk
• spending one-on-one time with your child
• giving your child a hug.

It’s also a good idea to ask your child’s mental health professional for specific things that you can do at home to support your child’s ARFID recovery.

In addition to any strategies that the mental health professional suggests, here are strategies you can try at home with your child:

• Encourage self-compassion for children and self-compassion for teenagers. When your child is hard on themselves, encourage them to speak to themselves as they’d speak to a close friend or someone they love in a similar situation.
• Plan enjoyable activities. Encourage your child to do something that they enjoy, like reading or playing soccer. These activities can lift your child’s mood and energy, even when their motivation is low. They can also improve your child’s self-esteem and reduce their focus on their eating difficulties.
• Use active listening with children and active listening with teenagers. Let your child tell you how they feel about eating and food. Accept your child’s feelings and avoid making judgments if you can.
• Talk about social media. Talk about the type of content that your child sees online and its accuracy. You can challenge inaccurate information and help your child find more reliable information.

ARFID causes and risk factors

It isn’t known what makes some children more likely than others to develop 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 special diets.

Children with ARFID are more likely than other children and teenagers to:

• dislike or be sensitive to particular tastes, smells or textures
• have past distressing or traumatic experiences with food, like choking or vomiting – children might have had these experiences themselves or have seen them happen to someone else
• have anxiety disorders
• have a family history of ARFID
• be neurodivergent.

ARFID can occur in both girls and boys. It’s more common in girls, but it affects more boys than other eating disorders.

ARFID and autism

Some autistic children have fussy eating habits. And there’s some overlap between fussy eating and autism and ARFID.

If your child has a diagnosis of autism and also has fussy eating habits, it’s a good idea to speak to your GP or paediatrician.