About avoidant restrictive food intake disorder (ARFID)

Avoidant restrictive food intake disorder (ARFID) is an eating disorder and a serious 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 and teenagers 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 certain foods or most foods
• fear that something bad will happen when they eat – for example, pain, nausea, vomiting or choking.

Unlike children and teenagers with other eating disorders, children and teenagers with ARFID aren’t trying to lose weight or thinking about their body shape. They aren’t unhappy with their bodies.

Some children or teenagers might develop ARFID in early childhood. In other children or teenagers, 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 and try 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 some foods.

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

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 and teenagers with ARFID might:

• lose weight or not gain weight as expected
• 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 development.

Behavioural signs and symptoms
Children and teenagers 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 and teenagers 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 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 for 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 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.

Treatments, therapies and supports 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.

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

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

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

Hospital treatment usually focuses on supporting children and teenagers at regular mealtimes and encouraging them 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 get sick again. 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 and teenagers more likely than others to develop avoidant restrictive food intake disorder (ARFID).

Some children and teenagers might have genetic factors that make them more sensitive to certain tastes.

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

• an increased number of taste buds on their tongue, which means that bitter flavours taste stronger
• past bad experiences with food, like choking or vomiting – either themselves, or seeing it happen to someone else
• anxiety disorders.

ARFID can occur in both girls and boys but, unlike other eating disorders, it’s more likely to occur in boys.

Avoidant restrictive food intake disorder (ARFID) and autism

Some autistic children and teenagers have fussy eating habits. And there’s some overlap between fussy eating and autism and avoidant restrictive food intake disorder (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.