Pediatric avoidant-restrictive food intake disorder (ARFID)

What is pediatric avoidant-restrictive food intake disorder (ARFID)?

ARFID is different from other eating disorders because children with ARFID aren’t worried about being thin. Their anxiety is not about their body, it’s about food. Children with ARFID struggle to eat a variety of foods. And parents of children with ARFID struggle to know how to help.

ARFID often starts in young children who don’t eat properly, often affecting their growth. Their extreme picky eating means they don’t get all the nutrients they need. This can make doctors and parents worry about their child’s health. And it can make dinner invitations, outings and school meals stressful.

ARFID can affect a child’s health, mood, behavior and energy level. As children get older, ARFID can also impact their social life. It gets harder to do fun things like attend parties, go to camp or have a sleepover.

What are the different types of avoidant-restrictive food intake disorder (ARFID)?

There are three different types of ARFID:

1. Medically complicated ARFID - When children have a medical problem (like Crohn’s disease or cancer) that triggers a change in their eating

2. Sensory-based ARFID - When children struggle with the color, texture, smell and taste of different foods

3. Trauma-related ARFID - When children have a traumatic event that changes their eating habits. These events may include things such as a choking episode.

What are the signs and symptoms of pediatric avoidant-restrictive food intake disorder (ARFID)?

The first sign that you – or your child’s doctor – may notice is that your child isn’t gaining enough weight for their age or height because they’re not getting enough nutrients.

Boys and girls with ARFID may also show some of these signs at mealtimes:

• Avoiding or refusing an entire category of food, like fruits and veggies

• Only eating particular brands

• Only eating foods with certain textures

• Preferring foods with carbs

• Not eating what the rest of the family eats

• Avoiding eating or taking a long time to eat

• Being very specific about which foods they’ll eat at which restaurants; insisting on only eating certain menu items

• Stopping eating certain foods that they used to eat (“I’m not going to eat my favorite muffin anymore.”)

You might also notice some social and emotional signs. A child with ARFID may:

• Not want to go to events with food, such as birthday parties

• Having tantrums or behavior problems

• Not having a lot of energy

• Having trouble focusing in school

How is pediatric avoidant-restrictive food intake disorder (ARFID) diagnosed?

One of our doctors will do a physical exam and ask questions about your child’s health history. We want to make sure your child doesn’t have a physical problem that affects how they eat.

For example, some children have jaw muscles that aren’t strong enough to chew well. Others may have problems swallowing. These problems may be causing or contributing to their eating problems. In those cases, we’ll connect you to the right specialist who can help, like an occupational therapist (OT), speech therapist or gastroenterologist.

We’ll also ask questions about your child’s behavior and eating habits. This helps us get a full picture of just how much your child’s picky eating affects their health and well-being.

What are the causes of pediatric avoidant-restrictive food intake disorder (ARFID)?

Many parents think, “I must have caused this to happen.” But you are not the cause and you can be part of the solution.

ARFID often starts in young children and can have one or more of these causes:

• Lack of interest in food - Some children just aren’t very interested in food from an early age. They get full quickly. And they have growth issues from eating so little.

• Sensory challenges - Some children eat normal amounts of foods, but only foods with certain textures or tastes. Many of these children are “supertasters” who can taste flavors that other kids can’t. This can make certain foods taste strange.

• Eating-related trauma - If a child chokes on food or watches someone else choke, it can make them scared to eat. Sometimes a bad stomach bug can cause a child to refuse to eat long after they get better.

• Stomach or digestive problems - Children who have the following might start avoiding food because it makes them feel sick. And children who feel sick to their stomach from medical treatments can sometimes develop ARFID.

  • Celiac disease

  • Inflammatory bowel disease

  • Constipation

How is an pediatric avoidant-restrictive food intake disorder (ARFID) treated?

ARFID affects a child’s body and mind and is best treated by a team of specialists who work together to address every aspect of your child’s health.

Children and families who take part in our four-week ARFID treatment program benefit from:

Individual and family therapy - Addresses behavior and eating habits, stressful or traumatic events, and identify any other mental health or physical issues. We use games and fun activities to connect with younger children. We also help you create a behavior plan to motivate your child to expand what they’ll eat.

• Group therapy - To help children and teens overcome fears around food and support each other in the process. We have separate groups for younger children and teens.

• Multifamily therapy - To help you connect with other families with children who have ARFID, so you can share tips, tricks and struggles.

• Occupational therapy (OT) - To learn exactly which textures, odors, temperatures and colors may trigger your child.

• Experiential therapy - To help children connect to their bodies and their feelings through art, music and recreation therapy.

• Meal therapy - To help your child slowly experience new foods, one bite at a time. We understand your child’s anxiety that can be caused by eating certain foods.

• Medication management - to help with problems like anxiety, obsessive compulsive disorder, depression, self-injury or PTSD. These problems can contribute to ARFID.

• Parent skills group - To teach parents how to set limits and motivate their child. We’ll empower you to continue the work of expanding what your child eats and help you to feel confident in your ability to manage your child’s eating problems at home.

Our specialists include:

• Child psychiatrists - Doctors that can diagnose and treat mental health and physical problems. Some children with ARFID may have other mental health diagnosis such as anxiety or Autism Spectrum Disorder (ASD).

• Child psychologists and licensed therapists - Provides individual, group and family therapy.

• Nurse practitioners - Oversees any medical care your child may need.

• Nurses - Provides nursing care and support to your child throughout their treatment.

• Dieticians - Works with you to know what foods to add to your child’s diet, and make sure your child is getting the nutrients they need to be healthy.

• Milieu therapists - Provides daily, ongoing guidance and support for all your child’s activities. They accompany your child in the hospital all day and provide continuous support and companionship.

• Occupational therapists (OT) - Works with your child to help them get better at finding and trying new foods they’ll like.

• Recreational, art and music therapists - Helps your child process feelings in creative ways.

• Our friendly service dog - Brings smiles, companionship and calm to children who like dogs.