Pediatric Avoidant/Restrictive Food Intake Disorder (ARFID)

What is ARFID (Avoidant/Restrictive Food Intake Disorder)?

ARFID means children have a strong dislike for certain foods or eating in general. Unlike other eating disorders, children with ARFID aren’t worried about being overweight. Their anxiety is about the effects of food itself. They may be overwhelmed by the taste, texture or smell of certain foods. Or they may avoid foods because of past negative experiences.

ARFID often starts in young children. Their extreme picky eating means they don’t get all the nutrients they need. As a result, ARFID can affect a child’s health, growth, 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 ARFID (Avoidant/Restrictive Food Intake Disorder)?

There are three different types of ARFID:

1. Trauma-based ARFID: Children with this type change their eating habits in response to a life event or experience. For example, children may develop ARFID after a choking episode. Symptoms of a medical problem like Eosinophilic esophagitis or celiac disease can also lead children to be extra picky or reluctant about eating.

2. Sensory-based ARFID: This type occurs when children struggle with the color, texture, smell or taste of different foods

3. Lack of Interest ARFID: Children with this type have a limited appetite, get full easily and are not interested in eating food.

What are the signs and symptoms of ARFID (Avoidant/Restrictive Food Intake Disorder)?

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. This can happen because they’re not getting enough nutrients.

At mealtimes, children with Avoidant/Restrictive Food Intake Disorder may also show signs like:

• 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

• Not eating certain foods that they used to enjoy (“I’m not going to eat muffins anymore”)

You might also notice some social and emotional signs, such as:

• Not wanting 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 ARFID (Avoidant/Restrictive Food Intake Disorder) diagnosed?

One of our doctors will talk to you to about your child’s eating habits. Then we will do an assessment with your child and ask about their health history.

The assessment helps us see if your child has a physical problem that contributes to their eating habits. For example, some children have jaw muscles that aren’t strong enough to chew well. Others may have problems swallowing. In those cases, we’ll connect you to a specialist who can help, like an occupational therapist, 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 selective eating disorder affects their health and well/being.

What are the causes of ARFID (Avoidant/Restrictive Food Intake Disorder)?

Many parents think, “I must have caused this to happen.” But you are not the cause.

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 too 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 them avoid certain foods.

• 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 avoid food long after they get better.

• Stomach or digestive problems: Children with conditions like celiac disease, inflammatory bowel disease or constipation might avoid food because it makes them feel sick. Some children who receive medical treatments that make them nauseous can also develop a food aversion disorder.

How is ARFID (Avoidant/Restrictive Food Intake Disorder) treated?

ARFID affects both a child’s body and their mind. The best treatment comes from a team of specialists who work together to address every aspect of your child’s health.

Children’s Health has a four-week ARFID treatment program that includes a wide range of treatments. Children and families come in a few hours a day for different sessions. Treatments include:

• Individual and family therapy: These sessions help children and families address eating habits, uncover stressful or traumatic events and identify other mental health or physical issues that may be involved. 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: These sessions bring children together to help them overcome food aversions and support each other. We have separate groups for younger children and teens.

• Multifamily therapy: Families connect with each other so they can share tips, tricks and struggles.

• Experiential therapy: Children learn to connect to their bodies and their feelings through art, music and recreation therapy.

• Meal therapy: Children slowly experience new foods, one bite at a time.

• Medication management: Some children with ARFID also struggle with anxiety, obsessive compulsive disorder, depression, self-injury or PTSD. We may prescribe or adjust medication to help with these issues.

• Parent skills group: Parents learn how to set limits and motivate their child. We’ll empower you to continue helping your child navigate their aversions and expand what they eat at home.

During the program, you may work with several different specialists.

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

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

• Nurse practitioners oversee any medical care your child may need.

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

• Dietitians work 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 provide 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.

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

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