Avoidant/Restrictive Food Intake Disorder (ARFID)

What Is ARFID?

Avoidant/restrictive food intake disorder (ARFID) is a fairly new eating disorder. Children with ARFID are extremely selective eaters and sometimes have little interest in eating food. They may eat a limited variety of preferred foods, which can lead to poor growth and poor nutrition.

ARFID usually starts at younger ages than other eating disorders and is more common in boys.

What Are the Signs of ARFID?

Kids with ARFID fall within three main categories:

Some kids are very selective eaters who may have strong negative reactions to smells, tastes, textures, or colors of foods. They may be highly fearful of new foods, called “neophobia,” and scared of negative experiences related to unfamiliar foods.
Some kids may have an overall lack of interest in eating and have a very low appetite or find eating minimally rewarding or not at all. These kids often deny feeling hungry.
Other kids are afraid of what might happen when they eat; for example, experiencing pain, choking, or vomiting.

Some kids with ARFID fall within just one of these categories, while others are in more than one.

Many kids with ARFID are underweight. Others reach a normal weight but may eat such a limited diet that they don’t grow, or it gets in the way of their school, family, and social lives.

Kids with ARFID are more likely to have:

anxiety or obsessive-compulsive disorder (OCD)
autism spectrum disorder or attention deficit disorder (ADHD)
problems at home and school because of their eating habits

What Problems Can Happen with ARFID?

ARFID may lead to problems from poor nutrition. Kids with the disorder may:

not get enough vitamins, minerals, and protein
need tube feeding and nutrition supplements
grow poorly
have delayed puberty

The lack of nutrition associated with ARFID can cause:

dizziness and fainting due to low blood pressure
a slow pulse
dehydration
weakened bones (osteoporosis) and muscles
stopped menstrual periods (amenorrhea)

What Causes ARFID?

The exact cause of ARFID is not known. Many experts believe that a combination of a child’s temperament, genes, and triggering events (such as choking). Some kids with ARFID have gastroesophageal reflux disease (GERD), eosinophilic esophagitis, allergies, or other medical conditions that can lead to feeding problems.

How Is ARFID Diagnosed?

If a doctor thinks a child might have ARFID, they'll do an exam and ask about the child's medical history, eating and exercise habits, and emotional issues.

Doctors and mental health professionals will look for:

significant weight loss or failure to grow
serious nutritional deficiencies
poor appetite, lack of interest in food, or food avoidance

Symptoms should not be because of a lack of access to food (food insecurity), another eating disorder (anorexia), or other medical problems. Kids with ARFID are also not concerned about or afraid of their weight.

Doctors may order blood tests, urine tests, or an electrocardiogram (ECG) to check for problems.

If you think your child may have ARFID, talk to your doctor. Dealing with the condition early on is the best way to successfully treat it.

How Is ARFID Treated?

ARFID is best treated by a team that includes a doctor, dietitian, and therapist who specialize in eating or feeding disorders. Treatment may include nutrition counseling, medical care, and feeding therapy. If choking is a concern, a speech-language pathologist can do a swallowing and feeding evaluation.

The main goals of treatment are to:

Achieve and maintain a healthy weight and healthy eating patterns.
Increase the variety of foods eaten.
Learn ways to eat without fear of pain or choking.

Doctors might prescribe medicines to increase appetite or treat anxiety. If anxiety is a concern, the therapist will teach children and families ways to handle worries around food.

Most children with ARFID can be treated at home, but some will need to go to a more intensive hospital-based program. Someone with severe weight loss and malnutrition or serious health issues will need treatment in a hospital. Some children with ARFID will need tube feeding or nutrition formulas to get the calories and vitamins they need.

ARFID can be hard to overcome, but learning about healthy eating and addressing fears helps many kids and teens feel better and do well. When the whole family works together to change mealtime behaviors, a child is likely to have continued success.

How Can Parents Help?

ARFID is linked to strong emotions and worries around food. Be supportive and encourage positive attitudes about exercise and nutrition at home. Try these tips:

Be a role model. Serve and eat a variety of foods.
Schedule regular meals and snacks.
Have regular family meals. Keep the mood at the table pleasant and avoid struggles during mealtimes.
Encourage your child to try new foods, but do not force them to eat.
Reward positive eating behaviors.
Find ways to manage anxiety and stress around food. Taking a couple of deep breaths can help your child relax. Yoga, meditation, music, art, dance, writing, or talking to a friend can help manage stress.
Stay calm and avoid blaming or criticizing your child for their eating struggles.

If you are concerned your child may have an eating disorder, call your doctor for advice. The doctor can recommend nutrition and mental health professionals who have experience treating eating disorders in kids and teens. You also can find support and more information online at: