Having mealtime battles with your toddler or older child is no fun. In fact, it can be downright scary. What about when picky eating seems like it is more than “picky eating”? Maybe you’ve heard about picky eating gone too far and are asking, “What is ARFID?”
This article will help you understand the differences between “picky eating” and Avoidant Restrictive Food Intake Disorder (ARFID).
What is picky eating?
A “picky eating” phase is normal in young children – especially between the ages of two and four years old. Unfortunately, there isn’t a widely accepted definition of picky eating. One definition that covers a lot of what I see in my practice with picky eating is “unwillingness to eat familiar foods or to try new foods, as well as strong food preferences.”1
What this looks like is your child rejecting foods they used to eat or refusing to try new foods even though you’ve put the food on the table, or their plate, multiple times. They may have a list of foods that they will eat and all other foods are no-gos.
Picky eating can lead to eating a limited variety of foods. You’re concerned that your child isn’t meeting their nutritional needs. If there may be a lack of variety of foods, however, the child continues to meet growth markers and stay on the trajectory of the height-weight charts as they get older, they may be OK.
However, there are a few things picky eating does not lead to:
- Weight loss
- The inability to meet nutritional needs to maintain their growth pattern
- Difficulty eating out or attending social gatherings due to fear that acceptable food won’t be available.2
You may find that some or all of the things picky eating isn’t (listed above), are happening. What then?
What is Avoidant Restrictive Food Intake Disorder (ARFID)?
Let’s talk about what ARFID is, so you have an idea about what you may be dealing with.
ARFID is a newly designated eating disorder. The formal definition of ARFID is an “eating or feeding disturbance that manifests by persistent failure to meet appropriate nutritional and/or energy needs associated with one or more of the following:
- Significant weight loss (or failure to achieve expected weight gain or faltering growth in children)
- Significant nutritional deficiency
- Dependence on enteral feeding or oral nutritional supplements
- Marked interference with psychosocial functioning.”3
As opposed to picky eating, ARFID causes the trajectory on the height-weight chart to plummet. Basically, the child may be following a consistent growth pattern then fall off the curve.
ARFID, and the reasons it develops, are not well understood. “[P]sychological, genetic, and triggering events (such as choking) can lead to the condition. Some kids with ARFID have gastroesophageal reflux disease (GERD) or other medical conditions that can lead to feeding problems.4
Some of the ways ARFID presents include:
- Having a lack of interest in food and eating
- Getting full quickly
- Having issues with food smells, tastes, textures, and temperature
- Fear of choking, becoming sick, or even a fear of dying from eating 5, 6
ARFID may result in an intense fear or anxiety about food and eating. The fear can be so extreme that there is a fear of dying if a food is eaten. Fear derived from ARFID may cause the mouth, throat, and digestive tract to constrict and stop a variety of foods from being eaten. 6
Someone with ARFID may not eat due to fear or anxiety even though they feel hungry.
ARFID is different from anorexia nervosa and bulimia nervosa because it is not driven by the desire to change the body’s shape or size, or a fear of weight gain.
Now that you know what ARFID is, you’re probably wondering what the risk factors are for developing ARFID.
Risk factors for developing ARFID
Since ARFID is not well understood, all of the risk factors are not understood. There are a few risk factors that have been shown to be associated with ARFID development:
- Autism spectrum disorders, ADHD, and intellectual disabilities
- Not outgrowing picky eating or having severe picky eating
- Having a co-occurring anxiety or mood disorder7, 8
Now that you know more about what ARFID is and isn’t you are probably wondering how it is diagnosed.
How is ARFID diagnosed?
An ARFID diagnosis takes the involvement of a couple of people – a medical doctor and a mental health professional, and possibly a registered dietitian.
A medical doctor can evaluate and determine whether or not there are signs of malnutrition. This involves both a physical exam and some tests such as blood work.
A mental health professional will evaluate based on the criteria in the DSM-5 and use other screening tools that are appropriate based on age.
A registered dietitian will evaluate eating patterns, allowed and restricted foods.
Together, the medical doctor, the mental health professional, the registered dietitian, the family, and the individual can determine whether moving forward with treatment for ARFID is appropriate.
Treatment options for ARFID
The good news is that treatment for ARFID is effective. The treatment depends on the underlying causes – anxiety, sensory disorders, etc. Normally, a treatment team is involved that includes a medical doctor, a mental health professional, and a registered dietitian. The treatment will be specific for the reasons why ARFID developed.
In my practice, we follow a multidisciplinary approach to treating ARFID. We require our patients to work with an ARFID-trained therapist and to have a medical provider on board for medical management. This allows us to focus on our role as a registered dietitian to work on food exposures and meeting nutritional needs to accelerate growth and improve health.
Picky eating is normal in kids, particularly in those between 2 and 4 years old. However, if the child’s normal growth pattern stops, or signs of nutritional deficiency appear, ARFID may be starting to develop. If you’re not sure about what is happening with your child, you can set up an appointment.
- Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes https://pubmed.ncbi.nlm.nih.gov/26232139/