ARFID in Children: Understanding Symptoms and Treatment Options
Table of Contents
What does ARFID look like in children?
Avoidant/restrictive food intake disorder (ARFID) is unique in the world of eating disorders.
Children with ARFID may avoid eating for several possible reasons:
- They are concerned with how foods taste.
- They don’t like the texture and physical qualities of foods, including what they look like or feel like.
- They have a low interest in eating, don’t enjoy eating or rarely feel hunger.
Young people with ARFID do not avoid eating in order to change their body shape or lose weight, which is commonly seen with eating disorders like anorexia or bulimia.
In this article, we explore common symptoms of ARFID in children. We also share details about the different types of ARFID.
As you read, you’ll find helpful resources for families and caregivers along with today’s most effective ARFID treatment options for children.
ARFID symptoms in children
In the table below, we compare typical childhood eating behaviors with possible ARFID symptoms in children
| Typical Childhood Eating Behavior | Potential Symptoms of ARFID |
|---|---|
| Accepts new solid foods from six to eight months old to early and middle childhood | Delays accepting new solid foods to 18 months or two years old |
| Eats at least a few foods from each of the major food groups: grains, proteins, dietary fats, dairy, fruits and vegetables | Eliminates entire categories of food |
| Expands variety of foods in preteen and adolescent years as taste buds change and develop | Shrinks variety of foods over time |
When it comes to babies, toddlers and young children, many parents often express concerns about their child’s food intake. It’s not uncommon for a parent to notice that their child has strong food likes and dislikes.
However, ARFID is different; it morphs into significant avoidance of or distress around food, leading to concerns about the child’s nutritional health, growth and development.
ARFID tends to show up more commonly in younger kids compared to other eating disorders.
Signs of ARFID to watch for
At age 3 years, a child’s taste buds start to change. Some caregivers will notice an increase in picky eating around this time. This is often normal.
So how can a parent or caregiver know if their child is developing typically or may be at risk for an eating disorder? If a child refuses to accept new foods or limits the number or types of foods they eat, you may want to discuss this with their doctor.
Here are some additional signs of ARFID to watch for in younger children:
- A baby or toddler who is developing ARFID may be difficult to feed. They may not be interested in eating or might have trouble transitioning to solid foods or new foods.
- Ideally, children will eat at least a few different foods from the major food categories (grains, proteins, fats, dairy, fruits and veggies). Children with ARFID may not do this.
- A person with ARFID will not be able to meet their nutritional needs. Eating a very restricted diet is a sign of ARFID and could be associated with increased health risks.
Remember, it is normal for a child’s taste buds to change every few years. This is why you often see adolescents and teens waiting to try more adventurous foods until they get older.
While ARFID can show up in early or middle childhood, some individuals aren’t diagnosed until adolescence or adulthood.
Note: if a child or adolescent is restricting their eating due to concerns about their body size, shape or weight, it is more likely that they are experiencing another type of eating disorder, and not ARFID.
How common is ARFID in children?
An estimated 5-22% of children and adolescents will be diagnosed with ARFID.
ARFID wasn’t formally recognized as an eating disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders until 2013. Therefore, it is hard to get exact estimates on this eating disorder in the general public since ARFID isn’t as well understood as other eating disorders like anorexia and bulimia.
To learn more about how common ARFID is in children, we spoke to clinical psychologist Michelle Jones, PhD, clinical manager at Eating Recovery Center (ERC), on a recent ARFID episode of the Mental Note podcast. Dr. Jones has studied ARFID since it first became a diagnosis over a decade ago.
"Nearly a quarter of people in higher levels of eating disorder treatment come in with an ARFID diagnosis.[1]
It's very important to continue to raise awareness of ARFID so patients receive an appropriate diagnosis to inform their recovery plan."
The 3 types of ARFID in children
While ARFID can affect people at any age, it is more common in children and adolescents. The subtypes of ARFID are similar for people of all ages, and there are three distinct subtypes:
- Sensory sensitivity, which causes a strong negative reaction to certain foods
- Fear of aversive consequences, which causes worry over how the body will react to food
- Lack of interest in eating, which causes limited or insufficient intake
Each subtype also has a strong connection to co-occurring conditions.
If your loved one has been diagnosed with another neurodevelopmental or mental health condition, such as autism, obsessive-compulsive disorder (OCD) or attention-deficit/hyperactivity disorder (ADHD), this article may help you better understand what they are experiencing.
Type 1: Sensory sensitivity subtype
Sensory sensitivity is a subtype of ARFID that involves avoiding foods that cause a strong and unpleasant sensory reaction.
Usually, the reaction is based on the food’s taste or texture, but it can also be about the food’s smell, temperature, color or other aspect of its appearance.
Type 2: Fear of aversive consequences subtype
Fear of aversive consequences is another subtype of ARFID that involves avoiding foods, but for a different reason.
Past trauma related to eating, or even perceived trauma, causes an intense fear of:
- Vomiting
- Choking
- Allergic reaction
- GI symptoms, or
- Pain
Type 3: Lack of interest subtype
In the last subtype, lack of interest in eating, people simply don’t enjoy food or are annoyed that they have to stop what they are doing to eat.
They don’t look forward to eating and don’t find it rewarding. Meals seem like a chore, so they put it off or forget about it.
ARFID, autism, anxiety, ADHD and OCD
As we mentioned in the section above, ARFID is strongly connected to certain co-occurring conditions, outlined in the table below.
| ARFID Subtype | Overlapping Condition |
|---|---|
| Sensory sensitivity | Autism spectrum disorder |
| Fear of aversive consequences | OCD |
| Lack of interest in eating | ADHD |
ARFID and autism
The sensory sensitivity subtype of ARFID has significant overlap with other conditions that involve sensory sensitivity, particularly autism spectrum disorder.
Signs of this subtype of ARFID that can appear in children include:
- Failure to maintain body weight and nutritional needs
- Deficits in growth and development
- Issues with psychological or social functioning (e.g., anxiety around food)
There is a clear connection between autism and ARFID. However, it’s important to note that not every person with autism has ARFID, and some people have been misdiagnosed with autism when they solely had ARFID.
ARFID and OCD
The fear of aversive consequences subtype of ARFID can overlap with OCD. Both involve similar patterns of thought.
The person is deeply afraid of, say, vomiting or choking. They experience unwanted, intrusive thoughts (obsessions), then try to neutralize them by avoiding or restricting food (compulsions).
“I have yet to meet a child or adult with a fear of aversive consequences," explains Dr. Jones, "who doesn’t also have OCD or another anxiety disorder, diagnosed or undiagnosed. They tend to be temperamentally a little bit more anxious than the average person."
See how exposure therapy can help those with OCD-like symptoms.
ARFID treatment for children
It can be overwhelming or worrisome to realize that your child may need professional help for an eating disorder like ARFID.
The good news is that there are many supportive clinicians who are passionate about helping children and families through these challenges.
There are also multiple effective interventions that you can try to help your child rebuild their relationship with food.
“One of the things that I feel passionate about is making sure that we are not forcing anyone with an ARFID diagnosis into our expectations of recovery,” shares Dr. Jones.
“This is really about their life and their functioning and how can we help them function in a way that is going to better their life and not cause adverse experiences.”
So, what does ARFID treatment look like in practice?
- The first priority of treatment is to fill any nutritional gaps and to support their body’s natural weight.
- Eating behaviors are then addressed slowly, over time, and within the person’s comfort zone.
Think about it like this: You are (slowly) helping your child make adjustments to their daily life and relationship with food that will ultimately lead to a more fulfilling and functional life for them.
ARFID treatment examples
Your loved one can heal from ARFID with a learning mindset, a lot of support and plenty of practice.
Dr. Jones shares a common example of an ARFID intervention with children.
"We might help them identify food they can take to school for lunch, because they won't eat anything in the school cafeteria.
If they don’t eat lunch, they're going all day at school without eating anything at all.
And that's not good for their health or their growth or their development or socialization or anything like that.”
In treatment children with ARFID are given specialized care, support and structure, helping them meet their individual needs.
“In treatment, we want to fill the most important nutritional gaps. If the child has no sources of protein that they're consuming, or no significant sources of protein, we're going to try to help them with that in a way that feels appropriate and comfortable for them.
The primary focus of ARFID treatment is to improve functioning and physical health more than anything else,” explains Dr. Jones.
Goals of ARFID treatment
Individual goals of ARFID treatment may include:
- Overcoming food fears through exposure therapy
- Getting into consistent eating routines to satisfy the body’s needs throughout the day
- Developing meal plans that include low-effort fast foods, frozen foods and other prepackaged options
- Ordering confidently from restaurant menus
- Introducing new foods based on current flavor profile preferences
- Helping young people challenge the eating disorder so they can begin to develop a pattern of eating that meets their nutritional needs
- Developing ways of coping with discomfort or distress that happen during this time of growth
Once the child gets into a routine of eating more regularly, they will start to feel better physically. Their brain will start to function better.
Treatment can help them break free from extremely restricted eating patterns and they may be open to trying a wider variety of foods over time.
What types of food will my child eat?
Keep in mind that people with ARFID may never eat a typical diet or what some people might consider “normal” -- enjoying a wide variety of foods -- and that’s OK.
We explain to patients and their families that frozen foods, fast foods, prepackaged foods and convenience foods are all possible choices, giving individuals a chance to expand their list of food options.
While a parent may prefer an all-organic, cooked-from-scratch meal plan, that might not be the most sustainable option for their loved one on a regular or long-term basis.
Learn more about ERC's nutrition program for eating disorders.
How to find ARFID treatment near you
Eating Recovery Center is the only health care system in the country dedicated to the treatment of ARFID at all levels of care, including:
- Virtual intensive outpatient program (virtual IOP), online program, three to four days a week
- Intensive outpatient program (IOP), in-person day treatment, three to four days a week
- Partial hospitalization program (PHP), in-person day treatment, seven days a week
- Residential program, 24-hour medical and psychiatric support in a comfortable, healing environment
- Inpatient program, 24/7 nursing supervision, medical management and oversight by a full-time primary care physician
If you think you or someone you care about may have ARFID, give us a call at 866-622-5914 or send us a quick note for a free and confidential assessment. When you’re ready to move forward, our team is here for you.
Free support groups for parents & caregivers
Try one of our free, online eating disorder support groups for caregivers of children with ARFID. And we’d love for you to listen to our helpful and informative podcast on ARFID, featuring Dr. Jones.
Learn more about ARFID and find support in our free virtual educational series “Supporting Loved Ones with ARFID” taking place in September and October 2024.
Read more articles on this topic:
Sources
- Nicely, T. A., Lane-Loney, S., Masciulli, E., Hollenbeak, C. S., & Ornstein, R. M. (2014). Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. Journal of Eating Disorders, 2(1), 21. doi: 10.1186/s40337-014-0021-3.
Bibliography
Archibald, T., & Bryant-Waugh, R. (2023). Current evidence for avoidant restrictive food intake disorder: Implications for clinical practice and future directions. JCPP Advances, 3(2), e12160. https://doi.org/10.1002/jcv2.12160.
Mammel, K.A., & Ornstein, R.M. (2017). Avoidant/restrictive food intake disorder: A new eating disorder diagnosis in the diagnostic and statistical manual 5. Current Opinion in Pediatrics, 29(4),407-413. doi: 10.1097/MOP.0000000000000507.
