Avoidant Restrictive Food Intake Disorder (ARFID)

Key points about ARFID 

• ARFID is an eating disorder and a serious mental health condition
• tamariki with ARFID either strongly dislike or avoid food or restrict their food intake for different reasons
• this can affect their growth, development, health and wellbeing
• having ARFID can lead to significant weight loss and health concerns when a child isn’t meeting their nutritional or energy needs
• unlike with other eating disorders, tamariki with ARFID don't limit their food intake because of concerns with their body weight or shape
• it's important to recognise eating disorders as early as possible and get help for your child straight away

What is ARFID? 

Avoidant restrictive food intake disorder (ARFID) involves ongoing feeding or eating issues that can cause tamariki to avoid food. It is more than just ‘picky eating’, which is common among tamariki. Tamariki with ARFID eat only a small range or amount of food. They often have an extreme dislike of certain foods or are generally not interested in food or eating.  

Tamariki with ARFID might restrict their food intake for a few different reasons. ARFID can look very different from one child to another. There can be more than one reason for avoiding food.

Sensory aversion

Some tamariki are very sensitive to how food feels, smells, tastes or looks. This is more extreme than just disliking certain foods. Their deep dislike of the sensation of food causes them to avoid eating. 

Fear of consequences

Some tamariki may avoid eating because they are worried about what will happen when they do. This could be a fear of things like vomiting, choking or pain. They might deal with this by avoiding certain foods and only eating foods they think are ‘safe’.

Lack of interest in food

Some tamariki don’t feel as hungry as others, or they have a ‘low appetite’. These tamariki may see eating as a chore. This can lead to them not eating enough food to stay well. 

Is ARFID an eating disorder?

Yes, ARFID is an eating disorder and a serious mental health condition. But, unlike other eating disorders, tamariki with ARFID don’t restrict their food intake because of concerns about their body weight or shape.

ARFID can look similar to anorexia nervosa, as some tamariki with ARFID significantly limit their food intake. Not eating the right quantity or variety of food can lead to medical problems. Other tamariki with ARFID may eat enough to maintain their body weight. But, eating a small range of foods may lead to low levels of important vitamins and nutrients. 

See the KidsHealth's page on eating disorders for more information on different types

What causes ARFID? 

There is not one single cause for ARFID. Experts are still trying to understand what makes some people more likely to develop ARFID. 

ARFID may happen due to a mixture of reasons such as environment, upbringing, health and genetics. Some tamariki may have a medical condition that puts them at risk of ARFID. This can sometimes occur with medical conditions that affect the digestive system or require special diets. 

ARFID may also happen after a child has a bad experience with food. This could be something that happened to them or something they saw, such as choking, gagging or vomiting.

Who is at risk of getting ARFID?

ARFID is common in tamariki and also occurs in rangatahi. ARFID occurs in both girls and boys but is more common in boys. ARFID most often develops in early childhood and can last into adulthood.

Could my child have ARFID, or are they a picky eater? 

Picky eating is common in tamariki, but it is very different to ARFID. ARFID is more than just fussy or picky eating. Tamariki with ARFID will deeply dislike certain foods or generally lack interest in food or eating. The behaviours in ARFID are ongoing and can cause serious medical problems.  

It is common for tamariki to dislike certain foods, but most tamariki will gradually eat and explore new foods as they get older. Tamariki with ARFID need a lot of support to try new foods and to eat the right quantity and variety of food to stay healthy. 

See the KidsHealth page on fussy eating in children for more information

What are the signs and symptoms of ARFID? 

It is important to look for certain signs if you are worried about your child’s eating. Tamariki with ARFID may show some of the following signs. 

Moods

• anxiety and distress around food and mealtimes
• afraid or upset when trying new foods
• upset by the sight and sound of others eating
• worried about pain, nausea, vomiting or choking when eating
• difficulty eating in unfamiliar places
• concerned if food packaging changes
• difficulty concentrating or learning

Behaviours

• lack of interest in food and eating
• refusal to eat
• eating very slowly or not finishing meals
• avoiding eating with others, such as at school camps or birthday parties
• only eating a small range of foods that are similar in taste, texture, smell, or sight
• easily disgusted by different foods

Physical health

• delayed growth and development
• weight loss or not gaining weight as expected 
• reduced appetite
• brittle nails, dry hair, hair loss
• tiredness or lack of energy
• later onset of puberty
• slow heart rate
• stomach pains
• feeling full after eating only small amounts
• bloating 
• feeling sick in the stomach
• constipation
• nutritional deficiencies on blood tests
• poor bone development

What are the complications of ARFID? 

When tamariki restrict their food intake, it can lead to complications that can affect their health, wellbeing and daily life. 

Significant weight loss

Some tamariki who restrict their food intake can lose a lot of weight. Or, they may not grow or gain weight as expected. 

Significant nutritional deficiency 

If a child isn’t eating enough or is limited in what they eat, they may not be getting the nutrients they need for their body to function. 

Impact on daily function

ARFID can have a big effect on a child's daily life. 

Functioning at school and home can be challenging due to:

• difficulties in eating with others
• only eating particular foods
• taking much longer to eat

Mental health

ARFID can affect your child’s mental health. They may experience low mood and anxiety around food and eating. They can also experience social anxiety and social withdrawal when they feel unable to eat around others. 

What should I do if I notice signs of ARFID in my child?

See your doctor as soon as you can if you notice the following in your child:

• eating a small range of foods
• eating a small amount of food
• regularly showing little to no interest in food 
• change in mood or behaviour, especially around food and eating

If you think your child has ARFID, visit your family doctor. Ask for a referral to a paediatrician (child health doctor) or eating disorder specialist service. The earlier you seek help, the closer your child is to recovery. 

See the KidsHealth page on getting help for a young person with an eating disorder 

How is ARFID diagnosed?

There is no single test to check for ARFID. Your doctor will talk with you and your child about their eating behaviour, habits and thoughts.

Your child may also need the following tests: 

• a full physical examination
• a blood test to check for nutritional deficiencies
• a urine sample
• an electrocardiogram (ECG) to check the heart's activity
• an x-ray

Your child’s doctor will not diagnose ARFID if another eating disorder explains your child’s symptoms better. The doctor will also make sure that the eating behaviours, weight loss or failure to grow are not due to another medical condition such as coeliac disease.

Your child’s doctor may refer your child to:

• an eating disorders service
• a paediatrician (child health doctor) 
• a mental healthcare provider, like a psychologist

These healthcare providers can confirm whether or not your child has ARFID. They can also recommend the appropriate treatment.

What are the treatment options for ARFID? 

ARFID is quite a new diagnosis, and experts are still researching which treatments work best. For all eating disorders, early diagnosis and treatment are likely to lead to better outcomes.

Psychological treatment 

If your child has ARFID, they might need psychological therapy. This can include whānau and family therapy or one-on-one sessions with your child. 

Cognitive-behavioural therapy (CBT)

CBT is a good treatment for people with ARFID. Treatment may involve gradually exposing your child to foods they fear alongside relaxation training.

Responsive feeding therapy (RFT) 

Responsive feeding therapy aims to:

• create pleasant mealtime experiences
• create comfortable whānau eating environments
• gradually introduce new foods into your child’s diet
• help your child learn to cope with their emotions while eating
• help your child understand how it feels when they’re hungry or full

Medical treatment

When tamariki don’t eat enough food, they can have medical problems. Tamariki with ARFID will need to have regular appointments with their healthcare provider to monitor their physical health.

Medicine

There is no medicine that can treat ARFID. Some tamariki with ARFID may also have depression or anxiety; sometimes, medicines may help with these conditions. Your child may need some nutritional supplements if tests show they have low levels of certain vitamins and nutrients. 

Hospital stay 

If a child with ARFID is very unwell, they may need to stay in hospital. Health professionals will monitor them until they are safe and well enough to go home.

Reach out for support

Having a child with ARFID can feel overwhelming. It is important to reach out for support when you need it. Eating Disorders Association of New Zealand (EDANZ) offers a support service for carers.

Recovery

With the right team and support, your child can recover from ARFID. Recovery is possible even if your child has had ARFID for many years. Tamariki with ARFID need a lot of love and support to get better and maintain healthy eating habits. They can sometimes develop ARFID symptoms again. If you notice your child is showing signs of ARFID again, contact your doctor as soon as possible.

See more KidsHealth content on emotional and mental wellbeing

See the KidsHealth's section on emotional and mental wellbeing