It’s not at all uncommon for kids to be picky about the foods they will — and will not — eat. As most parents know, it’s a problem that can turn mealtimes into battlegrounds.
In many cases, children outgrow their pickiness and food aversions. As they get older, their palates expand along with their willingness to try new things. But for kids who have avoidant/restrictive food intake disorder (ARFID), the food issues run deeper than simple distaste.
Unlike picky eaters, kids with ARFID typically need medical help to overcome the condition.
What is ARFID?
Avoidant/restrictive food intake disorder is a recently recognized eating disorder. People with the condition severely limit their food intake. “But unlike eating disorders such as anorexia, they’re not counting calories or trying to lose weight,” says Danielle Mein, RD, a pediatric dietitian at UCLA Health.
ARFID is more common in children than adults, sometimes starting in early childhood. Children with this condition have very little interest in most foods. They have extreme aversions to many foods (or entire food groups). In some cases, they may fear what could happen if they eat a certain food, such as choking or vomiting.
Because kids with ARFID have diets that are so restricted, they are at high risk for:
- Malnutrition from a lack of essential nutrients and not eating enough calories
- Poor growth and weight gain
- Delayed puberty
- Anemia (low iron)
What’s the difference between picky eating and ARFID?
“The biggest difference is that the average picky eater is still hungry and wants to eat,” says Mein. “Kids with ARFID would rather go all day without food — even though they are hungry — than deal with the discomfort they have around eating.”
Parents of picky eaters may feel like their children shun most foods. But the reality of picky eating is typically much different than life with a child dealing with ARFID. “If a kid hates green vegetables but still eats a variety of foods and is growing well, I tell parents to just relax,” says Mein. “With repeated exposures to new foods, most picky eaters will eventually come around.”
In addition to eating issues, kids with ARFID may also experience anxiety, ADHD, obsessive-compulsive disorder (OCD) or other mental health concerns. They may also experience GI issues such as irritable bowel disorder (IBD).
How feeding therapy can help
Treating ARFID successfully typically requires a team approach. Your child may need care from specialists including a pediatrician, psychologist, dietitian and feeding therapist.
“If your pediatrician has checked for nutritional deficiencies and diagnosed your child with ARFID, the first step of treatment is meeting with a dietitian,” says Mein. “The dietitian can help manage the immediate nutrition needs to deal with malnourishment.” That might include using nutritional supplements and working with a child’s “safe” foods to maximize nutrition and help them gain weight.
“ARFID is a psychological issue, so it requires a psychological approach to treatment,” says Mein. “A psychologist will work with a child to help them overcome their anxieties surrounding food.”
A food therapist is also key to successful treatment. They can help with food exposure, taking a food the child is afraid of and slowly getting them used to it. “Food therapy might start with just getting the child to allow a food to sit on their plate,” says Mein. “Gradually, the therapist helps the child work up to touching it, picking it up and bringing it to their mouth. Small steps on the way to finally eating it.”
When to see a doctor about food issues
Run-of-the-mill picky eaters rarely require medical or psychological treatment. “If you’re concerned about how your child is eating, talk to your pediatrician,” says Mein. “They can run tests for nutritional deficiencies and look at their growth chart.”
If the overall growth pattern is off, your child isn’t getting the nutrients they need, they’re avoiding entire food groups and have anxiety around eating, they may have ARFID. But with the right treatment and right nutrition, they can still thrive.
