6 Things to Know About ARFID: understanding this selective eating disorder

Many parents come to me with questions like this one: “Does my child have ARFID?” 

For those unfamiliar, ARFID is the abbreviation for the diagnosis of avoidant restrictive food intake disorder.

It can feel scary to think about a new diagnosis (or what this might mean).

As a pediatric dietitian, I am writing this article to ease your fears (whether your child is diagnosed with ARFID or not).  I want you to leave my blog feeling empowered, less stressed and to know you can get to a place with joy in feeding.

In this post we’ll talk about the facts surrounding ARFID in children, why it’s not something to be feared, and what you can do if you feel like your child may be struggling with feeding.

#1 What is ARFID?

ARFID (avoidant restrictive food intake disorder) is classified by the DSM-5 (which is where all mental disorders are classified) as an eating disorder that “occurs when individuals avoid or restrict food intake to the extent that they regularly fail to meet their nutritional and energy needs”, many parents describe their kids as “extreme picky eaters,” as ARFID is often referred to as an “extreme picky eating disorder.”

The DSM-5 defines that this eating or feeding challenge is associated with at least one of the below:

•          Substantial weight loss, failure to reach expected weight gain, and faltering growth in children

•          Severe nutrient deficiency

•          Dependence on enteral feeding or oral supplementation

•          Significant interference with psychosocial functioning

Typically, a child that is diagnosed with ARFID, meets one of the above criteria and this is NOT associated with “another eating disorder, medical condition, food insecurity, or cultural observance.”

Although an AFRID diagnosis may feel scary, certain schools of thought (including my own) will argue that the diagnosis itself doesn’t really make a difference. It’s more about how to move forward with a selective child.

#2 ARFID often coexists with anxiety, mood, and spectrum disorders. 

There are a number of factors that can cause ARFID, it typically involves a range of biological, psychological, and sociocultural factors. May times other conditions are occurring at the same time, like anxiety, mood, and spectrum disorders.

#3 ARFID is characterized by psychological and physical signs. 

The National Eating Disorder Association describes these are the signs and symptoms of ARFID (which includes both psychological and physical warning signs):

Psychological signs of ARFID include:

  • Worsening picky eating

  • Missing food groups and textures

  • Anxiety around new foods

  • Lack of interest in food

  • Fears around food like fear of vomiting

Physical signs of ARFID include: 

  • Dramatic weight loss

  • Gastrointestinal issues

  • Menstrual irregularities

  • Fatigue

  • Cold intolerance

  • Brittle nails, dry skin, thinning hair

#4 ARFID is NOT associated with a concern about body image or weight loss. 

What’s the difference between ARFID and other eating disorders?  It is not associated with a desire to lose weight or a concern of body image.  While weight loss often occurs in individuals with ARFID, it is not the reason for avoiding food.

#5 ARFID vs. Picky Eating  

While ARFID and picky eating share similarities, it is important to note that they are not the same. Individuals with ARFID experience severe distress from eating and may even experience choking, swallowing, anxiety, and sensory sensitivities that lead to food avoidance and food aversion.

Picky eaters typically do not share this level of anxiety and worry at mealtimes. While picky eaters generally eat from all food groups over days or weeks, individuals with ARFID often avoid entire food groups.

In contrast to picky eaters, ARFID interferes with growth, weight gain, and nutritional status.

#6 ARFID Treatment 

An ARFID diagnosis may feel overwhelming, but there are many treatment options that can help.

In fact, many of these options can be done right at home.

Some common options include family-based treatment and cognitive-behavioral approaches featuring consistent eating, food exposure, and response prevention but these are not the only options (and aren’t the best for everyone).

Like picky eating, a positive, no-pressure feeding environment is the foundation for treating ARFID.

At Nutrition in Bloom, we take an individualized approach to help support your child.

This approach could involve:

•          Strategies to support the feeding environment, minimize anxiety, remove pressure, and limit distractions

•          The creation of a mealtime and snack routine

•          A plan to increase food exposures and introduce new foods

•          Multivitamin supplementation, if needed

If feeding is a struggle for your child, start by downloading my free guide, 4 steps to help your child try new foods.