ARFID in Children: A Little-Known Eating Disorder

ARFID in children is a very common disorder caused by fear of trying new foods or choking. Learn more in today's article.
ARFID in Children: A Little-Known Eating Disorder
Silvia Zaragoza

Reviewed and approved by the nutritionist Silvia Zaragoza.

Written by Silvia Zaragoza

Last update: 27 December, 2022

Is your child very picky about food or do they avoid a large number of foods? They may have an eating disorder called Avoidance Restrictive Food Intake Disorder, or ARFID. This condition consists of the avoidance and restriction of various components of the diet. Keep reading to learn more about ARFID in children.

Although it may be new to you, the truth is that it was included in the Diagnostic Manual of Mental Disorders (DSM-V) in 2013, to differentiate it from other eating disorders. As of today, the prevalence of ARFID ranges between 5% and 14% and usually affects children between the ages of 8 and 13 years.

Diagnosis of ARFID in children

The diagnosis of this condition is determined by the inability to meet the energy and nutritional needs of the child, added to the presence of one or more of the following criteria :

  • Significant weight loss or difficulty achieving adequate gain based on age.
  • Significant nutritional deficit.
  • Dependence on the use of oral supplements to cover basic nutrient requirements.
  • Interference with daily activities due to the inability to eat properly. For example, the person avoids eating in public.

It should be noted that this entity is not related to the lack of availability of food or restrictions for cultural or religious reasons

In addition, it doesn’t imply an altered perception of weight or body image, as occurs in anorexia or bulimia. However, it can be associated with other mental disorders.

A young boy staring angrily at a plate of rice and vegetables.

The causes and symptoms of ARFID

This pathology usually manifests itself with non-specific symptoms: Abdominal pain, gastrointestinal discomfort, fear of vomiting or choking, a feeling of fullness, and aversion to certain textures, smells, or flavors of food.

As mentioned above, ARFID can be associated with other mental illnesses such as obsessive-compulsive disorder, generalized anxiety, autism, attention deficit and hyperactivity disorder, and some learning disorders.

Compared to anorexia, children with ARFID tend to have fewer episodes of depression and higher self-esteem, according to the Journal of Eating Disorders.

Finally, there are multiple possible causes for developing this condition:

  • A history of any traumatic eating experience (such as choking).
  • Hypersensitivity to certain sensory stimuli, such as food textures.
  • Parental pressure to improve dietary habits.
  • Lack of exposure to new foods early in life.

You may be interested in: Tips to Help Your Child Try New Foods

Nutritional consequences and complications of ARFID in children

According to the Archives of Pediatrie, the nutrient deficit that accompanies this condition varies depending on the restricted foods.

However, the most common deficiencies are iron, calcium, and vitamins C, D, and A. For this reason, it’s common for these children to suffer from anemia and decreased bone mass. In the long term, this can manifest itself as tiredness, poor concentration, and rickets.

Furthermore, there are complications that are secondary to malnutrition, such as bradycardia and electrolyte disorders.

How to manage ARFID in children

A child crossing is arms, surrounded by the word "no".

The treatment consists of addressing the child’s behavior and their dietary intake, which is why it requires several professionals, such as a psychologist and a dietitian-nutritionist.

Depending on the case, including a speech therapist to re-educate swallowing and improve the fear of choking may also be necessary. In this way, children can manage their anxiety about eating and meet their nutrient needs.

Regarding pharmacological treatments, there’s no evidence to support their use.

You should also know that some children require hospitalization to be fed through a nasogastric tube, but this is in more extreme cases.

Finally, it’s important not to force children to eat and to try to progressively expose them to those foods that they reject out of fear. The more peaceful the dinner table environment, the better the results.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Katzman, D K; Norris, M L; Zucker, N (2019) Avoidant Restrictive Food Intake Disorder. Psychiatr Clin North Am, 42(1): 45-57. 
  • Zimmerman, J; Fisher, M (2017) Avoidant/Restrictive Food Intake Disorder (ARFID). Curr Probl Pediatr Adolesc Health Care, 47(4): 95-103.
  • De Toro, V; Aedo, K; Urrejola, P (2021) Trastorno de Evitación y Restricción de la Ingesta de Alimentos (ARFID): Lo que el pediatra debe saber. Andes Pediatr, 92(2)298-307. 
  • Keery, H; LeMay-Russell, S; Barnes, T L; Eckhardt, S; Peterson, C B; Lesser, J et al (2019) Attributes of children and adolescents with avoidant/restrictive food intake disorder. J Eat Disord, 7:31.
  • Kurotori, i; Shioda, K;  Abe, T; Kato, R; Ishikawa, S;Suda, S (2019) An Inpatient Observational Study: Characteristics And Outcomes Of Avoidant/Restrictive Food Intake Disorder (ARFID) In Children And Adolescents In Japan. Neuropsychiatr Dis Treat, 15:3313-21.
  • Feillet, F; Bocquet, A; Briend, A; Chouraqui, JP; Darmaun, D; Frelut, ML et al (2019) Nutritional risks of ARFID (avoidant restrictive food intake disorders) and related behavior. Arch Pediatr, 26(7): 437-41.

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.