Sometimes children’s picky eating is a sign of something much more serious. It could be a sign of avoidant restrictive food intake disorder (ARFID), where people restrict the types and amounts of food they eat. But unlike other eating disorders like anorexia and bulimia, ARFID has nothing to do with body image or the desire to lose weight. According to the National Eating Disorder Association, it is characterized by a sensory aversion to food, fear of food, or a general lack of interest in eating, leading to weight loss or stalled development. Knowing the signs is important so children suffering from it won’t be dismissed as just picky eaters.
What is ARFID?
First off, people with ARFID aren’t being picky or difficult on purpose. Their eating habits are usually dependent on strong sensory sensitivities. They may react strongly to certains tastes, smells, textures, or appearances of food. They may have a fear of vomiting or choking, or a generally low appetite and disinterest in eating. And unlike most young picky eaters, children don’t grow out of ARFID and try new foods over time, since their aversions become ingrained into them.
“ARFID is not a choice, it’s not the patient’s fault, and it’s not simply ‘picky eating,’” said Kamryn Eddy, co-director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital. “These data can help patients, families, and providers to take the condition seriously.” She explained that she has noticed a dramatic increase in research on this topic as well as people seeking treatment for it. “At this point, more people are aware of the diagnosis and we find people are often feeling relieved at having a name for the condition they’ve been struggling with.” 
Signs of AFRID in Children
Children with ARFID are also likely to have anxiety, OCD, ADHD, autism, acid reflux, food allergies, or other conditions that could contribute to their struggles with food and eating. The exact cause is unknown but research is indicating there’s a genetic factor, perhaps because of the genetic nature of autism and ADHD.  Symptoms can vary from case to case, but they tend to include:
- Restricting types of food
- Restricting amounts of food
- Only eating foods with certain textures
- Feeling full or unwell around mealtimes
- Disinterest in food or low appetite
- Fear of vomiting or choking
- A small range of preferred foods that becomes increasingly smaller
- Weight loss
- Weakness or excessive energy
- A history of vomiting or choking
Unfortunately, there can be many complications and outcomes as a result of ARFID. Children may lack essential nutrients so certain body functions may stop working to conserve energy. Because the body can adapt to stress, sometimes blood tests could look normal even when the body is suffering. In extremely severe cases, nutritional deficiencies could lead to a heart attack. Many ARFID complications are similar to other eating disorders like bulimia and anorexia since they also result in inadequate nutrition.  These complications can include:
- Muscle weakness
- Dry and brittle or thinning hair
- Decreased immune function
- Dry skin and nails
- Brittle nails
- Lanugo (fine hair) growing on the body
- Frequently feeling cold
- Sleep issues
- Dizziness or fainting
- Slow heart rate
- Difficulty concentrating
- Stomach issues, like abdominal pain, heartburn, and constipation
- Amenorrhea (missing periods or losing them altogether)
- Low blood cell counts
- Low thyroid hormone levels
- Low iron
- Low potassium
Treatments for ARFID
When evaluating a child for ARFID, a doctor will ask about their medical history, eating and exercise habits, and emotional wellbeing. They’ll also look for nutritional deficiencies, weight loss, or underdevelopment. Treatment should begin as soon as possible. The earlier the intervention, the better.
Treatment is ideally conducted by a team including a doctor, a dietician, and a therapist who specializes in eating disorders. It can involve nutrition counseling, cognitive behavioral therapy, and medical care if needed. The professionals will help the child learn healthier eating habits, widen their diet, maintain a healthy weight, and eat without anxiety. Sometimes doctors prescribe medications to ease anxiety or stimulate appetite.
Treatment also happens at home. Since ARFID is associated with strong reactions and emotions, families should be supportive and exemplify positive attitudes about food. They should lead by example and eat a diverse diet. Schedule regular meals and make them fun and pleasant. So find ways to manage stress around food whether it’s taking deep breaths before eating or engaging in anxiety-reducing behaviors like yoga, meditation, art, dancing, etc.
Encourage new foods but don’t force them, and reward the child when they show healthy eating behaviors. Above all, don’t blame or criticize the child for their symptoms. So if you suspect your child might have ARFID or another eating disorder, contact their doctor or a mental health professional for advice. 
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- “Scientists are studying twins to understand a type of eating disorder linked to anxiety. It could be genetic.” Insider. Andrea Michelson. February 3, 2023
- “Avoidant Restrictive Food Intake Disorder—More Than Just Picky Eating: A Case Discussion and Literature Review.” The Journal for Nurse Practitioners. Emily Davis, Elizabeth L. Stone. December 2020
- “Avoidant/restrictive food intake disorder (ARFID): What to know.” Medical News Today. Jessica Caporuscio, Pharm.D. December 7, 2019
- “Avoidant/Restrictive Food Intake Disorder (ARFID).” Kids Health. Christina M. Cammarata, PhD. April 2023