Avoidant-Restrictive Food Intake Disorder (ARFID): When it’s more than picky eating

“My kid is just so picky!” said pretty much every parent at some point. But for some kids, there might be more at play than just a preference for pasta or chicken fingers.

Avoidant/restrictive food intake disorder (ARFID) is a relatively new term—it was added to the Diagnostic and Statistical Manual of Mental Disorders, 5^th edition (DSM-5) in 2013­—and one that Debra Katzman, a paediatric eating disorder specialist at Toronto’s Hospital for Sick Children, says many doctors still aren’t aware of. She and colleagues at other hospitals are studying the disorder to find out more about it: who it affects, how common it is and how it can be treated.

“If you’ve got a picky eater, but it waxes and wanes and they’re growing OK, that’s not ARFID,” says Katzman. Rather, kids with ARFID persistently don’t meet their nutritional and energy requirements because they’re just not eating enough. This can lead to weight loss, failure to gain weight at the normal rate or nutritional deficiencies like anemia. Sometimes kids with ARFID use nutritional supplements (such as Boost) to maintain their weight. The disorder can even interfere with a kid’s psychosocial development, particularly as he gets older, says Katzman. For example, parties and other social gatherings often revolve around food—a kid with ARFID may feel uncomfortable or choose not to go to the event at all.

So, what does a kid with ARFID look like? Katzman says they usually only eat one or two foods or even just one texture. She gives the example of a kid who will only eat if she doesn’t have to chew the food. It’s hard to meet all your nutritional requirements on a diet of yogurt and applesauce.

Katzman says it’s important that more doctors are aware of this disorder, so it can be diagnosed early and treated. For now, kids with ARFID are often sent to a family therapist and might have exposure therapy, where you expose the kid to food little by little, says Katzman. But, she stresses treatments for the disorder are still being studied, and exposure therapy is just one strategy doctors are currently using. She encourages parents who are concerned about their kid’s picky eating or weight to bring it up with their doctor.

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