What is ARFID (Avoidant Restrictive Food Intake Disorder)?
If your child is an extremely picky eater, avoids certain foods, or shows signs of fear around eating, it might be more than just a phase. They could be experiencing ARFID—Avoidant Restrictive Food Intake Disorder—a serious eating condition that can affect their growth, development, and overall well-being.
In this post, we'll break down what ARFID is, what causes it, how it’s different from other eating disorders, and what steps you can take to support your child.
What is ARFID?
ARFID is a type of eating disorder where a person avoids or restricts certain types of foods, however, the behaviors are unrelated to body image concerns. ARFID is a comprehensive term that includes a range of eating-related issues, including:
Apparent lack of interest in eating
Selective and demanding eating - also known as “extreme picky eating”
Food phobia - fear of food
Avoidance based on sensory characteristics of food - like taste, texture, or smell
Emetophobia – fear of vomiting
Functional dysphagia – “the sensation of solid and/or liquid foods sticking, lodging, or passing abnormally through the esophagus”
Globus hystericus – refers to anxiety that causes a physical sensation of a lump in the throat that causes difficulty or discomfort in swallowing
ARFID often leads to poor nutrition, weight loss (or lack of expected weight gain), and can interfere with a person’s ability to take part in everyday activities, like school or social meals.
It’s most commonly seen in children but can affect people of all ages. While there is limited research on the prevalence of ARFID, studies have found that between 0.5%-5% of children and adults in the general population have the disorder.
What Causes ARFID?
There isn’t one single cause of ARFID. Instead, it's usually a combination of several factors, including:
Sensory sensitivity: Children may avoid foods based on texture, taste, smell, or even color.
Fear-based avoidance: A past experience of choking on food, vomiting, or gagging may lead to a fear of eating.
Lack of interest in food: Some kids simply don't feel hungry or are uninterested in eating altogether.
Co-existing conditions: ARFID is more common in children with autism, anxiety, or ADHD.
Is ARFID a Mental Illness?
Yes, ARFID is classified as a mental health condition. It falls under the category of eating and feeding disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, it differs from other eating disorders like anorexia or bulimia because it’s not driven by body image concerns.
Instead, ARFID often stems from anxiety, sensory sensitivities, or fear of discomfort while eating. That’s why treatment typically involves both medical and psychological support.
ARFID Diagnostic Criteria
ARFID is a new diagnosis in the DSM-5, and represents a revision of what used to be called “Feeding Disorder of Infancy or Early Childhood.” A diagnosis of ARFID involves:
An eating disturbance (like avoiding or restricting food) that leads to:
Significant weight loss or failure to gain weight
Significant nutritional deficiencies
Dependence on nutritional supplements or tube feeding
Interference with social or emotional functioning
Additionally, the eating disturbance…
is not better explained by a lack of available food or by an associated cultural practice.
does not occur during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance of body image.
is not attributable to a concurrent medical condition or not better explained by another mental disorder.
There are three subtypes of ARFID listed in the DSM-5:
ARFID-low appetite - Refers to individuals with limited food intake who had low appetite, lack of interest in food; had difficulties with the act of eating, such as small bites, prolonged time to finish meals
ARFID-sensory limitations - Refers to those with limited variety associated with sensory problems and aversions related to certain foods or profound rigidity involving the act of eating, such as food selectivity and fear of new foods
ARFID-aversive - Refers to individuals with avoidance histories/nutritional restrictions that occurred and/or evolved as a result of an event (choking, vomiting) or specific fear (fear of choking, pain, or nausea).
ARFID Symptoms
Some common signs of restrictive food intake disorder in children include:
Eating fewer than 20 different foods
Avoiding entire food groups (like all fruits or proteins)
Refusing to eat foods based on smell, texture, or temperature
Anxiety about trying new foods
Getting full quickly or saying they’re “not hungry”
Poor weight gain or nutrient intake
ARFID Test
There’s no single test for ARFID, but evaluation typically includes a detailed medical and feeding history, growth measurements and nutritional assessments, psychological evaluation to check for anxiety or sensory issues, and parent/teacher questionnaires about eating habits.
A team approach—often involving a pediatrician, dietitian, and psychologist—is best for an accurate diagnosis.
ARFID in Children
ARFID often starts in early childhood and may go unnoticed in young children if parents assume it’s just picky eating. However, children with ARFID may continue to restrict foods long after their peers have expanded their diets.
Early intervention can help prevent long-term nutritional issues and improve a child’s relationship with food. If you have concerns, definitely don’t wait to bring them up with your child’s healthcare provider!
ARFID in Adults
Though ARFID is commonly diagnosed in children, it can persist into adulthood or even develop later in life. Adults with ARFID may avoid social situations involving food or stick to a small list of “safe” foods, which can lead to social isolation and malnutrition.
Treatment in adults often focuses on nutritional rehabilitation and cognitive-behavioral therapy to address underlying fears and food aversions.
Autism and ARFID
There is a strong link between autism and ARFID. Many children on the autism spectrum experience heightened sensory sensitivities, making them more prone to selective eating disorder behaviors.
While not all children with autism have ARFID, it's important to recognize when their limited eating patterns are impacting their health or daily functioning. A dietitian familiar with autism-related feeding issues can be especially helpful in supporting families.
ARFID Treatment
The good news? ARFID is treatable. The earlier the intervention, the better the outcomes—especially for children still developing lifelong eating habits. Treatment plans often include:
Nutritional support from a pediatric dietitian to improve nutrient intake
Feeding therapy to gradually introduce new foods in a safe, supportive way
Cognitive-behavioral therapy (CBT) to address anxiety and fear around eating
Parental coaching to help with mealtime strategies and reduce pressure
There are several programs available nationally to help individuals dealing with ARFID. Here is a short list of resources:
The Emily Program - Comprehensive ARFID treatment for children, adolescents, and adults, offering residential, partial hospitalization (PHP), and intensive outpatient (IOP) programs with multiple locations available across the country.
Alsana - ARFID treatment for adults of all genders, providing residential and virtual programs with multiple locations across the country.
Mount Sinai Center of Excellence in Eating and Weight Disorders - Evidence-based ARFID treatment tailored to individual needs, located in NY.
Cohen Children’s Medical Center - Specialized treatment for children and adolescents with ARFID. Located in NY.
Yale Medicine GI ARFID Program - Evaluation and treatment of ARFID symptoms in children, focusing on gut-brain interaction disorders. Located in New Haven, CT.
Final Thoughts…
While it’s normal for kids to go through phases of picky eating, ARFID goes beyond that. If your child’s eating habits are affecting their growth, health, or emotional well-being, don’t wait to seek help.
With the right team and approach, children with Avoidant Restrictive Food Intake Disorder can learn to enjoy a wider variety of foods and get the nutrition they need to thrive.
Need Help?
As a pediatric dietitian, I work with families to understand their child’s unique feeding challenges and create a supportive, individualized nutrition plan. If you're looking for personalized support, I am available for a virtual one-on-one consultation.
For more tips on feeding picky eaters, check out my FREE guide to reducing picky eating or enroll in my online course, Solve Picky Eating, which includes 12 self-paced short video lessons, downloadable guides, and checklists to support you along your journey of navigating picky eating.
Thanks for reading!