When should I worry about my child’s eating – picky eating or ARFID?

Picky eating is extremely common in very young children and can be a source of
anxiety and/or frustration for many parents. Most toddlers will at times refuse to try new
foods or even eat – this is a normal part of child development and not generally a cause
for concern. Over time most children will learn to eat a wider variety of foods and there
are definitely things that parents can do to help encourage this, for example, by
continuing to offer (but not force) foods that have previously been refused and eating
meals together as a family.

However, for a small percentage of toddlers picky eating habits can continue well into
childhood and sometimes even adolescence. For some children, eating a limited
amount and/or range of foods over a period of weeks, months or years can have a
significant negative impact on their physical and/or psychosocial development. This
could be an indication that your child is experiencing something called
Avoidant/Restrictive Food Intake Disorder (ARFID).

What is ARFID?

ARFID is a type of eating disorder that can affect people of any age and at any stage of
life, but is most commonly identified in children and adolescents. Children with ARFID
generally fall into one or more of the following categories:

1. They have had a negative experience involving food (for example, a choking or
vomiting episode) and as a result have developed anxiety about eating.

2. They have particular sensory sensitivities around food, for example they intensely
dislike the textures, tastes, smells and/or appearances of some foods.

3. They have a general lack of interest in food or eating.

Most children with ARFID will have a limited number of foods which they consider ‘safe’
to eat and will become very distressed at the thought of trying new or unfamiliar foods.
They will often refuse to eat the same meals as their parents and siblings and can take
a long time to finish their preferred meals. Unlike other eating disorders, children with
ARFID do not generally express concerns about their body weight or shape.

Effects on health and well-being

ARFID can seriously affect children’s health and development if left untreated. For
example, some children may experience significant weight loss and/or fail to grow as
expected due to nutritional deficiencies resulting from inadequate energy intake. In
some instances, they may even require an admission to hospital for nutritional
rehabilitation.

ARFID can also have a significant negative impact on children’s psychosocial
functioning. For example, they may not be able to attend parties or sleepovers with
friends due to anxiety about eating in these situations. Some children may be too
anxious and/or physically unwell to attend school. Unlike picky eating, children with
ARFID will not ‘grow out of it’ and this is why parents should speak to a health
professional about their concerns as soon as possible.

Help is available

The good news is that children with ARFID can learn to eat the types and amounts of
food they need to grow and thrive – if they receive the right care and support as early as
possible. The recommended treatment for ARFID is parent-supported cognitive
behavioural therapy (CBT). Ideally this would involve attending weekly sessions with a
specialist eating disorder psychologist, as well as some sessions with a dietitian and
possibly also a child psychiatrist.

Like most mental health disorders in children, getting help early can prevent many of the
negative consequences associated with ARFID. If you have concerns about your child’s eating, please reach out to Sage Clinics and we will put you in touch with one of our specialist eating disorder clinicians.

Written by: Dr. Hollie Shannon