ARFID or picky eating? Here's how to know

Picky, or fussy, eating is common in childhood, with almost all children going through a phase of rejecting new foods (even foods they previously liked). For some children, though, restrictive eating has such an impact on their everyday life, and even their weight and growth, that it may be an eating disorder called Avoidant Restrictive Food Intake Disorder – or ARFID.

Here is what to know about how picky eating and ARFID are different, and when you should consult a health professional for your child.

Picky eating versus ARFID

Picky, or fussy, eating is common in childhood, with almost all children going through a phase of rejecting new foods (even foods they previously liked). This type of behavior – called "food neophobia" – often appears between 1.5 and 2 years of age.

Fussy eating is considered a natural stage of development that passes on its own, as long as parents are careful about handling it in a supportive, encouraging way. (Here are 7 tips for winning over a picky eater).

Picky eating to the point of "not eating well" or "refusing to eat" is also more common than you might think, especially in early childhood. One study of more than 4,000 children, for example, found that more than one in four 1.5-year-olds and 3-year-olds were picky eaters (defined as their mothers saying they "sometimes" or "often" "did not eat well" or "refused to eat").

But by six years old, only about one in ten children were picky eaters.

And most children whose mothers said they were picky eaters at 1.5 or 3 years old were no longer picky eaters by age 6.

What is ARFID?

ARFID stands for Avoidant Restrictive Food Intake Disorder. While ARFID can be confused with picky eating, it is a type of restrictive eating that is especially extreme, that persists for a long period of time, and that impacts a child's physical or mental health.

If you have not heard of it before, it may be because, as a recognized diagnosis, it is relatively new: the American Psychiatric Association added it to their list of diagnoses in 2013. It replaced what was formerly known as a "feeding disorder of infancy or early childhood", with some criteria changed.

Only a health professional can make a diagnosis of ARFID. Criteria that they look for include not just whether a child refuses most foods (often consuming as few as five to ten different food items), but if this refusal is affecting their functioning.

A child with ARFID will experience either poor weight gain (or weight loss); significant nutritional deficiency; dependence on nutritional supplements or tube feeding; and/or psychological struggles around food, to the extent that they may avoid social functions or school mealtimes. They may experience some or all of these symptoms at once.

Furthermore, to be considered ARFID, this type of eating pattern cannot be the result of another mental disorder or health condition. Instead, it specifically results from a lack of interest in food; anxiety around food; an aversion to the texture, taste or smell of food; or previous pickiness that has intensified.

Researchers are still trying to figure out why some children develop ARFID, and some do not.

However, ARFID is much more common in children who have anxiety disorders, autism spectrum disorders, other neurodevelopmental disorders including ADHD, and gastrointestinal symptoms or disorders.

How common is ARFID?

In general, only a small proportion of children develop ARFID.

However, it may be more common than people realize. Studies of populations in countries including Switzerland, Germany and Portugal, for example, have found that anywhere from 3 to 15 children out of every 100 exhibit ARFID symptoms.

It is far less common for children to be officially and clinically diagnosed with ARFID. One analysis that surveyed 2,700 paediatricians in Canada about their patients, for example, found that only 1 out of every 50,000 children aged five to 18 had ARFID.

ARFID is, however, a common cause of children having nutritional deficiency or weight gain that is so extreme that they are enrolled at a feeding clinic. One study of 100 children at a pediatric feeding clinic in the Netherlands, for example, found that nearly two-thirds – 64 per cent – met the criteria for ARFID.

Treatment for ARFID

Normally, health professionals treat children with ARFID by addressing the underlying cause of why they are avoiding or restricting food. The purpose is to get the child to eat more, and more types, of food over time.

This can be done through psychological interventions, such as family-based therapy and cognitive behavioral therapy. Medication is also sometimes used.

In severe cases, children with ARFID may need to be hospitalized in the short term in order to get the nutrition and the support that they need.

If you are concerned about your child, it is important to speak to their health practitioner.