If you’ve ever worried that your child’s fussy eating is more than “just a phase”, read on…
As parents, we have all been in situations where our children refuse food. Some children will only eat beige food like chicken nuggets and bread, some won’t eat food if it’s touching other food, some may only want to eat plain boiled pasta for months. But when should we start to worry? If you have noticed that the “picky eating” phase isn’t passing and is instead exacerbating – causing stress, anxiety and frustration at every single meal time – you are not alone. This is the reality for families with children living with Avoidant/Restrictive Food Intake Disorder (ARFID).
What is ARFID?
ARFID is a complex eating disorder in which children avoid or significantly restrict their food intake. Unlike many other eating disorders, it is not driven by body image, but instead things such as sensory sensitivity, fear of choking or vomiting, or a lack of interest in food altogether. Typically children with ARFID eat only a small range or amount of food which, according to KidsHealth.org, can affect their growth, development, health and wellbeing.
Causes of ARFID
Experts are unsure what causes children to have ARFID but it may be a combination of reasons, including: a past bad experience with food; other medical conditions, such as special diets or gut issues; environmental pressures, such as being forced to eat at mealtimes; genetic or co-occurring conditions, like autism, anxiety disorders or obsessive-compulsive traits. According to KidsHealth.org, ARFID occurs in both girls and boys but is more common in boys. It often develops in early childhood and can last into adulthood.
Signs and symptoms
Children with ARFID may…
- eat only a very small number of foods;
- refuse to try new foods or even be near them;
- become anxious or distressed at mealtimes;
- avoid entire food groups based on texture, colour, or smell;
- avoid eating with others, such as at a birthday party.
Physical symptoms include…
- weight loss, nutritional deficiencies, or growth issues;
- tiredness or lack of energy;
- delayed puberty;
- low heart rate;
- constipation;
- poor bone density.
What to do if you notice signs of ARFID
Early intervention is crucial, so if you notice your child is restricting their food intake, ask your GP for a referral to a paediatrician or eating disorder specialist. There is no single test for ARFID but the health professional may do a full body examination, blood tests, a urine sample and an ECG to check your child’s heart activity.
What are the treatment options?
There is no one-size-fits-all approach, but your child may need psychological therapy, such as:
- Cognitive behavioural therapy (CBT-AR): developed specifically for ARFID and may help address food-related fears.
- Acceptance and commitment therapy (ACT): to help them embrace their thoughts and feelings.
- Responsive feeding therapy (RFT): to create pleasant mealtime experiences and help your child learn to cope with their emotions while eating.
Other treatment options include:
- Occupational therapy: good for kids with sensory processing challenges.
- Nutrition support: to address deficiencies and support safe food expansion.
- Family-based therapy: to involve caregivers and reduce mealtime stress.
How can family help
Progress is often slow and gradual – touching a new food, sitting near others who are eating, or tasting a small bite can be major milestones. Parents can support their child by being patient, celebrating small wins, modelling calm behaviour around food, avoiding shaming language (terms like “fussy” or “dramatic”) and getting professional assistance.
Helpful resources
EDANZ – Eating Disorder Association of New Zealand
F.E.A.S.T – Families Empowered and Supporting Treatment of Eating Disorders
