Avoidant restrictive food intake disorder (ARFID)

Avoidant restrictive food intake disorder (ARFID) involves ongoing feeding or eating issues that can cause tamariki to avoid food. It's more than just ‘picky eating’, which is common among tamariki. Tamariki with ARFID eat only a small range or amount of food. They often have an extreme dislike of certain foods or are generally not interested in food or eating.  

Tamariki with ARFID might restrict their food intake for a few different reasons. ARFID can look very different from 1 child to another. There can be more than 1 reason for avoiding food.

Sensory aversion

Some tamariki are very sensitive to how food feels, smells, tastes or looks. This is more extreme than just disliking certain foods. Their deep dislike of the sensation of food causes them to avoid eating. 

Fear of consequences

Some tamariki may avoid eating because they are worried about what will happen when they do. This could be a fear of things like vomiting, choking or pain. They might deal with this by avoiding certain foods and only eating foods they think are ‘safe’.

Lack of interest in food

Some tamariki don’t feel as hungry as others, or they have a ‘low appetite’. These tamariki may see eating as a chore. This can lead to them not eating enough food to stay well. 

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Yes, ARFID is an eating disorder and a serious mental health condition. But, unlike other eating disorders, tamariki with ARFID don’t restrict their food intake because of concerns about their body weight or shape.

ARFID can look similar to anorexia nervosa, as some tamariki with ARFID significantly limit their food intake. Not eating the right quantity or variety of food can lead to medical problems. Other tamariki with ARFID may eat enough to maintain their body weight. But, eating a small range of foods may lead to low levels of important vitamins and nutrients.

There isn't just 1 cause for ARFID. Experts are still trying to understand what makes some people more likely to develop it. 

ARFID may happen due to a mixture of reasons such as environment, upbringing, health and genetics. Some tamariki may have a medical condition that puts them at risk of ARFID. It can sometimes occur with medical conditions that affect the digestive system or require special diets. 

ARFID may also happen after a child has a bad experience with food. This could be something that happened to them or something they saw, such as choking, gagging or vomiting.

Who is at risk?

ARFID is common in tamariki and also occurs in rangatahi. ARFID occurs in both girls and boys but is more common in boys. ARFID most often develops in early childhood and can last into adulthood.

Picky eating is common in tamariki, but it's very different to ARFID. ARFID is more than just fussy or picky eating. Tamariki with ARFID will deeply dislike certain foods or generally lack interest in food or eating. The behaviours in ARFID are ongoing and can cause serious medical problems.  

It's common for tamariki to dislike certain foods, but most tamariki will gradually eat and explore new foods as they get older. Tamariki with ARFID need a lot of support to try new foods and to eat the right quantity and variety of food to stay healthy.

It's important to look for certain signs if you are worried about your child’s eating. Tamariki with ARFID may show some of the following signs. 

Moods

• Anxiety and distress around food and mealtimes.
• Afraid or upset when trying new foods.
• Upset by the sight and sound of others eating.
• Worried about pain, nausea, vomiting or choking when eating.
• Difficulty eating in unfamiliar places.
• Concerned if food packaging changes.
• Difficulty concentrating or learning.

Behaviours

• Lack of interest in food and eating.
• Refusal to eat.
• Eating very slowly or not finishing meals.
• Avoiding eating with others, such as at school camps or birthday parties.
• Only eating a small range of foods that are similar in taste, texture, smell, or sight.
• Easily disgusted by different foods.

Physical health

• Delayed growth and development.
• Weight loss or not gaining weight as expected. 
• Reduced appetite.
• Brittle nails, dry hair, hair loss.
• Tiredness or lack of energy.
• Later onset of puberty.
• Slow heart rate.
• Stomach pains.
• Feeling full after eating only small amounts.
• Bloating. 
• Feeling sick in the stomach.
• Constipation.
• Nutritional deficiencies on blood tests.
• Poor bone development.

When tamariki restrict their food intake, it can lead to complications that can affect their health, wellbeing and daily life. 

• Significant weight loss – some tamariki who restrict their food intake can lose a lot of weight. Or, they may not grow or gain weight as expected. 
• Significant nutritional deficiency – if a child isn’t eating enough or is limited in what they eat, they may not be getting the nutrients they need for their body to function.
• Impact on daily function – ARFID can have a big effect on a child's daily life. Functioning at school and home can be challenging due to:
  • difficulties in eating with others
  • only eating particular foods
  • taking much longer to eat.
• Mental health – ARFID can affect your child’s mental health. They may experience low mood and anxiety around food and eating. They can also experience social anxiety and social withdrawal when they feel unable to eat around others. 

See your healthcare provider as soon as you can if you notice your child is:

• eating a small range of foods
• eating a small amount of food
• regularly showing little to no interest in food 
• changing in mood or behaviour – especially around food and eating.

If you think your child has ARFID, visit your healthcare provider. Ask for a referral to a paediatrician (child health doctor) or eating disorder specialist service. The earlier you seek help, the closer your child is to recovery.

There is no single test to check for ARFID. Your healthcare provider will talk with you and your child about their eating behaviour, habits and thoughts.

Your child may also need the following tests: 

• a full physical examination
• a blood test to check for nutritional deficiencies
• a urine sample
• an electrocardiogram (ECG) to check the heart's activity
• an X-ray.

Your child won't be diagnosed with ARFID if another eating disorder explains their symptoms better. Your healthcare provider will also make sure that their eating behaviours, weight loss or failure to grow are not due to another medical condition such as coeliac disease.

Your child’s healthcare provider may refer them to:

• an eating disorders service
• a paediatrician (child health doctor) 
• a mental healthcare provider, like a psychologist.

These healthcare providers can confirm whether or not your child has ARFID. They can also recommend the appropriate treatment.

ARFID is quite a new diagnosis, and experts are still researching which treatments work best. For all eating disorders, early diagnosis and treatment are likely to lead to better outcomes.

Psychological treatment 

If your child has ARFID, they might need psychological therapy. This can include whānau and family therapy or one-on-one sessions with your child. 

Cognitive-behavioural therapy (CBT)

CBT is a good treatment for people with ARFID. Treatment may involve gradually exposing your child to foods they fear alongside relaxation training.

Responsive feeding therapy (RFT) 

Responsive feeding therapy aims to:

• create pleasant mealtime experiences
• create comfortable whānau eating environments
• gradually introduce new foods into your child’s diet
• help your child learn to cope with their emotions while eating
• help your child understand how it feels when they’re hungry or full.

Medical treatment

When tamariki don’t eat enough food, they can have medical problems. Tamariki with ARFID will need to have regular appointments with their healthcare provider to monitor their physical health.

Medicine

There is no medicine that can treat ARFID. Some tamariki with ARFID may also have depression or anxiety – sometimes, medicines may help with these conditions. Your child may need some nutritional supplements if tests show they have low levels of certain vitamins and nutrients. 

Hospital stay 

If a child with ARFID is very unwell, they may need to stay in hospital. Health professionals will monitor them until they are safe and well enough to go home.

Recovery

With the right team and support, your child can recover from ARFID. Recovery is possible even if your child has had ARFID for many years. Tamariki with ARFID need a lot of love and support to get better and maintain healthy eating habits. They can sometimes develop ARFID symptoms again. If you notice your child is showing signs of ARFID again, contact your healthcare provider as soon as possible.

Having a child with ARFID can feel overwhelming. It's important to reach out for support when you need it. Eating Disorders Association of New Zealand (EDANZ) offers a support service for carers.(external link)