Supporting a Child with ARFID at School
Practical guidance for parents, carers and schools
Prepared by
Dr Melissa Bujtor
HCPC Registered Dietitian · AfN Registered Nutritionist (RNutr)
Paediatric Feeding Specialist
For a child with ARFID, school can present challenges around food that may not be obvious to other people.
The dining hall may be noisy or overwhelming. Familiar foods may not be available. A particular brand or preparation may matter. Eating within a fixed time can be difficult. Other children may comment on what is being eaten, or what is not. Staff may understandably want to encourage a child to eat, without realising that encouragement can sometimes increase pressure.
For some children, simply getting enough food and fluid during the school day requires considerable effort.
The aim of support at school is not to make a child’s eating look the same as everybody else’s.
It is to help them eat safely, meet their nutritional needs and participate in school life with as little unnecessary distress or difficulty around food as possible.
Understanding ARFID at school
ARFID — Avoidant/Restrictive Food Intake Disorder — is a recognised feeding and eating disorder.1,2
A child’s eating may be affected by one or more of:
- sensory differences around food — particular textures, tastes, smells, temperatures, appearances or combinations of foods may be difficult or inaccessible;
- low interest in eating or food — appetite may be limited, hunger cues may be less noticeable, or eating enough may require considerable effort;
- concern about what might happen when eating — such as choking, vomiting or experiencing pain.1,2
Other factors can also influence eating at school, including feeding skills, gastrointestinal symptoms, neurodevelopmental differences, anxiety, communication, the environment and previous experiences.
This means that two children with ARFID may need very different support.
Why school can be particularly difficult
Eating at school is very different from eating at home. A child may be managing:
A child who eats adequately at home may therefore find eating considerably harder at school.
Understanding the environment around the child, rather than focusing only on the food, can reveal relatively simple changes that make a substantial difference.
Start by understanding what the child needs
School support should be individual. Before deciding what needs to change, it can help for parents, the child, school and involved professionals to consider:
Food
- What foods can the child reliably access and eat?
- Does brand, preparation, temperature or presentation matter?
- Do foods need to be separated?
- Are there foods that are particularly difficult to have nearby?
Environment
- Where does the child currently eat? Is the dining hall manageable?
- Are noise, smell, crowds or movement affecting eating?
- Would another eating space help?
- Does the child want to eat with peers, somewhere quieter, or a combination of both?
Time
- Is there enough time to eat? Does the child need longer than their peers?
- Does queuing use up time they need for eating?
- Would eating slightly earlier or later help?
Communication
- How does the child communicate that something is wrong?
- Do they find it difficult to ask for help?
- What language around food feels supportive, and what makes eating harder?
Nutrition
- Are they able to eat and drink enough during the school day?
- Are there particular foods, drinks or supplements that need to be available?
- Is there a nutritional plan from their dietitian or clinical team?
The child’s own experience should be included wherever possible.
Protect foods that are accessible
If a child has a limited number of foods they can reliably access and eat, these foods should not be withheld at school in an attempt to make the child hungry enough to eat something else.
Accessible foods are serving an important purpose. They may be providing:
Where food exploration, dietary expansion or increased flexibility forms part of an individually agreed therapeutic plan, the school’s role should be clearly defined with the family and professionals involved.
It should not be improvised at lunchtime.
School meals and therapeutic food work are not necessarily the same thing
For many children, the priority during the school day is being able to eat enough to support their nutrition, concentration, energy and participation in learning.
If a child is also working on increasing food range, flexibility or reducing fear around food, this should follow their individual therapeutic plan.
School staff should not independently:
- remove familiar or accessible foods;
- introduce food challenges;
- ask a child to “work up” to eating something unfamiliar;
- use hunger as a strategy;
- repeatedly encourage tasting;
- introduce rewards for trying foods;
… unless this has been specifically agreed as part of the child’s individual plan.
Where school does have a role in therapeutic work, everyone should be clear about:
- what the child is being invited to do;
- why it is being recommended;
- who is overseeing the intervention;
- how the child’s communication and autonomy will be respected;
- how distress will be recognised;
- what staff should do if the child does not want to continue.
ARFID support should be matched to the child’s presentation, health needs, developmental profile and individual goals rather than using one standard approach for every child.3,4
Use neutral, supportive communication around eating
Well-intentioned encouragement can quickly feel like pressure when eating is already difficult.
The aim in everyday school meals is not to make eating something the child has to perform for adult praise or reward.
Unless this forms part of an individually agreed therapeutic plan, keep communication around how much or what the child eats neutral and low-pressure.
What not to say — and what to say instead
Instead of
“Just have one bite.”
Try
“Your food is here. You can let me know if you need anything.”
Instead of
“You haven’t eaten very much.”
Try
“How is lunch feeling today?”
Or, if monitoring intake is not part of the child’s plan, simply avoid commenting.
Instead of
“Come on, you’ve nearly finished.”
Try
“You’ve got ten minutes left. Let me know if you need more time.”
This gives useful information without turning completion into the goal.
Instead of
“Everyone else has eaten theirs.”
Try
No comparison is needed. Focus on what the individual child needs.
Instead of
“You need to eat your sandwich before you can have your crisps.”
Try
“Your lunch is all here for you.”
Unless there is a specific clinical reason otherwise, avoid creating an eating hierarchy in which one food has to be earned by eating another.
Instead of
“If you try this, you can have a sticker.”
Try
“You don’t have to do anything with that food today.”
Or follow the child’s agreed therapeutic plan if food exploration forms part of their treatment.
Instead of
“You liked this last week.”
Try
“It looks like that isn’t working for you today.”
Being able to eat a food once does not mean it will always be accessible.
Instead of
“Your mum says you need to eat more.”
Try
“Is there anything that would make eating easier right now?”
If intake needs clinical monitoring, staff should follow the agreed plan rather than placing responsibility on the child in the moment.
Instead of
“That’s amazing — you tried it!”
Try
If the child wants acknowledgement: “I saw that.” or “How was that for you?”
Some children enjoy praise; others experience it as attention or pressure. Follow the individual child and any agreed therapeutic approach.
Instead of
“Don’t be silly, there’s nothing wrong with it.”
Try
“Something about this seems difficult today.”
This validates the child’s experience without assuming what is wrong.
Instead of
“You need to get used to eating what everyone else eats.”
Try
“Let’s work out what you need so that you can eat at school.”
The goal is access to nutrition and participation, not conformity.
Sometimes the most supportive response is not to comment on eating at all.
In everyday school meals, the aim is to create conditions in which the child can access the nutrition they need without also having to manage unnecessary attention, persuasion or judgement around their eating.
Make lunchtime more accessible
Depending on the individual child, useful adjustments might include:
These are possibilities, not a checklist. A quieter room may be invaluable for one child and isolating for another. Eating with friends may help one child and make eating significantly more difficult for somebody else.
The question should always be:
What barrier are we trying to remove for this particular child?
School food rules may need flexibility
Families are sometimes told that a particular food cannot be brought into school because it does not meet the school’s usual expectations for packed lunches or healthy eating.
For a child with ARFID, the immediate nutritional priority may be quite different.
A food that would not ordinarily form part of the school’s preferred lunch policy may be one of the few foods the child can reliably eat.
The aim should therefore be to support the child’s nutritional and health needs rather than applying general food rules without considering their individual circumstances.
Schools should work with parents, the child and relevant professionals to establish appropriate arrangements.
Reasonable adjustments
Some children with ARFID may meet the legal definition of disability under the Equality Act 2010, depending on the nature, duration and impact of their difficulties.5
Where a child is disabled within the meaning of the Act, schools have a duty to make reasonable adjustments so that they are not placed at a substantial disadvantage.
Current Department for Education guidance explicitly recognises ARFID in its examples of reasonable adjustments to school meal provision. It gives the example of a child with ARFID who can only eat a particular type of sandwich, with the school providing that sandwich so the child can access a meal during the school day.6
This does not mean that every requested adjustment must automatically be provided. Reasonable adjustments are individual and depend on the child’s circumstances.
It does demonstrate, however, that flexibility around usual school-food provision can be an entirely legitimate reasonable adjustment.
Depending on the individual child, reasonable adjustments could potentially involve changes to:
Children may also receive support through the school’s SEND arrangements or, where appropriate, an Education, Health and Care Plan (EHCP).
Not every child with ARFID will require the same arrangements, and not every child with ARFID will necessarily meet the legal definition of disability.
The important point is that individual needs should be considered rather than assuming the same lunchtime arrangements will work for every pupil.
Put the plan in writing
Where a child needs particular support around eating, it is helpful to have a clear written plan. Depending on the child’s needs and the school’s systems, this might sit within:
- an individual healthcare plan;
- SEN support documentation;
- an EHCP where relevant;
- an individual feeding or eating plan agreed with school.
The plan might record:
This helps prevent the child having to explain their needs repeatedly to different adults.
It also reduces the risk of one member of staff unknowingly undoing an agreed approach by using pressure, removing an accessible food or introducing a new expectation around eating.
Make sure everyone who needs to know, knows
A good plan only works if the relevant people understand it. Depending on the school, that may include:
Not everyone needs the child’s full clinical history. They do need enough information to understand what the child needs from them.
Include the child’s voice
Children should be involved in decisions about their eating and school support in ways that are accessible to them. This may be through:
A child does not need to be able to explain or justify a need verbally for that need to be taken seriously.
Useful questions might include:
A child’s answer may not match what adults assume.
Including them in decisions also reduces the experience of food becoming something that is constantly being discussed about them rather than with them.
Think beyond lunchtime
ARFID can affect other parts of school life too. Consider:
A child should not have to repeatedly disclose or defend their eating needs every time food appears in a different part of school life. Planning ahead can make participation much easier.
School trips and residentials
Trips involving meals can create additional challenges for children with ARFID and their families. Plan early. Consider:
The aim should be to find ways for the child to participate, rather than assuming that food difficulties automatically prevent them from attending.
Avoid making food a public issue
Children with ARFID may already be very aware that they eat differently from their peers. Where possible:
- avoid discussing their intake in front of other children;
- do not ask peers to encourage them to eat;
- do not use their food as a classroom discussion;
- avoid public praise for trying something unless this is something the child actively values and it forms part of their agreed support;
- do not compare their plate with somebody else’s;
- do not make them explain why they have different food;
- do not photograph or record food interactions without an agreed clinical reason and appropriate consent.
Privacy and dignity matter.
If your child comes home having eaten very little
First, find out what happened. Try not to assume that the child chose not to eat or that school failed to encourage them enough.
Ask practical questions:
Repeated low intake at school is useful information. It may mean the current plan is not adequately meeting the child’s needs and should be reviewed.
Where nutritional intake, growth or physical health is being affected, involve the child’s dietitian or medical team.
Having trouble navigating feeding issues at your child’s school?
Sometimes families know what their child needs, but putting that support into practice at school is difficult.
There may be disagreement about school meals or packed lunches. Staff may be unsure what ARFID is. A child may be eating very little during the school day. General healthy-eating policies may be applied in ways that do not fit the child’s clinical needs. Lunchtime arrangements may be contributing to distress, or different members of staff may be taking different approaches.
You do not have to navigate this alone.
Dr Melissa Bujtor works directly with families and schools to help translate a child’s feeding and nutritional needs into practical support within the school environment. This can include:
- school visits to understand the eating environment and identify barriers and supports affecting the child’s eating;
- liaison with teachers, SENCOs, pastoral teams and school leadership;
- collaborative planning around meals, snacks, eating environments and appropriate adjustments;
- written recommendations setting out a child’s individual feeding and nutritional needs;
- support with feeding and eating plans for use across the school day;
- staff teaching and education around ARFID, feeding differences and neurodiversity;
- staff teaching on supportive, neuroaffirming language and approaches around eating;
- support around school trips, residentials and transitions where eating needs require additional planning;
- working alongside the child’s wider clinical team where appropriate.
The aim is not to tell a school that it is “doing it wrong”. It is to help the adults around the child develop a shared understanding and a consistent, workable approach that supports nutrition, access to education and participation in school life.
Enquire about school feeding support
When to seek further clinical advice
School adjustments can make eating considerably more accessible, but they do not replace appropriate clinical care.
Seek further professional advice
Seek further professional advice if your child:
- is regularly unable to eat or drink enough during the school day;
- has weight loss, faltering growth, or a concerning change in their usual height or weight trajectory;
- shows signs of nutritional deficiency;
- becomes faint, unusually tired, weak or physically unwell;
- experiences persistent pain, vomiting or gastrointestinal symptoms associated with eating;
- coughs or chokes when eating or drinking;
- has difficulty chewing or swallowing;
- is experiencing increasing fear or distress around eating;
- is losing foods they were previously able to eat;
- is increasingly unable to participate in school because of eating.
Some symptoms require prompt medical assessment. If your child is acutely unwell, seek appropriate urgent medical care.
A final thought
Supporting ARFID at school is not about persuading a child to eat like everybody else. It is about understanding what makes eating possible for that child.
Sometimes the most useful changes are practical: access to familiar food, enough time, an appropriate place to eat, predictable arrangements, less attention around eating and adults who understand why these things matter.
The aim is not to remove every difference. It is to remove unnecessary barriers while protecting nutrition, health, autonomy and participation.
When home, school and the clinical team work from the same understanding, the child does not have to carry the responsibility for making the system work around them.
Written by Dr Melissa Bujtor, HCPC Registered Dietitian, AfN Registered Nutritionist (RNutr) and Paediatric Feeding Specialist, for Dr Melissa Bujtor Specialist Dietetic Practice. This guide provides general information and is not a substitute for individual clinical assessment, legal advice or recommendations specific to your child’s school or circumstances.
References
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5-TR. 5th ed, text rev. Washington, DC: American Psychiatric Association Publishing; 2022.
- World Health Organization. Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. Geneva: World Health Organization; 2024.
- Menzel JE, et al. Avoidant/restrictive food intake disorder: review and recent advances. Curr Psychiatry Rep. 2024.
- Kambanis PE, Thomas JJ. Assessment and treatment of avoidant/restrictive food intake disorder. Curr Psychiatry Rep. 2023;25:53–64.
- Equality Act 2010. London: The Stationery Office; 2010.
- Department for Education. Free school meals: guidance for local authorities, local-authority-maintained schools, academies and free schools. London: Department for Education; 2026.
- Royal College of Psychiatrists. Avoidant/restrictive food intake disorder (ARFID). London: Royal College of Psychiatrists.
- Society for Adolescent Health and Medicine. Medical management of restrictive eating disorders in adolescents and young adults. J Adolesc Health. 2022;71(5):648–654.
- Assessing growth in children and adolescents with avoidant/restrictive food intake disorder. 2024.
- Physical health complications in children and young people with avoidant restrictive food intake disorder: a systematic review and meta-analysis. 2024.
Written by Dr Melissa Bujtor, HCPC Registered Dietitian, AfN Registered Nutritionist (RNutr) and Paediatric Feeding Specialist, for Dr Melissa Bujtor Specialist Dietetic Practice. This guide provides general information and is not a substitute for individual clinical assessment, legal advice or recommendations specific to your child’s school or circumstances.
About the author
Dr Melissa Bujtor
A HCPC Registered Dietitian and AfN Registered Nutritionist with specialist expertise in paediatric dietetics, feeding development and eating disorders.
Dr Bujtor also holds a British Psychological Society-accredited Master’s degree in Psychology, bringing an understanding of behaviour, cognition and emotional development to her clinical work with children and young people.
She is a published scientist whose work spans research, policy and advocacy, and serves on the Board of Trustees of The Feeding Trust, helping to connect research, policy and clinical practice to improve outcomes for children, young people and families.
Her clinical practice combines evidence-based dietetics with a developmental understanding of feeding — looking beyond what a child eats to understand the factors that may be contributing to their difficulties.
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