Understanding ARFID
A clear, evidence-based introduction for parents and carers
Prepared by
Dr Melissa Bujtor
HCPC Registered Dietitian · AfN Registered Nutritionist (RNutr)
Paediatric Feeding Specialist
If your child eats a very limited range or amount of food — and their eating seems to be affecting their nutrition, health or everyday life — you may have come across the term ARFID.
This guide explains what ARFID is, the different ways it can present, how it differs from the food selectivity many children experience, and when it may be worth seeking further advice.
It provides general information, not a diagnosis. ARFID can only be diagnosed following an appropriate clinical assessment.
What ARFID means
ARFID stands for Avoidant/Restrictive Food Intake Disorder.
It is a recognised feeding and eating disorder in which someone avoids or restricts the amount or range of food they eat to the extent that there is a significant impact on their nutrition, physical health or everyday life.1,2
This might include:
- weight loss or difficulty growing as expected;
- nutritional deficiency;
- reliance on nutritional supplements or enteral feeding to meet nutritional needs;
- significant interference with everyday life, such as eating at school, taking part in social occasions or eating away from home.1,2
Importantly, ARFID is not defined by the number of foods a child eats.
A child can eat a relatively small range without having ARFID, while another child may eat more foods but still experience significant nutritional or everyday consequences. It is the overall impact, considered alongside the nature of the restriction and the wider clinical picture, that matters.
ARFID was introduced as a diagnosis in DSM-5 in 2013 and is also recognised within ICD-11.1,2 Our understanding of ARFID continues to develop, and awareness among families and professionals is increasing.
Understanding your child’s experience of eating
ARFID does not look the same in every child. Three commonly recognised presentations help us understand what may be contributing to restricted intake.3 A child may experience one or, very commonly, a combination of these.
i
Sensory differences around food
For some children, particular textures, tastes, smells, temperatures, appearances or combinations of foods may be uncomfortable, overwhelming or difficult to manage. They may rely on foods with particular sensory characteristics, or prefer specific brands, shapes, textures, colours or preparation methods because these make eating more predictable or accessible.
ii
Low interest in eating or food
Some children experience little appetite or interest in food. Eating may require considerable effort, they may become full quickly, or hunger cues may be less noticeable. For these children, eating enough may be difficult even when they are not frightened of food and do not find its sensory characteristics particularly challenging.
iii
Concern about what might happen when eating
Some children restrict food because they are frightened or concerned about something happening when they eat — such as choking, vomiting or experiencing pain. This may develop following a particular experience, although there is not always a single identifiable event. Avoidance can then become a way of trying to prevent the feared experience from happening again.
These presentations are useful ways of understanding ARFID, but children do not need to fit neatly into one category. A good assessment looks beyond the label to understand what eating is like for the individual child and what may be contributing to their restriction.
How is ARFID different from common food selectivity?
Many children experience periods when their food range becomes smaller, they are cautious around unfamiliar foods or they develop strong preferences about what and how they eat. This can form part of typical feeding development.
ARFID is different because the restriction has become significant enough to have an important impact.1,2 A child with ARFID may experience one or more of the following:
- Growth or weight may be affected — for example, weight loss or difficulty growing as expected.
- Nutrition may be affected — including inadequate intake of energy or particular nutrients.
- Nutritional supplementation may be needed — and some children require enteral feeding to meet nutritional needs.
- Everyday life may be significantly affected — for example, eating at school, travelling, attending social occasions or eating away from home may become difficult or distressing.
ARFID can also persist over time rather than following the more transient patterns of food selectivity experienced by many children.4
However, there is no single food number, behaviour or severity threshold that parents can use at home to distinguish ARFID from selective eating. Assessment considers the whole child and the impact their eating is having.
What about body image?
ARFID differs diagnostically from eating disorders in which restriction is driven by concerns about weight or body shape.1,2
A child with ARFID may still have thoughts or feelings about their body — particularly as they grow older — but these are not what is driving the avoidant or restrictive eating that characterises ARFID.
This distinction is important because different eating disorders require different assessment and treatment approaches.
What ARFID is not
Because restricted eating is still frequently misunderstood, it helps to be clear about what ARFID is not.
- It is not a child simply being difficult, defiant or attention-seeking.
- It is not evidence of poor parenting.
- It is not defined by wanting to lose weight or change body shape.
- It is not something that can necessarily be resolved by hunger, persuasion, rewards or repeated instructions to “just try” a food.
- It is not something you can identify simply by looking at a child’s body size.
Understanding these distinctions matters. When a child’s eating is having a significant impact, dismissing it as “just fussiness” can delay appropriate assessment and support.
Who can experience ARFID?
ARFID can affect people of any age and can continue into adolescence and adulthood, and cases are identified across the UK and Ireland in children and young people of all ages.6 It can occur across the weight spectrum.
A child does not need to be underweight to have ARFID or to experience nutritional consequences from restricted eating. For example, a child may obtain enough energy to support their weight from a limited range of foods while still having inadequate intake of particular nutrients.
ARFID also commonly co-occurs with neurodevelopmental differences, including autism and ADHD. Research examining autism specifically has found substantial co-occurrence between the two.5
The relationship is complex and should not be reduced to sensory processing alone. Sensory differences may be important for some children, while appetite, interoception, attention, predictability, anxiety, previous feeding experiences and other individual factors may also contribute.
Being autistic or having ADHD does not mean a child necessarily has ARFID, and having ARFID does not mean a child is necessarily neurodivergent. Where neurodevelopmental differences are present, support should recognise and accommodate the child’s individual sensory, communication, regulatory and developmental needs.
Why does ARFID happen?
There is no single cause of ARFID.
Current understanding suggests that ARFID can develop through a complex interaction of biological, psychological, developmental and environmental factors, and the combination is different for each person.3 Relevant factors may include:
For some children, there may be a clear history explaining how eating became difficult. For others, there is no single identifiable starting point.
What ARFID is not understood to be is the result of a parent simply doing something wrong.
Assessment should therefore focus less on blame and more on understanding the individual child: what is contributing to their eating, what is already helping, and what support they need.
What can help?
Support for ARFID should be individualised. There is no single approach that is right for every child, because the reasons for restricted eating — and its consequences — vary considerably.
Support may include:
- A comprehensive assessment to understand the child’s eating and feeding history, nutritional intake, growth, physical health and the factors contributing to restriction.
- Supporting nutrition and growth by making the most of foods the child already eats, and using supplementation or other nutritional support where needed.
- Reducing unnecessary pressure around eating, and creating an eating environment that takes account of the child’s individual needs.
- Supporting food range or flexibility where appropriate, using an approach suited to the reasons foods are difficult for that child.
- Addressing fear or anxiety where this is contributing to restriction.
- Understanding sensory needs and using appropriate adaptations and support.
- Assessing feeding or swallowing skills where there are concerns.
- Working as a team where needed — which may include a dietitian, psychologist or other mental health professional, paediatrician, speech and language therapist, occupational therapist or others.
The goal is not simply to make a child’s eating look more typical.
Depending on the child, meaningful outcomes may include improved nutritional adequacy, safer eating, reduced distress, greater flexibility, improved participation in everyday life, a more manageable experience of eating, or an increased range of foods where this is an appropriate goal.
When should I seek advice?
Consider seeking professional advice if your child’s eating is affecting their nutrition, growth, physical health or ability to participate in everyday life — or if you are concerned about the extent or direction of their restriction.
You do not need to be certain that your child has ARFID before asking for help.
Seek prompt medical assessment
Some signs require more prompt medical assessment, including significant or rapid reduction in food or fluid intake, weight loss, dehydration, fainting, unusual weakness or lethargy, persistent vomiting, or concerns about swallowing or physical health.
If your child is acutely unwell, seek appropriate urgent medical care.
A word about language
Words matter. Describing a child as difficult, stubborn, manipulative or “just fussy” tells us very little about why eating is difficult for them.
More useful questions are:
A diagnosis of ARFID is not a judgement about the child or their family. Used appropriately, it can provide a shared way of understanding a significant eating difficulty and help identify the support that is needed.
Wondering whether your child may have ARFID?
You do not need to work this out alone.
If your child’s food range is very restricted, you are concerned about their nutritional intake or growth, or eating is having a significant impact on everyday life, an assessment can help establish what is happening.
At Dr Melissa Bujtor Specialist Dietetic Practice, assessment looks beyond the number of foods a child eats. We consider nutrition, growth, feeding development, sensory experiences, appetite, medical and gastrointestinal factors, feeding skills and the impact eating has on the child and family.
If you are wondering whether your child’s eating may be ARFID, or would like to discuss whether an assessment would be appropriate, get in touch.
Enquire about ARFID assessment and support
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 or advice.
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.
- Thomas JJ, Lawson EA, Micali N, Misra M, Deckersbach T, Eddy KT. Avoidant/restrictive food intake disorder: a three-dimensional model of neurobiology with implications for etiology and treatment. Curr Psychiatry Rep. 2017;19(8):54. doi:10.1007/s11920-017-0795-5.
- Sanchez-Cerezo J, Nagularaj L, Gledhill J, Nicholls D. What do we know about the epidemiology of avoidant/restrictive food intake disorder in children and adolescents? A systematic review of the literature. Eur Eat Disord Rev. 2023;31(2):226–246. doi:10.1002/erv.2964.
- Sader M, Weston A, Buchan K, Kerr-Gaffney J, Gillespie-Smith K, Sharpe H, et al. The co-occurrence of autism and avoidant/restrictive food intake disorder (ARFID): a prevalence-based meta-analysis. Int J Eat Disord. 2025;58(3):473–488. doi:10.1002/eat.24369.
- Sanchez-Cerezo J, Neale J, Julius N, Lynn RM, Hudson L, Nicholls D. Incidence of avoidant/restrictive food intake disorder in children and adolescents across the UK and Ireland: a BPSU and CAPSS surveillance study. BMJ Open. 2024;14(11):e088129. doi:10.1136/bmjopen-2024-088129.
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 or advice.
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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