A Parent’s Guide to ARFID

(Avoidant Restrictive Food Intake Disorder)

What is ARFID?

While it’s common for young children to go through picky eating phases, ARFID goes far beyond that. Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder that involves extreme picky eating, food avoidance, or a lack of interest in eating—that is not motivated by negative body image. While ARFID and anorexia can sometimes look very similar, the underlying motivation for each of those disorders is different. Children and teens with ARFID may avoid food due to sensory sensitivities (like texture, smell, or temperature), fear of choking or vomiting, or because eating simply feels overwhelming.

ARFID can lead to serious nutritional deficiencies, weight loss, slowed growth, or disruptions in daily life—such as avoiding social events that involve food. Many parents first notice that their child eats an extremely limited variety of foods, becomes anxious around mealtimes, or refuses entire food groups. The current requirements for an ARFID diagnosis are:

  • Significant weight loss or failure to gain weight in normal child development.

  • Significant nutritional deficiency.

  • Dependence on tube feedings or nutritional supplements (like Ensure)

How does ARFID develop?

ARFID is somewhat of an umbrella diagnosis that can cover a wide variety of presentations, and that can make it difficult to understand the disorder. In our experience, there are three common (but unofficial) presentations of ARFID. Please note that these are not official categories of ARFID. They are simply common presentations of the disorder.

Food and texture aversions

Some children with ARFID have intense sensory sensitivities, such as being "super tasters" (people with more taste buds than average) or having strong aversions to certain textures or flavors. This presentation is especially common in children with autism, though it’s not exclusive to that population.

These reactions go far beyond typical picky eating—they’re rooted in an exaggerated disgust response in the brain. Imagine eating a moldy, rotten piece of fruit. Does that make you cringe or even gag? That’s how people with flavor/texture aversions feel to what most people would consider a normal food.

Now imagine that you felt disgusted by a majority of food available to you in the world. That’s what it’s like for the kids with this presentation of ARFID. For these kids, mealtimes can feel overwhelming and distressing, not by choice—but because their brains are wired to protect them from what feels gross and even dangerous.

General anxiety presentations

Some children with very high levels of general anxiety can lose their appetites when they feel anxious. In extreme cases, that anxiety can cause them to become nauseous or even vomit.

The loss of appetite, nausea, and vomiting are not intentional, and they are not related to body image concerns. These symptoms are a consequence of severe general anxiety.

When a child with anxiety this severe experiences these symptoms, they often avoid eating because it’s easier and more comfortable than forcing themselves to eat without an appetite.

OCD/Phobia presentations

kids with this presentation have very high anxiety and may also have an OCD diagnosis. In this presentation, ARFID develops as a side effect of their primary anxiety disorder.

For example, many people with ARFID have a choking phobia. This phobia can cause them to avoid eating certain foods, and if the phobia worsens over time, they may begin avoiding food entirely due to their fear of choking.

Kids with contamination OCD, for example, can avoid foods they believe are “contaminated” and could potentially make them ill. Notice that in both of these examples, food avoidance is a consequence of a larger issue.

How would I know if my child has ARFID?

The good news about ARFID, at least in comparison to other eating disorders, is that kids with ARFID don’t tend to hide their symptoms. Unlike other eating disorders rooted in shame, secrecy, or body image concerns, ARFID behaviors are often more visible—children may openly refuse foods, express distress at mealtimes, or have very clear patterns around what they will and won’t eat.

While this can be frustrating or confusing for parents, it also means the signs are often easier to observe. Recognizing these patterns early can help you get the right support in place before the behaviors become more entrenched. Below are some of the most common behavioral signs associated with ARFID.

Emotional Signs

  • Has very high anxiety

    Either high general anxiety, or appears to have specific phobias or fears that pertain to eating.

  • Expresses a fear of choking, vomiting, or contamination. This fear may or may not be related to an event that child actually experienced.

  • Expresses a general fear, dislike, or disinterest in eating.

  • Is uncomfortable eating in new environments.

    This can include other people’s homes, in restaurants, or at school.

  • Is sad or depressed with no known cause.

    Malnourishment can contribute to lethargy and low motivation in children.

Behavioral Signs

  • Picky about every aspect of food

    The color, the texture, the flavor, how the food is prepared, where it came from, how the food is presented on the plate, etc.

  • Having a small selection of safe foods they are willing to eat.

  • Refusing to eat at restaurants or other people’s homes.

  • Refusing to eat variations of a safe food

    For example, a different brand of the same type of chip, or a chicken nugget not from their preferred fast food chain.

  • Throwing fits or temper tantrums at meal times.

  • Refusing to eat foods with specific textures

    Soft foods, crunchy foods, foods with inconsistent textures, etc.

  • Low willingness to try to new foods.

ARFID risk factors

Due to the diverse nature of this disorder, there is not a lot of high quality research available to suggest who may be most at risk for developing ARFID. Because this disorder can present so differently from person to person, it’s challenging for researchers to define a clear “at-risk” profile. But here is what we do know:

  • Children who naturally develop as extremely picky eaters are more at risk.

  • People with autism are more likely to struggle with food related flavor and texture aversions, increasing the risk of ARFID.

  • People who have other medical conditions that make digestion, chewing, or swallowing difficult may be more at risk.

Medical complications of ARFID

The medical complications associated with ARFID are very similar to complications common to anorexia since both disorders can result in restriction and malnutrition. However, severe ARFID most commonly occurs in childhood, whereas severe anorexia can develop at any age. Below are some of the medical complications that can occur due to restriction associated with ARFID.

Loss of menstrual cycle (amenorrhea) - For girls and teens who have started menstruating, the absence of a period can be a sign the body isn’t getting enough energy to function properly.

  • Thinning hair or hair loss - Hair may become dry, brittle, or fall out due to nutritional deficiencies and hormonal changes.

  • Lanugo (fine hair growth) - Soft, downy hair may appear on the arms, back, or face as the body tries to stay warm during malnutrition.

  • Always feeling cold - Poor circulation and low body fat can make your child feel cold all the time, especially in their hands and feet—even when others are comfortable.

  • Hypoglycemia (low blood sugar) - Caused by inadequate food intake, it can lead to shakiness, dizziness, confusion, fainting, and in severe cases, seizures or loss of consciousness.

  • Dizziness or fainting - Low blood pressure, dehydration, and inadequate nutrition can cause your child to feel lightheaded or faint.

  • Bradycardia (slow heart rate) - A dangerously low heart rate caused by the body conserving energy during malnutrition; can increase the risk of fainting, fatigue, and heart failure.

  • Osteopenia & Osteoporosis - Prolonged malnutrition can lead to a reduction in bone density. Even children and adolescents can develop osteopenia or osteoporosis throughout the course of their anorexia.

  • Gastroparesis - Also referred to as delayed gastric emptying, malnutrition can cause the stomach to slow down, causing food to linger in the stomach for longer than normal. Symptoms of gastroparesis include extreme bloating, nausea, and the sensation of early fullness (feeling stuffed after just a few bites of food).

  • Low energy or fatigue - You may notice your child seems tired, moves slowly, or avoids physical activity—they simply don’t have the fuel to keep up.

How do you treat ARFID?

ARFID, like all eating disorders, requires a comprehensive, team-based approach to treatment. The most effective care involves a multidisciplinary team that includes a therapist, a registered dietitian, a medical provider, and—when needed—a psychiatrist. This coordinated model is often referred to as a “treatment team.”

For outpatient care, the core team typically includes a therapist and dietitian working together to support both the emotional and nutritional aspects of recovery. Given the serious medical risks associated with ARFID, regular monitoring by a physician is essential, and psychiatric support may be added to manage co-occurring conditions like anxiety or depression. Every primary provider should have specific training in ARFID. It is a complex disorder, and ARFID treatment is even distinct from the treatment of other eating disorders.

Therapist: The therapist plays a central role in your child’s eating disorder treatment team. Their job is to help your child understand why the eating disorder developed, what maintains it, and how to manage the emotional challenges that come with recovery. Therapists work with clients to build skills for coping with anxiety, increasing distress tolerance, managing depression, and addressing any underlying fears—such as fears of choking or vomiting.

That intense anxiety your child feels before eating? The therapist helps them learn how to manage it. Of all the providers on the team, the therapist is often the one your child will work with the longest, providing a consistent space for emotional growth and support throughout recovery.

  • Dietitian: The dietitian on your child’s treatment team plays a crucial role in restoring physical health and supporting a more balanced relationship with food. Their job is to provide accurate, evidence-based nutrition education, correct common myths about dieting or “healthy” eating, and create a structured meal plan tailored to your child’s needs.

    Unlike general dietitians, eating disorder dietitians are trained to work through the emotional side of eating. They spend time exploring your child’s fears around food and help them take gradual steps toward expanding their food repertoire. Because of their expertise in nutrition and the effects of malnutrition on the body, dietitians are also skilled at recognizing early signs of medical instability and will refer to a physician when additional care is needed.

  • Medical Providers: Whether it’s a medical doctor, nurse practitioner, or physician assistant, a medical provider becomes an essential part of the treatment team when an eating disorder begins to impact a child’s physical health. These providers monitor key medical indicators—such as lab work, vital signs, and growth patterns—to assess for signs of medical instability. In addition to regular monitoring, they may prescribe medications that support recovery.

    For example, gastrointestinal discomfort is common in eating disorder recovery, and a provider can offer treatments to ease those symptoms and make eating feel more manageable. While medical providers can prescribe basic psychiatric medications, like antidepressants, they will often refer to a psychiatrist for more complex medication needs. It is ideal for your child’s medical provider to have specific training in eating disorders, as many medical complications can be subtle—and easily overlooked by providers without this expertise.

  • Psychiatrist: A psychiatrist is a medical doctor who specializes in mental health and is responsible for managing psychiatric medications, such as antidepressants, anti-anxiety medications, or mood stabilizers. Appointments with a psychiatrist may feel similar to therapy sessions, but they tend to focus more on symptom monitoring and medication management. Psychiatrists usually meet with patients less frequently than therapists—often every few weeks or months—to assess progress and make any necessary adjustments to medications.

    While it’s ideal to work with a psychiatrist who has some understanding of eating disorders, they don’t necessarily need to be a specialist. As long as they have a basic awareness of how eating disorders work, they can safely and effectively support your child’s mental health needs without interfering with the overall recovery process.

Treatment approaches

ARFID treatment should be tailored to the individual, as no single approach works for everyone. However, almost every case of ARFID will benefit from exposure to new foods. Kids often need to eat new foods 5-10 times before they get used to the smell, flavor, and texture - which is why so much exposure work is necessary in ARFID treatment. But kids with ARFID can also benefit from therapies that teach them to better manage their feelings of stress and anxiety. Some of the most commonly used evidence-based treatments include:

  • Exposure With Response Prevention (ERP): Exposure therapy for ARFID typically involves the creation of a food hierarchy, in which the child lists foods in order of least to most difficult to eat. Starting with the lowest items on the list, the therapist will practice eating those foods with the child and teach them to regulate their feelings of anxiety and distress during the process. With repeated practice, ERP can be an effective method for increasing the number and type of foods kids with ARFID are willing to eat.

  • Family-Based Treatment (FBT): Also known as the Maudsley Method, FBT is a structured, three-phase approach that empowers parents to take an active role in their child’s recovery. It focuses on early weight restoration and has strong evidence supporting its effectiveness, particularly for adolescents still living at home. Though created for the treatment of anorexia, the basic premise of FBT can be adapted to ARFID cases in which the child needs to gain weight.

  • Dialectical Behavior Therapy (DBT): A modern, skills-based approach that helps individuals learn to regulate their emotions, cope with distress, and practice mindfulness. One of its core concepts, Radical Acceptance, encourages people to acknowledge difficult thoughts or feelings without judgment. DBT can be especially helpful in eating disorder treatment, as many individuals struggle to manage overwhelming emotions or tolerate distress without turning to disordered behaviors.

  • Acceptance and Commitment Therapy (ACT): Pronounced like the word “act”—is a modern therapeutic approach that helps individuals respond to difficult thoughts and emotions without turning to self-destructive behaviors. A core goal of ACT is to help people build a values-based life, meaning they learn to make choices aligned with what truly matters to them, even in the presence of emotional pain. For those in eating disorder recovery, ACT can be a powerful tool for reconnecting with purpose and developing healthier, more flexible ways of coping.


The path to recovery

Supporting a child with ARFID can feel confusing, exhausting, and emotionally draining—but you are not alone. ARFID is a legitimate and treatable eating disorder, and with the right support, children can expand their food variety, reduce anxiety around eating, and meet their nutritional needs in a sustainable way. Early intervention matters, and so does having a team that understands the unique challenges of this diagnosis. With compassion, patience, and expert guidance, recovery is not only possible—it’s within reach. If you’re unsure where to start, we’re here to help.

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Citations

  • Gaudiani, J. L. (2019). Sick enough: A guide to the medical complications of eating disorders. Routledge.

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