What is Avoidant Restrictive Food Intake Disorder (ARFID)?
Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder characterized by a persistent pattern of limited food intake that can affect a child’s growth, nutrition, health, and quality of life. Unlike anorexia nervosa or bulimia nervosa, ARFID is not driven by concerns about weight, body shape, or appearance.
Three Primary Presentations
Lack of Interest in Eating or Food
- Don’t feel hungry
- Eating is a chore Early satiety
- Don’t find food
enjoyable/worthwhile - “If I could take a pill for all my nutrition, I would”
Sensory Sensitivity
- Avoidance due to smells, texture, temperature, taste or appearance
- May eat a very bland diet
- A “white diet” is common (i.e. pasta, crackers, chicken nuggets, bread, cereal)
Fear of Adverse Consequences
- Fear something bad will happen if food is eaten
- Fears of choking, vomiting, gagging, allergic reaction, stomach discomfort, etc
- “I gagged on an apple peel, so if I eat any food with a skin I’ll gag or choke”
Understanding ARFID: More Than Picky Eating
While it is common for children to go through phases of liking and disliking certain foods, it is not typical for them to consistently eliminate foods from their diet without adding new ones. Children with Avoidant/Restrictive Food Intake Disorder (ARFID) are often misunderstood as being “picky eaters” or stubborn, but their challenges with food are much more complex.
ARFID can present in several ways, including sensory sensitivities to taste, texture, smell, or appearance of food; fear of negative consequences such as choking, vomiting, or allergic reactions; or a lack of interest in eating and food. Many children experience symptoms from more than one presentation, and food-related trauma may contribute to any of these patterns.
ARFID can significantly affect a child’s daily life and relationships. Children may struggle to eat at friends’ homes, feel comfortable only at certain restaurants, refuse school lunches, or avoid vacations and social events where food options are uncertain. Over time, these challenges can limit social opportunities and create increased stress for the entire family.
Without proper treatment, ARFID can lead to serious health concerns. Children may fall off their expected growth curve, develop vitamin and mineral deficiencies, experience a weakened immune system, and face developmental delays due to inadequate nutrition.
Why Mental Health Treatment Is Essential for ARFID
Because ARFID is both a feeding and mental health disorder, successful treatment requires addressing not only nutrition but also the anxiety, avoidance, sensory sensitivities, and emotional factors that maintain the disorder.
Licensed mental health clinicians play a critical role in treating ARFID by addressing the anxiety, fear, and avoidance that often drive food restrictions. By targeting the emotional and behavioral factors associated with eating, therapists help children develop a healthier relationship with food while preventing additional anxiety around meals and food exposures. Mental health clinicians are also trained to identify when referrals to occupational therapy or speech and language therapy may be beneficial.
In some cases, occupational therapy or speech and language therapy may be the first intervention recommended for a child struggling with food intake. However, when progress stalls or food avoidance continues, an evaluation with a licensed mental health clinician is often the appropriate next step. Addressing the underlying emotional and psychological factors can be key to achieving lasting improvement.
Registered Dietitians (RDs) with training in mental health and eating disorders provide valuable education and support to families navigating ARFID. Because they understand the factors that maintain the disorder, they can help caregivers better understand their child’s eating challenges, reduce mealtime stress, and identify practical ways to meet nutritional needs while treatment is underway.
A Team-Based Approach to ARFID Treatment
A multidisciplinary approach is considered the standard of care for eating disorders, including ARFID. An effective treatment team typically includes a medical provider, licensed mental health clinician, and registered dietitian, with support from occupational therapy and speech and language therapy when needed. Each professional brings a unique perspective and skill set to support the child’s overall health and well-being.
During treatment, the licensed mental health clinician focuses on the child’s emotional and behavioral needs, helping them work through fears, anxieties, and avoidance patterns related to food. At the same time, the registered dietitian partners with caregivers to provide education, guidance, and strategies for creating positive mealtime experiences while supporting the child’s nutritional needs. Together, this collaborative approach helps families move toward healthier, less stressful relationships with food.
While other disciplines such as Occupational Therapy can aid with sensory processing issues, licensed mental health clinicians are essential for addressing the psychological maintaining factors of ARFID to ensure the best chance for recovery. This is particularly true for children older than age 5 when medical or mechanical feeding issues are not present.
ARFID is a treatable condition, and early intervention can make a significant difference in a child’s health, development, and relationship with food. With support from a licensed mental health clinician and a multidisciplinary treatment team, children and families can build confidence, reduce mealtime stress, and expand food variety over time.
Christine Burianek
MSW, LCSW, RPT
Christine primarily treats children and adolescents. She uses EMDR, CBT and Child-Centered Play Therapy to support children and families struggling with ARFID. She follows standard of care and coordinates and collaborates with the team of professionals needed to help children successfully overcome ARFID.
Amanda Atkinson
MA, RD, LD, CEDS, CPT
Amanda is a Registered Dietitian that is trained to treat ARFID and support families working alongside doctors to identify nutritional deficiencies to help stabilize health and weight through a nutritional aspect while also helping to expand amount and variety of food. She works with families and parents of younger children to provide psychoeducation and support with meal and nutrition changes during ARFID treatment.
Sources:
1. Thomas, J. J., Becker, K. R., & Eddy, K. T. (2021). The Picky Eater’s Recovery Book. Cambridge University Press.
2. Thomas, J. J., & Eddy, K. T. (2018). Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder. Cambridge University Press.
3. Ramirez Z, Gunturu S. Avoidant Restrictive Food Intake Disorder. [Updated 2024 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK603710/