As a kid, I was a ridiculously picky eater. The truth is that while I was quite thin, my entire family was also naturally thin. I was constantly accused of having an eating disorder such as anorexia or bulimia. Nobody ever asked me how I felt when I ate. And they certainly never considered that something else could be going on. What if I didn’t have anorexia or bulimia but instead was suffering from avoidant/restrictive food intake disorder (also known as ARFID) that stemmed from a digestive issue?
The truth of the matter is that I DID exhibit signs of ARFID because I did avoid and restrict eating certain foods. Why? The simple truth is that my eating habits were due to the fact that I felt ill whenever I ate certain foods. But I didn’t understand this at a young age.
Once I realized in my young adulthood that certain foods made me feel ill and that my problem was a physical one that caused depression and anxiety around mealtime, things changed for me. I finally understood that I had always been a very picky eater because I was subconsciously trying to avoid the very foods that made me feel tired, bloated, constipated, and, for lack of better word, “blah.”
Eventually, once I started to eat foods that made me feel energetic, I ate more of those foods and no longer felt alienated or that something was “wrong” with me. In all fairness, at that time, the medical community only had eating disorders as an option for “labeling” my situation. And it’s quite possible that if this happened in our modern times today, I may have been more properly diagnosed with ARFID. Or, at the very least, further investigation would’ve found underlying digestive issues.
Now, children are known for picky eating, and some of this is due to strange textures and flavors that takes some getting used to on their palate. But kids are also very intuitive and might be picky eating because they don’t feel quite right when eating certain foods that others may think are great. They may have some digestive issues that affected their eating habits, just like I did. Certain foods might give them a stomachache or cause bloating, so they avoid them. So, are they truly a picky eater or just avoiding foods that cause digestive discomfort?
If you’re concerned about your young child or teen’s picky eating habit and you aren’t sure if it’s just picking eating or something more, you came to the right place. Let’s learn more about ARFID, also commonly known as selective eating disorder, so you can best determine the next steps for how you can help your child have a healthier, more balanced diet.
What is ARFID?
As I mentioned above, ARFID stands for avoidant/restrictive food intake disorder. It’s also known as “extreme picky eating.” Now, it’s important to note that ARFID is different to other eating disorders such as anorexia nervosa because it’s not about body image or intentionally trying to reach a certain body weight.
Instead, people with ARFID lose weight because of very selective eating—to the point where they aren’t getting enough nutrients. This may cause secondary psychological symptoms, especially during the teen years, due to lack of nutrition or social judgement and isolation for being “different.”
Avoidant/restrictive food intake disorder usually first appears in children and adolescents, but it can last into adulthood. Those struggling with this disorder may have other comorbidities, such as anxiety or obsessive-compulsive disorder, but this isn’t asbolute. 
They may also develop other comorbidities as a result of the disorder due to the lack of nutrients. It can also cause social issues for a child or adolescent as well since so much socializing centers around food and eating. For example, they may be embarrassed by their eating habits or they may feel anxious about getting together with friends to go out for pizza. 
The causes of ARFID aren’t clearly understood, but, in many cases, children who develop the disorder have experienced some kind of food- or eating-related trauma. For example, they may intuitively know that a food doesn’t make them feel well, but cannot pinpoint what it is, as in my case. (I later discovered that dairy and gluten caused my significant digestive symptoms, and those are primary ingredients in a typical teenage diet!)
Alternatively, a child may have witnessed someone close to them choking on their food. Or they may have had a choking incident themselves. Or, perhaps, they can feel what their body needs in that moment, so they focus on eating foods that make them feel good rather than foods that are less desirable.
ARFID can also present in different ways.  Here are some of the most common ways someone may experience ARFID:
- Displays a lack of interest in eating and/or gets full quickly.
- Shows signs of sensory avoidance such as food texture aversion or issues with certain tastes, temperatures, or smells.
- Fears negative consequences such as illness, choking, nausea, or allergies.
- Complains of feeling “unwell” or “not right” after eating certain foods or food groups.
The 4 Key ARFID Symptoms and ARFID Diagnosis
So, how can you tell if your child is just a picky eater or if there is something more serious going on? ARFID can be difficult to diagnose—and without diagnosis in childhood, it can last into adulthood.
The American Psychiatric Association has determined that someone must exhibit one or more of the following symptoms in order to be diagnosed with ARFID: [4, 5]
- Significant weight loss or inability to gain weight as expected. Rate of growth impacted in children.
- Notable nutritional deficiencies.
- Need for nutritional supplements or tube feeding in order to receive enough nutrients.
- Social life and mental health are impacted significantly.
If you find that your child is showing symptoms of ARFID, speak to a pediatrician to discuss next steps and come up with a plan.
Solutions for ARFID and Picky Eating
Having been there myself as a child, I understand how difficult this situation can be on family members. First and foremost, despite being a picky eater, one of the biggest questions to ask is this: Are they malnourished or simply avoiding certain foods?
Children don’t not always have the emotional maturity to understand why they aren’t eating something, and this is where your maturity as a parent comes into play. Consider the root cause of why the child is not eating well. Ask them questions and understand that not everyone likes the same foods. Listen to your kids, be there as a support, and if their nutritional status is being impacted, seek some help.
If your child simply shows signs of an unwillingness to eat anything other than his or her favorite foods, there are a few things you can do at home to help instill better eating habits. Often, the help needed is not psychological but nutritive. And this means you have to get creative!
Do they like smoothies? Try incorporating the nutrients lost via those yummy treats. Are there certain healthy foods that they will eat? Perhaps you can make their “favorite” dishes by replacing some components with more nutritious options. You can find some great kid-friendly options through this site, such as my Mac and Cheese or Chocolate Tart. (Tip: I like to use this tart filling as pudding for my kids!)
Also, try to offer a wide variety of food and try to stay patient throughout the process. How? Remind yourself that children typically can be offered a certain food up to 15 times before they will actually try it! I like to get my kids in the kitchen with me on a regularly basis, so that they’re a part of the preparation and cooking process. It makes them more open to trying new foods.
So, what if they’re refusing food because they don’t feel well? Try to find an alternative. Forcing a child to eat something that doesn’t agree with them just opens the door to more health problems.
In more extreme cases, you can request food allergy tests and also discuss whether there’s a physiological condition causing your child’s food aversions. Cognitive behavioral therapy (CBT) is currently a recommended approach because it has been used with success to treat other eating disorders. It may help the child identify the “why” behind their restrictive eating, and offer more options for nutritive treatment.
Depending on the situation and any other comorbidities, other treatments may be recommended including family-based therapy (FBT), tube-feeding for severe cases, and possibly even medication. [6, 7]
As a parent, it can be frustrating and very worrying when your child doesn’t want to eat properly. If your child is an extremely picky eater and you’re concerned about their health, take the time to talk with them and see how they’re feeling. Ask lots of questions to try to get a firm handle on what’s happening with their eating habits. Then, if necessary, schedule an appointment with your child’s pediatrician to discuss your concerns and come up with a plan of action.
- ARFID stands for avoidant/restrictive food intake disorder and it is also known as “extreme picky eating.” It was previously known as “selective eating disorder.”
- Eating problems caused by ARFID are not due to body image disturbance.
- An individual must have one or more symptoms to be diagnosed with ARFID.
- More research is needed to understand the best ways to treat ARFID, but you have many options—from allergy testing to searching for a related physical condition to cognitive behavioral therapy (CBT).
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