Avoidant Restrictive Food Intake Disorder (ARFID) is a broad diagnosis that includes children and adults with selective food intake (severe picky eating, typically associated with sensory issues), restricted intake due to fear of consequences of eating (e.g., fear of vomiting or choking), or limited intake due to lack of appetite or interest in eating. In all cases the avoidant or restricted eating results in deficiency of energy and/or specific micronutrients. The ARFID diagnosis can apply to anyone with these characteristics from infancy through adulthood. Children with special health care needs often meet criteria for this diagnosis due to poor appetite (e.g., children with ADHD who are treated with stimulant medications), fear of eating (e.g., children who have experienced negative consequences of eating due to gastroesophageal reflux, eosinophilic esophagitis, or disorders that cause gastrointestinal pain and/or nausea, such as celiac disease, Crohn’s disease or ulcerative colitis), or selective eating due to sensitivity to tastes and textures (e.g., children with autism spectrum disorder).
This issue of Nutrition Focus reviews ARFID: definition, diagnosis, and suggested treatment approaches. It uses a series of case examples to illustrate different types of ARFID and the use of an interdisciplinary treatment team. A previous issue (volume 35, number 3 – “Anxious Eaters, Anxious Mealtimes: Support for Seriously Picky Eaters”) examined feeding problems and ARFID in younger children.
Avoidant Restrictive Food Intake Disorder