ARFID in Children, an Little-Known Eating Disorder

ARFID in children is a recently discovered behavioral disorder. It can have serious consequences if it's not treated in time. Learn more.
ARFID in Children, an Little-Known Eating Disorder

Last update: 24 December, 2022

Eating disorders in children are very common problems that tend to cause delays in growth. The most frequently detected diseases in this population are bulimia and anorexia. However, there are other severe disorders that can go unnoticed, such as ARFID in children.

Most little ones are very selective when it comes to eating their food. Some just don’t want to eat fruits or vegetables. This attitude shouldn’t have any impact on development. However, excessive selectivity when it comes to eating can mask a major digestive disorder.

What is ARFID in children?

ARFID in children is an eating disorder that comes from the acronym for Avoidant or Restrictive Food Intake Disorder. It’s a disease in which children have restrictive behaviors with food, so they avoid consuming it.

The main difference between ARFID and other disorders such as anorexia is that the restrictive attitude isn’t motivated by the desire to lose weight. This is a disorder discovered a few years ago, so it can go unnoticed many times. In fact, it was added to the fifth edition of the Diagnostic and Statistical Manual of Mental Illnesses (DSM-V) in 2013.

Unfortunately, the incidence of ARFID in children is quite high. Some studies suggest that it can affect up to 3.2% of infants between the ages of 8 and 13. In addition, the disorder is more common in men and in patients with autism spectrum disorder (ASD).

Girl with disgust at some foods has ARFID.
Rejection or disgust in the face of certain food products is expected in children. But after a certain limit, it’s considered a disorder.

Signs and symptoms of ARFID in children

Symptoms of ARFID in children, such as anxiety, usually appear right at the time of eating. However, they can tend to be very subtle. Food refusal can appear for many reasons, from an unpleasant texture or color to a possible fear of ingesting it.

The amount of food will become much more limited over time in children with ARFID. At the same time, the consumption of food in front of other people can also produce childhood anxiety in those affected.

One of the main manifestations of ARFID in children is the rejection of a particular food category. Children will refuse to eat foods that contain such ingredients.

Unfortunately, other manifestations aren’t as obvious, so parents should be aware of the following behaviors:

  • Lack of appetite and little interest in food
  • Decrease in the amount of food eaten
  • Taking a long time to eat or being opposed to eating
  • Preferring only certain specific brands
  • Not eating the same as the rest of the family
  • The sudden elimination of foods that they used to consume
  • Aversion to liquids

Causes of ARFID in children

Specialists don’t yet know the specific cause of ARFID in children. Some studies suggest that it’s a disorder of multifactorial origin, with biological, psychological, and environmental implications.

One of the most obvious causes of this disorder is a traumatic experience that may or may not be related to a particular food. Children can develop restrictive behaviors after the death of a family member or after going through a chronic disease.

Fear of eating food due to its possible consequences, such as vomiting or choking, can also be a trigger for ARFID in children. In addition, there are multiple conditions that increase the probability of suffering from the disease, among which the following stand out:

  • Premature children or those with intrauterine distress
  • Autism spectrum disorder
  • Multiple food allergies
  • Hormonal alterations
  • Anxiety disorders
  • Gastroesophageal reflux
  • Parents with eating disorders
  • Authoritarian or controlling parenting styles

Possible consequences

Eating disorders can have serious consequences for people who suffer from them, as they don’t ingest an adequate amount of nutrients. Children are in the process of growth and development, so their requirements are usually higher.

Children with ARFID or any other eating disorder don’t get enough vitamins or minerals, so their development and growth are impaired. In this regard, children may present any of the following manifestations:

  • Stunted growth
  • Rickets
  • Chronic malnutrition
  • Lack of energy to do daily activities
  • Poor academic performance and trouble concentrating
  • Delayed puberty

Diagnosis and treatment

The diagnosis of ARFID in children is purely clinical. The presence of the disorder is confirmed when the child isn’t able to meet their nutritional needs. In addition, the disease must lead to significant weight loss, dependence on vitamin supplements, or interfere with psychosocial functioning.

ARFID can be very similar to anorexia, especially in younger children, so doctors must make a differential diagnosis. In this regard, children with ARFID shouldn’t feel any discomfort regarding their physique or weight.

Unfortunately, there’s not much research on the treatment for ARFID in children. One study used an intensive behavioral intervention to treat different eating disorders in pediatric patients, showing favorable results.

The use of certain medications can also help treat this eating disorder. Some research shows that cyproheptadine has shown satisfactory results. This is an antihistamine and anxiolytic, capable of increasing appetite as part of its side effects.

Children with severe malnutrition tend to need hospitalization to receive food through a tube. In turn, all family members should receive psychological support.

Hospitalization of children with ARFID.
Hospitalization is reserved for cases of severe malnutrition that require parenteral feeding.

A common and dangerous disorder

ARFID in children is a recently discovered disorder that can have serious consequences if it’s not treated in time. This eating disorder is characterized by an evasive attitude towards certain foods, which generates a nutritional deficit and delayed growth.

The presence of this alteration can go unnoticed many times. In this regard, parents must be alert to sudden changes in the diet of their children, especially boys. It’s important to seek specialized medical help if the presence of the disorder is suspected.



  • De Toro V, Aedo K, Urrejola P. Trastorno de Evitación y Restricción de la Ingesta de Alimentos (ARFID): Lo que el pediatra debe saber. Andes pediatr. 2021;92(2): 298-307.
  • Zimmerman J, Fisher M. Avoidant/Restrictive Food Intake Disorder (ARFID). Curr Probl Pediatr Adolesc Health Care. 2017 Apr;47(4):95-103.
  • Iron-Segev S, Best D, Arad-Rubinstein S, Efron M et al. Feeding, Eating, and Emotional Disturbances in Children with Avoidant/Restrictive Food Intake Disorder (ARFID). Nutrients. 2020 Nov 4;12(11):3385.
  • Mairs R, Nicholls D. Assessment and treatment of eating disorders in children and adolescents. Arch Dis Child. 2016 Dec;101(12):1168-1175.
  • Sharp WG, Stubbs KH, Adams H, Wells BM et al. Intensive, Manual-based Intervention for Pediatric Feeding Disorders: Results From a Randomized Pilot Trial. J Pediatr Gastroenterol Nutr. 2016 Apr;62(4):658-63.
  • Feillet F, Bocquet A, Briend A, Chouraqui JP et al. Nutritional risks of ARFID (avoidant restrictive food intake disorders) and related behavior. Arch Pediatr. 2019 Oct;26(7):437-441.

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