What is Avoidant Restrictive Food Intake Disorder?

Avoidant restrictive food intake disorder is usually diagnosed in children between two and six, much earlier than most eating disorders.

Many pediatricians may at first believe that the child is simply a picky eater and that they are going through a phase they will outgrow. This can make it difficult to get an accurate diagnosis.

Studies indicate that children with avoidant restrictive food intake disorder may have a lack of interest in food or they may avoid food for other reasons.

In some cases, they cannot tolerate the sensory properties, like the taste, smell, texture, or appearance of certain foods. ARFID may also result from a fear of the consequences of eating. For example, if the child is afraid they will choke or vomit or if they had previous bad experiences eating particular foods.

The main symptom of avoidant restrictive food intake disorder is picky eating or a general lack of interest in eating. Some children with ARFID do not gain enough weight, but others are at a healthy weight or may be overweight if they will only eat junk or processed foods.

ARFID can occur independently, but it is more common in children with anxiety, ADHD, OCD, and autism.

Adults may have ARFID if children with the condition experience spontaneous remission or if the condition continues into adulthood. Unfortunately, researchers do not know much about the adult version.

Selective eating in childhood is a risk factor for psychiatric symptoms later in life, but this does not necessarily apply to ARFID. Children with ARFID may never reincorporate things they avoid into their diet and continue avoiding individual foods and broad food categories into adulthood.

In addition to poor physical development, avoidant restrictive food intake disorder can cause other physical and mental health problems. People with ARFID are at risk for amenorrhea, electrolyte abnormalities, and low heart rate.

One case study showed that an adolescent male with ARFID not only had vitamin A, B12, D, E, K, and folate deficiencies but also experienced spinal cord degeneration from malnutrition. In one study of children with ARFID, half of the participants also had a generalized anxiety disorder.

Scientists do not fully understand what causes avoidant restrictive food intake disorder, but research suggests that a few factors may make it more likely that someone will develop ARFID. These factors include a history of gastrointestinal problems, like acid reflux or vomiting, or mental health conditions like OCD, anxiety, or autism.

Children with ARFID are also more likely to have mothers with an eating disorder or parents with anxiety. Research also suggests that changes in brain activation may play a role. In people with ARFID, brain activity is increased in the parts of the brain that process attention, emotional regulation, rewards, and body signals.

Doctors consider a number of criteria when diagnosing avoidant restrictive food intake disorder, including a lack of interest in food or avoidance of food because of texture, taste, or smell, inability to gain enough weight, interference with psychosocial functioning, and dependence on dietary supplements or tube feedings.

Doctors may also perform imaging and blood testing to determine if there are any medical reasons for weight loss or GI discomfort and to screen for nutritional deficiencies. Some children need additional testing, such as endoscopy or brain imaging, but doctors usually diagnose ARFID from a health history and physical exam.

Although avoidant restrictive food intake disorder is equally common in male and female infants and toddlers, by mid-childhood it becomes more common in boys, usually when it occurs with autism.

Studies also show that ARFID often develops at even younger ages, and children go undiagnosed for longer periods than with other eating disorders.

The best treatment for avoidant restrictive food intake disorder requires medical care, feeding therapy, and nutritional counseling and requiring a team with a doctor, therapist, and dietitian. A speech pathologist may also be involved if the child needs help with swallowing and feeding.

Treatment focuses on developing healthy eating patterns, achieving and maintaining a healthy weight, and learning to eat without fear. Outpatient treatment is suitable for most children, but a hospital-based program is often necessary for those with severe health issues or who require tube feeding.

Avoidant restrictive food intake disorder is difficult to overcome. For best results, the whole family should work together to reinforce good mealtime behaviors.

Complications of ARFID include constipation, delayed cognitive functioning, and dependence on tube feedings. Some people with ARFID may develop anorexia nervosa during treatment as their bodies change when gaining weight, though this is rare.