Picky eater or eating disorder?

Children can be picky eaters. It's a concern many parents face. Some children won't eat foods that are green; some avoid foods with certain textures. Preschoolers are notoriously picky eaters, often limiting the foods they eat to just a couple of favorite items.

For many children, picky eating is a behavior they will eventually grow out of. But for others, food preferences and limitations may persist – and even start to affect their health. As parents, understanding the difference between picky eating and something more serious is important to help address food and health challenges.

What is Avoidant Restrictive Food Intake Disorder (ARFID)?

Children with Avoidant Restrictive Food Intake Disorder (ARFID) are not just picky eaters. ARFID is an eating disorder in which a child limits the amount or types of food consumed. Children with ARFID do not consume enough calories, which can lead to growth and development issues. Unlike eating disorders like anorexia and bulimia, children with ARFID don't have a distorted body image; they experience anxiety related to the food itself.

What causes ARFID?

ARFID often begins in early childhood and can have different causes. Jasmine Ghannadpour, Ph.D., Psychologist in the Center for Pediatric Eating Disorders at Children's Health℠ and Assistant Professor at UT Southwestern, explains that ARFID often has one of four different causes, though in some children these causes can overlap.

1. Lack of interest in food. "Children with general food aversion may have never been interested in eating from birth," says Dr. Ghannadpour. "They may get full quickly and usually have growth issues because they eat so little food."
2. Sensory food aversions. Some children may experience ARFID because of a sensory food aversion. These children eat normal quantities of food but may only eat foods of a certain texture or taste. Dr. Ghannadpour says many of these children are supertasters who may taste flavors in foods that others don't detect. Depending on the variety of food these children eat, they may also have growth issues.
3. Trauma. ARFID can also be caused by trauma. For instance, if a child chokes on food or watches someone else choke on food, they may become afraid to eat. Sometimes children who experienced or witnessed this may refuse to eat almost anything.
4. Stomach or GI conditions. Children with gastrointestinal conditions like inflammatory bowel disease, celiac disease, constipation or other conditions may start to avoid food because it makes them feel ill. Even children who have experienced excessive vomiting due to an illness or cancer treatment can develop ARFID.

What are symptoms of ARFID in children?

A child with food avoidance behaviors such as ARFID exhibits both physical and emotional signs. ARFID symptoms may include:

• Anxiety around food in social situations
• Changes in eating habits
• Growth problems
• Less energy than normal
• Weight loss

"The behavior a parent is looking for is avoidance," says Dr. Ghannadpour. "These kids may take longer and longer to eat the meal. They may try to negotiate with parents and say things don't taste right or ask for something in particular."

It's also important to note that it's not just small kids who can have ARFID. Children of all sizes may have the condition.

"Sometimes kids who are normal weight or overweight get overlooked because providers aren't worried about growth," says Dr. Ghannadpour. "But eating a limited variety may still cause children to be vitamin deficient."

Dr. Ghannadpour says most parents know when it is more than just picky eating. Parents may spend too much time getting specific brands or types of foods, preparing foods a certain way or packing food to take with them anywhere the child goes. Parents may also have to prepare multiple dinners when feeding their family just to make sure their child eats.

How is ARFID treated?

ARFID is a complex condition that requires comprehensive treatment. If your child shows signs of ARFID, he or she needs a thorough assessment including a physical and psychological history. Your child may also need an evaluation by an occupational therapist for sensory issues or a gastroenterologist for digestive health issues.

If your child is diagnosed, he or she can begin treatment to help increase the variety and volume of foods eaten and decrease anxiety around food. ARFID treatment may include:

• Inpatient or partial hospitalization
• Outpatient individual and family therapy
• Music, art or recreational therapy
• Parents skills group

During treatment, a child is gradually exposed to new or "challenge" foods. Coping skills are taught and motivators are used to help kids develop healthy eating behaviors.

As a parent, you also learn strategies to help your child continue their progress toward more normalized eating. Many parents feel more confident in their parenting skills after going through treatment with their child.

"We have a variety of levels of care at Children's Health, including a unique, ARFID specific program," says Dr. Ghannadpour. "We support parents in making lasting changes in mealtime avoidance behaviors at home, and we constantly evaluate progress to ensure kids get better."

Learn more

The Center for Pediatric Eating Disorders at Children's Health offers an evidence-based, family-centered program specifically for children and teens who have been diagnosed with ARFID. Learn more about our eating disorders services and programs.

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