Avoidant Restrictive Food Intake Disorder, or ARFID, is a relatively newly recognised disorder in the DSM-V.

It was originally known as Selective Eating Disorder and was applied only to young children but has been renamed and recognised as occurring past infancy.

So what is it?

Well, the clue is in the name – avoidant restrictive. Your child might not be interested in eating or in food. Your child might have significant sensory issues around food, they might refuse foods with a particular texture or insist on only eating foods with a particular texture.

Perhaps they won’t eat if other people are around or will only eat if they’re distracted from the process of eating.

There might be a significant anxiety about consuming food, a worry that they’ll choke or vomit, or they might be anxious about the food itself, whether it’s mouldy or contaminated in some way.

Like a lot of disorders, many people might exhibit some of these behaviours at some point, but it becomes a disorder if a certain threshold is reached.

The DSM-V says you might be dealing with ARFID if one or more of the following are present:

• Significant weight loss or, in children, being below age-appropriate weight or experiencing slow growth.
• Significant nutritional deficiency.
• Significant social impacts
• Dependence on enteral feeding or oral nutritional supplements

ARFID is not being a “picky eater”.

ARFID is about the relationship between the person and their food, and how they experience food and hunger. It can be triggered by unpleasant experiences with food, such as choking or vomiting, and it’s also often comorbid with a family of neurodivergent conditions where sensory issues are often present.

Many neurodivergent children forget to eat, or have ‘safe foods’ that they eat often, or strong preferences about how or when to consume food, but not every situation amounts to a disorder.

ARFID occurs when the situation is so extreme that the person’s health is suffering as a result of weight loss, malnutrition, and social consequences.

Common comorbidities include ADHD, autism spectrum disorder, obsessive compulsive disorder, and anxiety disorders.

Important Note: ARFID is not related to body image. It is not spurred on by body dysmorphia. There is no desire for thinness in the way that can be exhibited by sufferers of anorexia and other eating disorders.

ARFID can also be present in people who are overweight and is just as much of a risk to their health as it is to those who are thin.

ARFID has been identified in very young children, can continue into adulthood, and is often associated with brains that are literally built different.

This means you can feel free to ignore any ‘helpful’ person trotting out the usual approaches to ‘picky eating’. They’re not going to work.

Plus - You’ve probably already tried them.

Once you’ve reached the point where you think ARFID could be what your child is experiencing, you know that “they’ll eat when they’re hungry” absolutely does not apply here. Some people with ARFID literally cannot identify what “hungry” feels like.

So what do you do if your kid has ARFID or you’re worried they might develop it?

Let’s acknowledge that food is not a neutral subject in society!

There are expectations about eating at particular times, with family, in particular rooms, and how to accept or reject food graciously. There are patterns of behaviour or social structures that everyone is generally expected to follow. It’s a lot to learn for anyone but for the neurodivergent brain, and especially one where food can cause significant anxiety, these structures can cause significant stress.

Structure is often helpful and calming for the neurodivergent brain, but nothing works for everyone all the time and at Awhi, we look for structures that support, not ones that imprison.

There are a number of treatment options, and what works will depend on each child’s situation – their age, their restrictions, and their medical history. As always, approaches to treatment will need to be specifically tailored to each individual’s needs.

Check in with your child’s care team.

ARFID, like any eating disorder, is a major health challenge and you need the professionals on your side. All the love and patience in the world cannot make up for science-backed therapeutic knowledge and training. Professional support takes multiple forms so ideally your child’s care team would include a qualified nutritionist and some form of registered therapist.

If you aren’t already, consider talking to a counselor yourself so you have a space to express your anxieties that is separate from your child.

Communication! Talk with your kid about what’s going on! This is stressful for you, yes, but your child is the one experiencing ARFID, not to you. Sensory issues and anxiety are not something they’re doing on purpose and understanding what’s happening is the first step to lowering their anxiety levels.

Your child might feel isolated and unable to describe what they feel or experience, so help them out. Describe your experiences of food, what you enjoy or don’t enjoy. Give children the vocabulary to express their experience of food, what they do and don’t enjoy.

Chill The F*** Out. ARFID is heavily correlated with anxiety. Anxiety often stems from a lack of control, resulting in stress, and stress impacts appetite. If your child is stressed out, they’re not going to eat. 

If every meal has become a battle, change your approach. Stop trying to sneak zucchini into chocolate cake. Don’t rush your kid. Look for ways to work with your child, not against them. Treatment has to be approached carefully, preferably with the assistance of trained professionals. 

Start with the basics. For some people, ARFID is a life-threatening condition. Food is fuel so focus on what your child eats that will give them the calories to function. 

Then look at macronutrients: carbohydrates, protein, fats and fibre. Can you name a single food that your child eats that provides one or more of these? Lean into them. 

Micronutrients are trickier – they’re found in foods that are often difficult for people with ARFID. Diets of people with ARFID tend towards being highly processed and high in carbohydrates, while being low in fibre and micronutrients. Use supplements in pills, gummies, shakes and dissolvable powders. There are many communities who consume nutrients in unexpected ways. Look for tips from body builders, aged care experts, and people who have had weight-loss surgeries.

Identify patterns: If a group of foods are always eaten, look for others that are similar. If crunchy textures are always bad, don’t offer crunchy food. If soft blended food works, blend the food. Will they drink from a bottle but not a cup?

Buy three more identical bottles so you can always have one to hand.

“Exposures” – the technical term for experiencing unfamiliar foods. Lower the stakes by exploring new foods away from mealtimes, removing the expectation that they will eat the food. You’re looking for ways to introduce and familiarise your child with a food before you ask them to eat it.

Start really small, by sniffing food. Ask your child to prod the food with a spoon or a finger. Ask them to squish it and see what happens. Explore the differences between hot, cold and room temperature foods, like frozen peas vs cooked peas. Give examples of how different preparation methods result in different foods - apple could be sliced, in pieces, or grated, or cooked down to a puree. These are all different experiences.

Change how they eat: feeling comfortable enough to eat is more than just having the right food. Examine your surroundings.

If your kid gets overwhelmed, perhaps they need quiet and solitude. Consider letting them eat in a different room to the rest of the family or at a different time. Even sitting facing away from everyone else might help.

Some kids might eat best when they’re stimulated by other sensory input. Put the television on and see if they’ll absentmindedly suck on a yoghurt pouch. Play music and crunch crackers to the beat. Put out bowls of finger food and play a game where everyone dances around, eating something each time they pass a bowl.

Be patient. Your child will likely need to be exposed to new foods many times before they feel comfortable eating it. Treating ARFID, as with any eating disorder, is a marathon, not a sprint, so find ways to celebrate the wins.

As always, encouragement and celebration works better than shame.