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Understanding ARFID (Avoidant/Restrictive Food Intake Disorder)

Avoidant/Restrictive Food Intake Disorder (ARFID) is a serious eating disorder that goes far beyond typical picky eating. It is characterised by extreme restriction of food intake and a very limited range of accepted foods, which can lead to nutritional deficiencies, growth problems, and significant social and emotional challenges.

First officially recognised in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) in 2013, ARFID can affect people of all ages but is especially common among children and young people.

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Diagnostic Criteria for ARFID

According to the DSM-5, ARFID is diagnosed when an eating or feeding disturbance results in persistent failure to meet appropriate nutritional and/or energy needs, accompanied by one or more of the following:

• Significant weight loss or failure to gain weight and grow as expected (faltering growth in children)

• Significant nutritional deficiencies

• Dependence on tube feeding or oral nutritional supplements

• Marked interference with daily life and psychosocial functioning

ARFID is diagnosed only when the eating difficulties:

• Are not caused by a lack of available food or cultural practices

• Do not occur exclusively during anorexia nervosa or bulimia nervosa

• Are not explained by concerns about body weight or shape

• Cannot be fully attributed to another medical condition or mental health disorder beyond what would be expected for that condition

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Warning Signs and Symptoms of ARFID

Recognising the signs early can help families seek the right support. Symptoms can be behavioural, psychological, and physical.

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Behavioural and Psychological Signs

• Dramatic weight loss or failure to gain weight appropriately

• Eating only foods of a certain texture, colour, or brand

• Fear of choking, vomiting, or other distressing consequences of eating

• Ongoing gastrointestinal complaints without a clear medical cause (such as constipation or stomach pain)

• Limited range of foods that becomes narrower over time

• Lack of appetite or apparent disinterest in food

• Dressing in layers to stay warm due to weight loss

• No body image concerns or fear of gaining weight (unlike other eating disorders)

Physical Signs

When nutritional needs are not met, children and young people may experience:

• Digestive issues (constipation, reflux)

• Dizziness, fainting, or feeling cold

• Dry skin, brittle nails, or thinning hair

• Slow wound healing and increased infections

• Menstrual irregularities or loss of periods (in adolescents)

• Muscle weakness and fatigue

• Cold, mottled hands and feet, or swelling of extremities

• Laboratory abnormalities such as anaemia, electrolyte imbalances, or low hormone levels

How ARFID Is Managed

Effective ARFID treatment is multidisciplinary, addressing nutritional, psychological, sensory, and medical needs. Each child’s plan is personalised to their unique challenges.

Dietetic Support

• Ensuring nutritional requirements are met to support growth, development, and overall health

• Creating balanced meal plans using foods that feel safe and acceptable to the child

• Guiding appropriate use of oral nutritional supplements when needed

Psychological Support

• Helping children and families manage anxiety around eating

• Teaching coping strategies and reducing mealtime stress

• Addressing any traumatic experiences related to eating, such as choking incidents

Sensory and Feeding Therapy

• Supporting gradual desensitisation to new foods

• Improving oral-motor skills and tolerance for different textures and smells

• Creating positive, pressure-free experiences with food

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How Paediatric Dietitians Support Children with ARFID

Our paediatric dietitian team plays a vital role in supporting children and families affected by ARFID:

1. Understanding the Underlying Causes
We work closely with families and professionals involved in the child’s care, such as psychologists, occupational therapists, and speech and language therapists, to explore why the child avoids certain foods. This could be related to sensory sensitivities, anxiety, or previous traumatic experiences.

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2. Comprehensive Nutritional Assessment
We assess growth, dietary intake, and potential nutrient deficiencies, including iron, B12, zinc, and vitamin D, which may affect physical or cognitive development.

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3. Individualised Meal Planning
We create practical meal plans using foods the child feels comfortable eating. This helps ensure nutritional stability and reduces parental stress.

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4. Supplement Recommendations
When food alone is not sufficient, we provide tailored guidance on nutritional supplements that meet the child’s needs and respect sensory preferences.

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5. Sensory Desensitisation Strategies
Our team uses stepwise exposure techniques to help children gradually build confidence with new foods. This process is gentle, child-led, and focuses on exploring and accepting new foods without pressure.

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6. Multidisciplinary Collaboration
We coordinate care with your wider support network, including GPs, therapists, and educators, to deliver cohesive, holistic support.

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7. Parent Coaching and Practical Strategies
We provide parents and carers with evidence-based tools to reduce mealtime conflict, manage food refusal, and foster a more positive experience with eating. Our approach is supportive and non-judgemental.

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Every child with ARFID is different - and so is our approach. Our dietitians tailor support to your child’s needs, pace, and goals, always prioritising compassion and progress over perfection.

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FAQs About ARFID Nutrition Support

Is ARFID the same as fussy eating?
No. ARFID is a recognised eating disorder where extreme avoidance and restriction can impact growth, nutrition, and daily life.

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Can you help if my child has additional needs?
Yes. Our team has experience supporting children with autism, sensory processing differences, and other neurodevelopmental conditions alongside ARFID.

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Do you offer in-person consultations?
We primarily offer online consultations, making it easy for families across the UK to access expert ARFID support from home.