HealthInfo Waitaha Canterbury

Avoidant/restrictive food intake disorder (ARFID)

Avoidant/restrictive food intake disorder (ARFID) is a common feeding problem in tamariki (children). It affects the way a tamaiti (child) eats. This often limits the amount and variety of food they eat.

ARFID is an eating disorder, but unlike other eating disorders, it is unrelated to concerns about body weight or shape.

ARFID involves ongoing feeding or eating issues that can cause tamariki to avoid food. It is more than just fussy eating, which is common among tamariki. Tamariki with ARFID only eat a small range or amount of food. They often extremely dislike certain foods or are generally not interested in food or eating.

Some tamariki with ARFID avoid eating food due to how it looks, smells, tastes or feels. Some avoid eating because they are worried about what will happen when they do. This could be a fear of things like vomiting, choking or pain. Others may just have a general lack of interest in food.

ARFID is a serious mental health condition. It can affect growth, development, health and wellbeing. Having ARFID can lead to significant weight loss and health concerns when a child is not meeting their nutritional or energy needs.

ARFID is common in tamariki. Rangatahi (teenagers and young adults) and adults can also get it. Both girls and boys can get ARFID, but it is more common in boys. ARFID most often develops in early childhood and can last into adulthood.

Causes of ARFID

Health professionals are still trying to understand what makes some people more likely to develop ARFID.

ARFID may happen due to a combination of reasons such as environment, upbringing, health and genetics. Some tamariki may have a medical condition that puts them at risk of ARFID. This can sometimes happen with medical conditions that affect the digestive system or need special diets.

ARFID may also happen after a tamaiti has a bad experience with food. This could be something that happened to them or something they saw, such as choking, gagging or vomiting.

Symptoms of ARFID

Tamariki with ARFID may show some of the following signs:

Moods

• Anxiety and distress around food and mealtimes.
• Being afraid or upset when trying new foods.
• Being upset by the sight and sound of others eating.
• Being worried about pain, nausea, vomiting or choking when eating.
• Having difficulty eating in unfamiliar places.
• Being concerned if food packaging changes.
• Having difficulty concentrating or learning.

Behaviours

• A lack of interest in food and eating.
• Refusing to eat.
• Eating very slowly or not finishing meals.
• Avoiding eating with others, such as at school camps or birthday parties.
• Only eating a small range of foods that are similar in taste, texture, smell or appearance.
• Being easily disgusted by different foods.

Physical health

• Delayed growth and development.
• Weight loss or not gaining weight as expected.
• A reduced appetite.
• Brittle nails, dry hair or hair loss.
• Tiredness or lack of energy.
• A later onset of puberty.
• A slow heart rate.
• Stomach pains.
• Feeling full after only eating small amounts.
• Bloating.
• Feeling sick.
• Constipation.
• Nutritional deficiencies on blood tests.
• Poor bone development.

Serious complications

• Significant weight loss or not gaining weight as expected.
• Not getting enough nutrients for the body to function.
• School or home life being affected due to difficulties eating with others, only eating certain foods and taking much longer to eat.
• Low mood and anxiety,
• Social anxiety and social withdrawal.

Getting help with ARFID

See your general practice team as soon as you can if you notice the following in your tamaiti:

• eating a small range of foods
• eating a small amount of food
• regularly showing little to no interest in food
• change in mood or behaviour, especially around food and eating.

Diagnosing ARFID

There is no single test to check for ARFID. Your general practice team will talk with you and your tamaiti about their eating behaviour, habits and thoughts.

Your tamaiti may need a full physical examination. Also, a blood test, a urine sample, an electrocardiogram (ECG) and an X-ray.

Your general practice team will consider whether other eating disorders or medical conditions could be causing the weight loss or delayed growth. For example, coeliac disease.

If your general practice team think your tamaiti may have ARFID, they may refer them to a specialist for a definite diagnosis. This could be an eating disorders service, a child health doctor (paediatrician) or a mental health provider, like a psychologist.

Treatment options for ARFID

If your child has ARFID, they might need psychological therapy. This can include whānau (family) therapy or one-on-one sessions with your child.

Cognitive-behavioural therapy (CBT) is a good treatment for people with ARFID. The treatment may involve gradually exposing your child to foods they fear alongside relaxation training.

Acceptance and commitment therapy (ACT) aims to help children embrace their thoughts and feelings rather than fighting or feeling overwhelmed by them.

Responsive feeding therapy (RFT) aims to:

• create pleasant mealtime experiences
• create comfortable whānau eating environments
• help your tamaiti learn to cope with their emotions while eating
• help your tamaiti understand how it feels when they are hungry or full
• gradually introduce new foods into their diet.

When tamariki do not eat enough food, they can have medical problems. Tamariki with ARFID will need to have regular appointments with their healthcare provider to monitor their physical health.

There is no medicine that can treat ARFID. Some tamariki with ARFID may also have depression or anxiety. Medicines may sometimes help with these conditions. Your tamaiti may need some nutritional supplements if tests show they have low levels of certain vitamins and nutrients.

If a tamaiti with ARFID is very unwell, they may need to stay in hospital. Health professionals will monitor them until they are safe and well enough to go home.

Support

Having a child with ARFID can feel overwhelming. It is important to reach out for support when you need it. Eating Disorders Association of New Zealand (EDANZ) offers support to for carers.

Long-term outcome

With the right team and support, your tamaiti can recover from ARFID. Recovery is possible even if your tamaiti has had ARFID for many years. Tamariki with ARFID need a lot of love and support to get better and maintain healthy eating habits.

Tamariki can sometimes develop ARFID symptoms again. If you notice your tamaiti is showing signs of ARFID again, contact your general practice team as soon as possible.

  HealthInfo recommends the following videos

• Listening to families – ARFID

  A series of short videos providing answers to families' questions about ARFID in tamariki.

  HealthInfo recommends the following pages

• EDANZ – Avoidant/restrictive food intake disorder

  Basic information about ARFID and its effects.

• Te Whatu Ora Waitaha – Resources for families and whānau

  Online learning packages for subjects such as nutritional needs and creating positive mealtimes.

Adapted from KidsHealth as part of a National Health Content Hub collaborative. Page created December 2024.

Sources

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