Is It Picky Eating or Something More? What Parents Should Know About ARFID

My daughter hates broccoli, would eat mac and cheese every day if I let her, and will refuse an entire meal if there’s even one blueberry on her plate. It’s annoying for sure, but she’s just a picky eater, right? Probably. But for some kids, dinnertime power struggles aren’t just a phase, but could be a sign of ARFID or Avoidant/Restrictive Food Intake Disorder.

ARFID is often mistaken for picky eating, but is in fact a much more serious disorder (and more common than parents may think, according to the experts I spoke with). Kids with ARFID may have extreme aversions to a wide variety of foods, be uninterested in eating and struggle to get the nutrition that they need. 

But as a parent, it can be hard to tell the difference between your standard picky eater and a kid who needs more support. So to help me recognize the signs and navigate the next steps, I spoke with two experts who work directly with families navigating ARFID.

Meet the Experts

• Vanessa Rissetto, MS, RD, is a registered dietitian and CEO of Culina Health. A sought-after speaker, Vanessa is a frequent guest on the Today Show and has been featured in multiple publications including The New York Times, Bon Appetit, Vogue, Women's Health, Shape, Good Housekeeping, Men's Health, Prevention, PopSugar, Well+Good, Refinery29, INSIDER, and Allure.
• Jaclyn Pederson, MHI, is the Chief Executive Officer at Feeding Matters, a national nonprofit focused on the care for children with pediatric feeding disorder (PFD) and individuals with ARFID.

ARFID, or Avoidant/Restrictive Food Intake Disorder, is more than just a dislike of certain foods (“carrots are gross!”). ARFID is a diagnosable eating disorder that can have a serious impact on a child’s health.

“Kids may only eat a very small range of foods, avoid certain textures or smells or get upset when trying something new,” explains Rissetto. “They might have trouble gaining weight, show signs of poor nutrition or feel anxious or scared around mealtimes,” she adds. 

At the dinner table, ARFID might look like any of the below:

• A lack of interest in food (forgetting to eat, eating very slowly or being easily distracted)
• Strong sensory aversions (“the smell makes me gag”)
• Refusal to eat foods with a certain taste, texture or color (like avoiding eating anything green)
• Fear of negative consequences (“I’m scared I’ll choke if I eat that”)

ARFID often shows up in children and teens, although it can affect people at any age. And while it is a relatively new diagnosis, per Pederson it may affect anywhere from 0.3 to 15.5 percent of children and adolescents, depending on the group studied. “Think of it this way: nearly every school classroom in America likely has a child living with PFD,” the expert notes. 

Most parents are familiar with picky eating: the tween who eats PB&J for three months straight or the toddler who won’t touch anything green. But this is usually temporary.

“Picky eating is a normal phase many children grow out of,” says Rissetto. “Kids with ARFID often avoid entire food groups, have intense fear or anxiety around eating or show signs of nutritional deficiencies or poor growth.”

Pederson echoes this distinction: “With picky eating, kids typically grow well, stay healthy and outgrow the phase. However…when eating is hard, scary or hurts, it’s not picky eating. With ARFID, eating is so limited or stressful that it affects health, growth and daily life.”

Adults can also experience ARFID. “This may be a person that can’t be around food so they don’t go to social events, has had to change jobs due to the severity of their condition,” Pederson explains.

TL;DR: Occasional fussiness at the dinner table is typical. Severe restriction that interferes with growth, health or social life is not.

According to Rissetto, parents should look for red flags like food avoidance that’s “causing significant health, growth or social issues—or if mealtimes are a source of extreme stress rather than occasional fussiness.”

Pederson adds: “If a child’s picky eating does not seem to be getting better and mealtimes in your house are incredibly stressful, it’s important to seek care.”

If you’re worried about your child’s eating, both experts recommend starting with your pediatrician.

“If a parent suspects their child has ARFID, treatment typically involves a team approach,” says Rissetto. “They should begin with their pediatrician to check for growth or nutritional concerns, then work with a dietitian to ensure the child gets proper nutrients and gradually expands their diet. Seeing a therapist can also help address anxiety or fear around food.”

A pediatrician can help rule out medical causes first and refer parents to specialists like gastroenterologists, dietitians, occupational therapists and psychologists.

Pederson also suggests utilizing the free questionnaire at questionnaire.feedingmatters.org, which uses your child’s birth date to highlight what’s typical for their stage of development and flag any areas that may need extra attention. She also encourages parents to reflect on their child’s feeding journey: “Has feeding always been a struggle, or did it worsen after a certain incident?” Bring your experiences with you to your pediatrician. 

It’s normal for kids to prefer chicken nuggets over lentils. But ARFID goes beyond picky eating and is a recognized eating disorder that can impact a child’s growth, health and quality of life. If you’re worried about your kid’s eating habits, trust your gut and seek help. Both experts emphasize that early intervention matters and that with the appropriate support, mealtimes can go from stressful to positive.