ARFID and Picky Eating: What You Should Know
By Alexis Altshuller
Eating challenges in children are often talked about casually, but for some families, educators, healthcare providers, and community members, they are a significant concern. Understanding the difference between Avoidant/Restrictive Food Intake Disorder (ARFID) and picky eating can help reduce confusion, stigma, and unnecessary stress.
Picky Eating
Picky eaters are usually defined as children who consume an inadequate variety of foods through rejection of foods that are familiar (and unfamiliar) to them. Typically, this behavior peaks between the ages of 2 and 6, then decreases until it becomes stable in adulthood. There is no typically agreed-upon definition of picky eating, so it can be difficult to identify.
Research has suggested that rates of picky eating are relatively high in food-insecure households compared to food-secure families.
Avoidant/Restrictive Food Intake Disorder (ARFID)
ARFID is a clinical diagnosis defined by diagnostic criteria found in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5):
- An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
- Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
- Significant nutritional deficiency.
- Dependence on enteral feeding or oral nutritional supplements.
- Marked interference with psychosocial functioning.
- The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
- The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
ARFID has an estimated prevalence of 0.35% to 3.2% in children, and from 0.3% to 3.1% in adults. ARFID tends to be more common in childhood, but a person can be diagnosed with ARFID at any age. Due to ARFID being a relatively recent official diagnosis, research is ongoing to assess prevalence.
The Role of Adults
How adults respond to children’s eating behaviors plays an important role in shaping mealtime experiences. When parents feel stressed or depressed earlier in the day, they are more likely to use restrictive feeding practices, serve less homemade food, and more pre-prepared foods. Restrictive feeding practices include bribing or rewarding children with dessert, forcing a number of bites, etc. Restrictive feeding practices often backfire, leading to more stress. Supportive tools and reliable information can help reduce stress and build confidence around food.
Support and Resources
TABLE’s new Nutrition Resources page is packed with tools to help your family eat well and feel confident in the kitchen. Discover new ingredients with our Produce List, learn to love your greens with our Guide to Greens, and cook along with our Chefs@Home videos & recipes.
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