Extreme picky eaters can have an actual diagnosis: Understanding avoidant/restrictive food intake disorder

When you think of picky eaters, what comes to mind? Maybe a toddler who only ever wants chicken nuggets. Or perhaps a young child who refuses to eat vegetables. But what about children who only eat three types of foods and gag at the idea of trying something new? When picky eating goes too far, it can turn into what’s known as avoidant/restrictive food intake disorder (ARFID). As many as five percent of children develop ARFID, affecting more boys than girls. It can also affect adults who never overcame their food aversions as a child.

There are many issues involved with extreme picky eating. Anxiety and fear can affect both the parent or caregiver and the child with food aversions. Over time, this can be extremely nerve-racking as you worry about whether your child is getting the right nutrients. While overcoming picking eating is a slow but steady race, it is doable, and we’re going to help your child get there.

What Is Avoidant/Restrictive Food Intake Disorder (ARFID)?  

ARFID is the newest addition to the eating disorder category in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). ARFID is not simply something that children “grow out of.” According to a recent study conducted by researchers from Brunel University London and Aston University, there is a link between eating difficulties, behavioral problems, and sensory hypersensitivity in children with AFRID, picky eating (PE), and children with autistic spectrum disorders (ASD). Out of the three groups, children with AFRID had the lowest food-responsiveness. Food-responsiveness is the urge to eat when you see, smell, or taste appetizing foods. The lower this is, the fewer foods you’re willing to try.

Having low food-responsiveness imposes implications. When a child is not eating enough varieties of foods (fruits, vegetables, carbs, etc.), it limits the number of nutrients the child receives. If your child is unable to meet basic nutritional needs, gets upset around new foods, struggles to eat solids, or avoids social situations where they might be pressured into trying new foods, there’s a good chance they might be experiencing this extreme picky eating.

While it would be nice to know why your child is experiencing ARFID, there isn’t always a distinguishable cause. Brittany Morris, MSW, LCSW of Thriveworks Counseling in Chesapeake, VA—specializing in eating disorders, trauma, chronic illness, and LGBTQIA+ issues—says the development of this condition is often due to a combination of biological, genetic, and sociocultural factors.

If you’re wondering if your child might be experiencing avoidant/restrictive food intake disorder, take these situations, for example:

1. Minor: One child gets upset when their parents make chicken alfredo instead of spaghetti and meatballs. They start crying when they realize what has been served for dinner. The parents explain to the child that they can have spaghetti and meatballs another night, but that isn’t what’s being served for dinner on this particular evening. They hug it out and continue to pick up their fork and eat.
2. Extreme: Another child who is eating pasta for dinner smells something different than they’re used to. The familiar smell of spaghetti doesn’t hit them when they walk into the kitchen like it usually does. They start to feel anxious and on-edge. When the child sits down for dinner with their family and realizes that chicken alfredo is being served instead of spaghetti, they start sobbing and feel nauseous before even attempting to taste it. The color of the white sauce turns them off, and they are inconsolable.

You can tell between these two situations that one child is merely upset over not having what they may want or expect for dinner and the other is so thrown off by the change that it causes them to have an extreme physical reaction. Other symptoms of ARFID include an upset stomach, dramatic restriction in amounts of food eaten, hatred for many food textures, nutritional deficiency, difficulties concentrating, anxiety, dizziness, feeling cold, and fears of choking or vomiting.

How to Help and Support Your Child Who has ARFID: 4 Tips 

Working with a child who has ARFID can be extremely challenging and exhausting. A lot of parents develop their own form of anxiety surrounding their child’s situation. You never know when your child might fall apart over food and going out for a family dinner becomes a chore that you dread. Most of all, you constantly worry on a daily basis if your child’s nutritional needs are being met. Unfortunately, the process of overcoming extreme picky eating is a slow one. However, here are some ways you can start helping and supporting your child:

1. Start slow: If your child is only eating about ten different types of foods right now, they’re not going to add another ten over the course of a month. “The relationship with food can be a complicated one to fix, but it is totally doable. Try to focus on little pieces of progress rather than the big, overwhelming goals. Even small steps forward mean a lot,” says Morris. “And as always, for someone with eating issues, recovery is not linear. There will be steps forward and steps back, but the important thing is to commit to the process.”
2. Keep incorporating new “approved” foods in rotation: If your child tries asparagus for the first time and doesn’t hate it, try serving asparagus one or two times a week. Once they get fully used to the new food, you won’t have to start the introduction process repeatedly. “Like most exposure to a wider variety of food choices, an individual will need to understand which foods they feel comfortable and uncomfortable with and why. This can help them understand which foods are more overwhelming to incorporate into their daily regimen than others,” explains Morris. “In my experience, it is best to work with the least intimidating food/food groups and slowly introduce them with food the individual already enjoys or tolerates. Ultimately, the main goal will be to create as much variety in their eating as possible while managing the anxiety or overwhelming emotions that created the aversion in the first place.”
3. Make games out of trying new foods: Well-known Super Nanny, Jo Frost, worked with a child who was an extremely picky eater during one of her episodes. To help picky eater Max, she devised a plan that got the whole family involved. She chose ten different new food items and put them into individual bowls. The whole family then tried these new foods with Max to better understand what he likes and, most importantly, why he doesn’t like certain foods. In the end, Max only ended up liking one or two foods which was a small victory for someone who only ate one type of food before. You can try this at home with your child and “play” once a month.
4. Seek the help of a therapist: Mental health professionals have the training and expertise to accurately diagnose your child and provide the proper treatment plan. If there are some underlying anxiety issues surrounding their picky eating, a therapist can help identify what those issues are and give your child the coping mechanisms to move forward. Cognitive behavioral therapy is proven to help children with ARFID make significant progress. Also, therapists can provide you with tips and tricks to progress your child in their eating habits!

Helping out a child who is an extremely picky eater is not an easy job. It can take a massive toll on you as a parent or caregiver. You must stick with your child during this process, try to understand their feelings better, and work with them to overcome their food aversions. With a little time and patience, they can make great strides in their eating habits.

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