Avoidant/restrictive food intake disorder (ARFID): Overview

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Learn about the possible causes of ARFID and how it differs from picky eating.

Key points

A child who has ARFID eats very little food or avoids certain foods for a range of reasons, for example because of concerns about food texture or not feeling well when eating.
Some people with ARFID have anxiety disorders that appear as a fear of vomiting or choking.
ARFID is not the same as picky eating. It involves having a poor appetite overall, rather than a rejection of a few foods, and needs medical attention and psychological care. ARFID usually develops in childhood but can occur in people of all ages.

Introduction

What is avoidant/restrictive food intake disorder?

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder that occurs when a child or teen doesn’t eat enough to meet their energy or nutritional needs. People with ARFID are not concerned about their body weight, shape or size.

Instead, they avoid foods due to worries about vomiting or choking; or dislike of certain food textures, smells or tastes; or because they are not interested in eating or food. Because of their problems with eating, they may lose weight or not grow as expected.

Causes, risk factors and prevalence

What causes ARFID?

Not a lot of information is currently known about the causes of ARFID.

Some children and teens with ARFID will struggle with anxiety disorders that appear as a fear of vomiting or choking. Other children and teens may experience eating issues as part of another disorder, for example autism. They would only be diagnosed with ARFID, however, if their food issues were more severe than would be expected with the disorder.

Is ARFID the same as "picky eating"?

No, ARFID is not the same as "picky eating".

Children with ARFID may refuse to eat foods of a certain texture, colour, taste, temperature or smell. Picky eating typically involves only a few foods.
If a child has ARFID, they tend to have a poor appetite and experience delayed growth. So-called picky eaters have a normal appetite, eat enough food overall and develop normally.
The problems that people with ARFID develop with food continue for a long time and need medical attention and psychological care. The eating patterns found among picky eaters usually resolve on their own eventually.

Who is affected by ARFID?

ARFID typically begins during childhood but can occur in people of all ages. Unlike those with anorexia nervosa or bulimia nervosa, people with ARFID do not have body image concerns or fears about gaining weight.

At SickKids

SickKids has an eating disorder program that treats children and teens who are struggling with symptoms of anorexia nervosa, bulimia nervosa and avoidant restrictive food intake disorder. For more information on our program visit: www.sickkids.ca/adolescentmedicine/eating-disorders-program

Resources

Further information

For more information on avoidant/restrictive food intake disorder (ARFID), please see the following pages:

ARFID: Signs and symptoms

ARFID: Medical complications

ARFID: Treatment options

ARFID: How to help your child at home

Please visit our teen mental health hub for teen-specific resources on avoidant/restrictive food intake disorder (ARFID).

Resources

NEDIC – National Eating Disorder Information Centre (Canada)

NEDA – National Eating Disorder Association (United States)

American Academy of Pediatrics – Eating Disorders in Children 

BEAT – Beating Eating Disorders (United Kingdom)

Kelty Eating Disorders (Kelty Mental Health Resource Centre, BC Children's Hospital)

Children's Hospital of Eastern Ontario – Eating Disorders

ANAD – National Association of Anorexia Nervosa and Associated Disorders (United States)

Virtual care services for children:

Boomerang Health was opened by SickKids to provide communities in Ontario with greater access to community-based services for children and adolescents. For more information on virtual care services in Ontario to support eating disorders, visit Boomerang Health powered by SickKids.

Last updated: September 12th 2023