Avoidant/restrictive food intake disorder (ARFID) can cause serious complications that require medical attention . See your child's health-care provider if your child displays any of the signs or symptoms outlined below.
Behavioural signs of ARFID
Sudden refusal to eat foods
A person with ARFID may no longer eat food that they ate previously.
Fear of choking or vomiting
People with ARFID may refuse certain foods for fear that they will make them choke or vomit.
Losing appetite for no known reason
A person with ARFID may complain of having no appetite but without a medical or psychological condition to explain it (e.g., migraine, infection or depression).
Eating very slowly
People with ARFID may consistently eat very slowly or be unable to finish what is served.
Difficulty eating meals with family or friends
Because of the problems with eating, young people with ARFID may have difficulty taking part in normal social activities, such as eating with friends and family members and maintaining relationships with others.
Other behavioural signs of ARFID include:
- lack of interest in eating or food
- anxiety
Physical signs of ARFID
No longer gaining weight
As children are growing, they should always be getting bigger. Clear signs that a child has stopped growing or gaining weight include not needing to wear bigger clothing or shoes.
Losing weight
Because teens stop growing eventually, ARFID is more likely to be suspected in this age group if someone loses weight. If your teen is losing weight, they should be evaluated by their health-care provider.
No growth or delayed growth
Children with this disorder may not grow as expected.
Other physical signs of ARFID include:
- showing signs of malnutrition such as:
- feeling cold all the time
- dizziness
- low energy
- changes in how the heart works
- dehydration
- delayed or stopped menstrual periods
How ARFID is diagnosed
Before diagnosing ARFID, your child’s health-care provider should assess your child for a physical disorder that can have similar signs and symptoms.
A health-care provider will do a complete history (medical, nutritional and psychosocial history) and a thorough physical examination including:
- weight and height (plotting measurement on a growth curve)
- blood pressure and heart rate both lying and standing
- temperature
- assessment of puberty
They may also do some initial tests including laboratory studies to check the blood and urine for abnormalities, including nutritional deficiencies, and an electrocardiogram to check how the heart is functioning.
Physical disorders that can cause weight loss (or lack of growth or weight gain) include digestive tract disorders that reduce the ability to absorb nutrients from food, hormonal problems such as diabetes and other serious conditions such as cancer.
Your child's health-care provider should also consider other mental health conditions that can cause weight loss, such as depression, anxiety, schizophrenia and other eating disorders such as anorexia nervosa or bulimia nervosa.
Symptoms that do not lead to an ARFID diagnosis
ARFID is not diagnosed in a child or teen if their symptoms can be explained by:
- lack of available food, for example if they live in poverty
- cultural practice, for example if they fast during Ramadan or Yom Kippur
- another medical condition such as diabetes or Crohn's disease
- a mental health disorder or eating disorder, such as anorexia nervosa or bulimia nervosa.
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
Further information
For more information on avoidant/restrictive food intake disorder (ARFID), please see the following pages:
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)