Picky eating is common in toddlers. While some children may grow out of picky eating, some may experience more severe picky eating that does not go away and may lead to impaired health outcomes, such as weight loss or stunted growth, nutrient deficiencies, and a need for nutritional support. When picky eating leads to these outcomes, it can potentially be considered a medical condition known as Avoidant/Restrictive Food Intake Disorder (ARFID).
What is ARFID?
ARFID is when a child has a significant social or mental health challenge related to eating that causes them to not meet their estimated nutritional needs. (1,2)
These challenges that influence a child’s eating habits may be related to one or a combination of these factors (3):
- Little interest in food or eating.
- Refusing to eat foods with certain sensory qualities (texture, taste, smell, color).
- Fear of something bad happening while eating (for example: choking, vomiting, feeling sick).
When a child restricts their food over a period of time, this can lead to problems such as poor weight gain, nutrient deficiencies or reliance on nutritional supplements. Children with ARFID can also have anxiety around eating which can impact their ability to engage in social experiences, increase family stress around mealtimes or worsen mental health difficulties. (2)
Because ARFID can greatly impact a child’s physical health, growth and emotional well-being, it is recognized as an eating disorder that often requires support and treatment.
Who is at risk for ARFID?
ARFID can develop for many different reasons. People who are most commonly at risk of having ARFID include (4):
- Picky eaters whose picky eating becomes more severe or is not outgrown.
- Children with medical conditions that make eating more difficult or uncomfortable (for example, a child with lung disease who has a hard time breathing while eating).
- Children with developmental or psychiatric differences (such as Autism Spectrum Disorder (ASD), ADHD, anxiety).
Having one or more of these traits does not mean a child will develop ARFID, but they may benefit from closer monitoring and early support around eating and nutrition.
What are the signs & symptoms of ARFID?
Some of the most common signs and symptoms of ARFID include (1-3):
- Sensitivity or a strong dislike to foods based on textures, smells or tastes.
- Weight loss or a low BMI that falls below expected growth patterns.
- Nutritional deficiencies such as low iron or vitamin levels.
- Becoming dependent on oral nutrition supplements or tube feeding to meet their needs.
- Having difficulties socializing or avoiding social situations that involve food, like parties, school lunches or family gatherings.
How common is ARFID in children?
Studies suggest that anywhere from 2.8-6% of children are diagnosed with ARFID, though the true number is likely higher. (5,6) This is because a lot of children with ARFID are described as “picky eaters” for years and remain undiagnosed and untreated.
While ARFID is often identified in adolescence, it can occur at any age. It can even start as early as infancy or toddlerhood!
Research also shows that ARFID affects females and males at similar rates. (7) It has also been found that children with other conditions such as ASD or ADHD may be at a higher risk of developing ARFID.
How does ARFID differ from picky eating?
Picky eating is when a child is selective in their food choices, often refusing new, unfamiliar foods. (8) While ARFID involves similar restrictions to foods as with picky eating, it is usually more severe. Picky eating is also usually outgrown as a child gets older while ARFID can become a long-term medical problem.
Here’s how ARFID can be more challenging than typical picky eating:
- Nutrition and growth concerns (1,3-4): Children with ARFID may eat such a limited variety or amount of food that they do not get the nutrients they need to grow and develop as expected.
- Family stress (2): Because eating is often highly restricted, mealtimes can become more stressful for families. Parents may worry about whether their child is meeting their nutritional needs, and strategies that work for picky eating may not be enough.
- Social and emotional well-being (2): Children with ARFID may experience anxiety around eating and avoid food-related social situations, such as school lunches or celebrations, which can affect social participation and confidence over time.
Is there a treatment for ARFID?
Before starting any treatment, consult with a primary care physician (PCP) for a full assessment and evaluation needed to formally diagnose ARFID. This may include a growth chart assessment, lab work for identifying any nutritional deficiencies, psychological assessment for social development, and possibly other related tests.
There are multiple ways that ARFID and its symptoms can be improved or treated (1,9):
- Family behavioral interventions: After parental training by a health professional, family members can help support positive mealtime routines and reduce stress around eating.
- Cognitive behavior therapy: Focuses on fears, anxiety or restriction related to eating.
- Feeding therapy: Involves slow introduction and exposure to new or unfamiliar foods.
Most or all of these treatments can involve multiple health professionals such as a PCP, pediatric dietitian, psychologist, speech and language expert and more. While one treatment method may work for a child, others may often need a combination of treatments. This may be determined by the health care team after a medical evaluation to decide on the best approach for you and your family to help treat your child’s ARFID symptoms.
While picky eating can be common for many children, ARFID is a serious feeding and eating disorder that can have long-term effects on a child’s growth, nutritional status and social health. Recognizing the signs and symptoms of ARFID can help parents identify when nutrition concerns go beyond typical picky eating and when additional support may be needed. With early identification and guidance from health care and nutrition professionals, children with ARFID can improve their nutritional intake and develop a healthier, more positive relationship with food.
Sources
1. National Eating Disorders Association. (n.d.). Avoidant restrictive food intake disorder (ARFID). Retrieved February 5, 2026, from https://www.nationaleatingdisorders.org/avoidant-restrictive-food-intake-disorder-arfid/
2. Kambanis, P. E., Kuhnle, M. C., Wons, O. B., Jo, J. H., Keshishian, A. C., Hauser, K., Becker, K. R., Franko, D. L., Misra, M., Micali, N., Lawson, E. A., Eddy, K. T., & Thomas, J. J. (2020). Prevalence and correlates of psychiatric comorbidities in children and adolescents with full and subthreshold avoidant/restrictive food intake disorder. The International journal of eating disorders, 53(2), 256–265. https://doi.org/10.1002/eat.23191
3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
4. Van Buuren, L., Fleming, C.A.K., Hay, P. et al. The prevalence and burden of avoidant/restrictive food intake disorder (ARFID) in a general adolescent population. J Eat Disord 11, 104 (2023). https://doi.org/10.1186/s40337-023-00831-x
5. Hog, L., & Dinkler, L. (2025). Recent insights into the epidemiology of avoidant/restrictive food intake disorder (ARFID). Current opinion in psychiatry, 38(6), 402–409. https://doi.org/10.1097/YCO.0000000000001041
6. Sader, M., Harris, H. A., Waiter, G. D., Jansen, P. W., Williams, J. H. G., & White, T. (2025). Neural correlates of children with avoidant restrictive food intake disorder symptoms: large-scale neuroanatomical analysis of a paediatric population. Journal of child psychology and psychiatry, and allied disciplines, 66(6), 785–795. https://doi.org/10.1111/jcpp.14086
7. Watts, R., Archibald, T., Hembry, P., Howard, M., Kelly, C., Loomes, R., Markham, L., Moss, H., Munuve, A., Oros, A., Siddall, A., Rhind, C., Uddin, M., Ahmad, Z., Bryant-Waugh, R., & Hübel, C. (2023). The clinical presentation of avoidant restrictive food intake disorder in children and adolescents is largely independent of sex, autism spectrum disorder and anxiety traits. EClinicalMedicine, 63, 102190. https://doi.org/10.1016/j.eclinm.2023.102190
8. Silvers, E., & Erlich, K. (2023). Picky eating or something more? Differentiating ARFID from typical childhood development. The Nurse Practitioner, 48(12), 16–20. https://doi.org/10.1097/01.NPR.0000000000000119
9. Białek-Dratwa, A., Szymańska, D., Grajek, M., Krupa-Kotara, K., Szczepańska, E., & Kowalski, O. (2022). ARFID-Strategies for Dietary Management in Children. Nutrients, 14(9), 1739. https://doi.org/10.3390/nu14091739
