Home » What is the Difference Between Picky Eating and ARFID?
Picky eating (also known as fussy or selective eating) is a common stage of development in childhood that has no formal definition (1). Toddlers often become wary of trying new foods in what is termed the neophobic phase (2), which is typically after 12 months old and peaks around 18 months and they may start to refuse certain foods they previously enjoyed.
Most children grow out of this neophobic phase after a few years (3) if given the right support to develop a healthy relationship with food. Believe it or not, it may take 10 or more exposures to a new food for them to start to like it! (4)
Avoidant restrictive food intake disorder, known as ARFID, is extreme food refusal that in 2013 became a classified eating disorder (5). Children with ARFID may only eat as little as five different foods, and only accept specific brands and flavours (6).
The characteristics of the eating disorder are:
Interestingly, ARFID characteristics do not include concern with body image, shape or size.
Very common and affects about one third of typically developing children between ages 1–5 years old
Less common in typically developing children and quite common in children with Autism Spectrum Disorder
Usually little to minor growth or health consequences
Can have moderate or severe growth and health consequences (but not always)
Can be very stressful for parents
Usually extremely stressful for parents
Children usually grow out of it over weeks to months when the first line help is followed
Children can take a long time to make even small changes to their eating – even when the first line help is followed. Extra strategies are often needed
Eat a range of foods including some from each food group although some days they may only eat very little or have preferences for a narrow range of foods
Eats a limited range of foods – often less than 20 different food items. Often refuse entire food groups all together
Can be upset by exposure to new foods, changes in their favourite foods or when foods touch each other
Can be upset by exposure to new foods, changes in favourite foods or foods touching each other – this may be more extreme and may present similar to a phobia
Hiding foods in other foods sometimes works, e.g., vegetables puréed in sauces
Hiding foods in other foods can be easily detected and can cause a child to become fearful of that previously accepted food and therefore isn’t recommended
Won’t ‘starve themselves’ if you just offer usual family foods and ignore the tantrums
At risk of becoming ill from not eating or drinking if it is insisted that they just eat what is in front of them
Will sometimes respond to ‘heavy handed’ tactics like demanding they eat usual family foods, but this is not recommended as increased anxiety at food times is counterproductive in the long run
‘Heavy handed’ tactics like demanding they eat usual family foods is not recommended as it can trigger extreme anxiety and may cause a child to stop eating and drinking altogether for a period of time
Figure 1: Adapted from Sheffield Teaching Hospital NHS Foundation Trust ‘Help for children who are extremely fussy eaters’
There are several strategies that you can use to work through some of the challenges with picky eating – the important point to remember is perseverance because it can sometimes take more than 10 exposures to a food before they start to like it.
Now this may sound like a lot but do not fret, it’s all a learning experience!
Establishing an eating routine is key for beginning to improve relationship with food.
Children learn by ‘role modelling’
Supporting a child with ARFID can be challenging because they often have a lack of interest in food and sensory aversions that make eating a very anxious experience.
Some of the above tactics for picky eaters can be helpful, particularly routine, however there are some additional strategies you may want to consider!
If your child is only eating a limited number of foods, and missing any food groups, you could consider a general children’s multivitamin that contains vitamin D to promote optimal bone and immune health.
In most cases, it is beneficial to work with a multidisciplinary team including speech and language therapist, occupational therapist and registered paediatric dietitian to help manage ARFID, sensory hyper-sensitivity and other potential psychosocial challenges. Reach out to your GP at first point-of-call for referral.
This advice is the opposite to common picky eating.
If your child’s eating behaviour is consequently impacting development, health, education, or social and psychological wellbeing, it is advised to seek support from your paediatrician/GP and a Registered Dietitian who can work with children. This will be important to examine and monitor growth and nutritional status, as well as improve related issues such as constipation, and recommend supplementation when necessary.
The Embody Health London team would be delighted to support you and your family to ensure optimal health and development for everyone. If you require support, please contact us at firstname.lastname@example.org to find out more about how we can help!
Zoe Light, RD
EHL Team x
Embody Health London champions food freedom, positive body image, mental health and emotional wellbeing through a uniquely blended scientific and holistic approach. The EHL team specialises in treating chronic dieting and eating disorders by coaching clients to build confidence and reduce anxiety around their eating habits and food choices.
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