Feeding difficulties and ARFID (Avoidant/Restrictive Food Intake Disorder)

Key Messages

• ARFID is a recognized diagnosis based on ICD11 and DSM5, with specific criteria. It describes a broad range of children, focusing on those who are nutritionally compromised.
• ARFID isn’t solely about limited food intake but involves a deeper understanding of what drives a child to restrict their diet.
• Specialist ARFID services are currently limited and difficult to access.
• The ARFID label should be applied judiciously, as it can cause undue stress and confusion, especially if used too broadly.

What to Do

• Investigation: Monitor the child’s weight and consider checking nutritional levels by evaluating FBC, vitamin D, and ferritin.
• Management:
  • Many children don’t meet criteria for ARFID but still have some restrictive food intake:
  • For children with autism:
    • preschool non verbal young children with learning disability: Provide reassurance and support around food chaining and maintaining weight.
    • School-aged, cognitively able children: They may have a limited but adequate diet. Provide reassurance and small suggestions for improvement.
    • Children with significant dietary restriction: May require specialist support, especially if their growth is compromised.
  • Advise families to minimize worry and encourage the child to try similar but varied foods. Recommend an over the counter multivitamin.
  • If the child exhibits a strong fear of eating, consider seeking specialist support.
• Co-existing Conditions: Recognize the influence of other conditions eg autism. Tailor support and interventions accordingly.

When to Refer

• Consider referral to dieticians if there’s significant weight loss or a markedly poor diet.
• If mental health issues like anxiety are present, consider referral to psychological services.
• there are current challenges in accessing specialist ARFID services

Acknowledgements summary of guidance from Dr Cousins and Dr Mathur