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What is ARFID?
What is ARFID?
ARFID stands for Avoidant/Restrictive Food Intake Disorder. It is a serious eating problem that was first included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. The DSM-5 is the manual used to diagnose mental health disorders . ARFID is different from other eating disorders because children with ARFID do not worry about their body weight or how they look. Instead, they have real trouble eating enough food for different reasons.
ARFID is NOT just "picky eating." Many children do not like some foods, but ARFID is much more serious. It affects a child's health, growth, and daily life.
Main Signs:
Not interested in eating - the child does not feel hungry very often or does not care about food
Does not like how food feels, tastes, or smells - they may refuse foods because of texture (how it feels in their mouth), taste, smell, or how it looks
Afraid something bad will happen - they worry about choking, throwing up, or getting sick from food
Does not worry about body weight - this is different from some other eating disorders
Can happen at any age - but often starts when children are young
What You Might See:
Children may lose weight, not grow properly, need special food supplements (e.g., meal replacement drinks), or have trouble in social situations because of eating problems. Many children have more than one type of difficulty with food - for example, they might be both very sensitive to textures AND be worried about choking. This makes eating even more difficult for them.
How Common is ARFID?
How Common is ARFID?
Recent studies show that between 3 and 55 children out of every 1,000 may have ARFID (Archibald et al., 2024). The numbers are different in different studies, but we know it happens more often than we used to think.
Important Facts:
Children with ARFID are more commonly boys, particularly in younger age groups. There is a significant overlap between ARFID and certain neurodevelopmental conditions; many children with autism also experience ARFID. Similarly, ARFID frequently co-occurs with Attention-Deficit/Hyperactivity Disorder (ADHD). Within eating disorder clinics, ARFID represents a notable portion of the cases seen in children.
ARFID and Autism
ARFID and Autism
Children with Autism are more likely to have ARFID because they may:
Be very sensitive to how foods feel, taste, or smell
Not like changes in their routine, including new foods
Have trouble with food textures and temperatures
Find eating with other people difficult
Important: Not all children with Autism have ARFID, and not all children with ARFID have autism. These are two different conditions.
How does ARFID affect health?
How does ARFID affect health?
Physical Health Problems:
Losing too much weight or not growing properly
Not getting enough vitamins and minerals
Feeling tired all the time
Weaker bones
Stomach problems
Heart problems
Daily Living Problems:
Feeling left out at parties or school events with food
Family stress at meal times
Trouble focusing at school because of hunger
Feeling worried or sad
Lower quality of life
How is ARFID Treated?
How is ARFID Treated?
Treatment works best when different types of health workers work together as a team. Research shows that children can get better with the right help.
The Treatment Team May Include:
Family doctor or pediatrician (children's doctor)
Dietitian (nutrition expert)
Occupational therapist or physiotherapist (help with sensory issues)
Psychologist or psychological associate (mental health experts)
Registered Behaviour Analyst (behaviour expert)
Speech therapist (helps with swallowing problems)
Social worker (helps families)
Types of Treatment:
Talk therapy - helps children feel less worried about food
Family therapy - teaches families how to help at meal times
Gradual food exposure - slowly trying new foods in a safe way
Reward programs - giving positive feedback for trying new foods
Sensory therapy - helping with texture and taste sensitivity
Nutrition support - making sure the child gets enough nutrients
How can families help at home?
How can families help at home?
Make Meal Times Easier:
Keep meal times at the same time each day
Let your child eat their "safe foods" while also offering new foods
Use "food chaining" (slowly change foods your child already likes)
Make meal times happy and relaxed
Do not force, bribe, or fight about food
Show your child that you enjoy eating
Get professional help early
Create a Low Stress Eating Environment:
Turn off TV and put away phones during meals
Keep meal times structured but calm
Give your child choices when possible
Respect when your child says they are full
Celebrate small steps forward
An example of food chaining:
An example of food chaining:
Goal: To introduce carrots to a child who currently only eats plain, crunchy, orange-colored French fries.
Accepted Food: Crispy, thin French fries (e.g., from a specific fast-food restaurant).
Small Change (Shape/Brand): Offer a different brand of thin, crispy French fries, or slightly thicker "steak" fries.
Small Change (Texture/Preparation): Introduce homemade baked fries that are still crispy but might have a slightly different texture or taste profile.
Small Change (Shape/Color/Texture): Offer small, thin, crispy sweet potato fries. These maintain the orange color and crispiness but introduce a new vegetable and slightly different flavor.
Small Change (Shape/Texture): Present thin, roasted carrot sticks that are seasoned similarly to the fries and have a slightly softer but still firm texture.
Small Change (Form): Gradually move towards slightly thicker or steamed carrot sticks, or small pieces of raw carrot.
Each step is introduced slowly, alongside accepted foods, and without pressure, allowing the child to explore and become comfortable with the new food's characteristics before moving to the next step in the chain.
What are some tips for school staff?
What are some tips for school staff?
Let the child bring safe foods from home (don’t worry about nutritional value)
Tell families before doing activities with food like cooking
Let the child eat in a quiet place if needed
Do not use food as rewards or take food away as a consequence
Work with families to make a plan for the child
Use kind words about food choices
Focus on the child's overall well-being, not just eating
Tell families if you notice changes in eating
Keep the child's eating problems private
How can you build your help team?
How can you build your help team?
Start with: Family doctor or pediatrician
Consult with a Dietitian recommended by your doctor or from a community health centre
Consult with an Occupational therapist/physiotherapist through your child’s school or through a community agency
Consult with a child psychologist or psychological associate through your child’s school
Consult with a school or community speech-language pathologist if the student is having difficulties swallowing food.
Where can you get help?
Where can you get help?
See our Eating and Feeding Problems resources in the Community Supports section
Community Health Centres (CHCs)
Many CHCs across Ontario have dietitians and mental health workers who can help with eating difficulties
Click here to find your local CHC
Ontario Health@Home (formerly CCAC or LHIN)
Coordinates home care services across Ontario
May provide occupational therapy and dietitian services at home for eligible children
Phone: 310-2222 (no area code required)
ARFID practice guidelines and surveillance data
Educational resources for professionals
Free online resources
Provincial and national ARFID resources
Information for families and family doctors
Available in different languages
Free access to all materials
School Boards
Many school boards offer training on supporting students with complex needs
May include information about ARFID and feeding difficulties
TDSB Occupational/Physiotherapy Department Google Site - feeding resources
Resources
Resources
ARFID Tip Sheet
References:
Archibald, T., Bryant-Waugh, R., Watters, A., & Katzman, D. K. (2024). Current evidence for avoidant restrictive food intake disorder: Implications for clinical practice and future directions. Journal of Child Psychology and Psychiatry, 65(2), 123-145. https://doi.org/10.1111/jcpp.13915
Becker, K. R., Keshishian, A. C., Liebman, R. E., Coniglio, K. A., Wang, S. B., Franko, D. L., Eddy, K. T., & Thomas, J. J. (2019). Impact of expanded diagnostic criteria for avoidant/restrictive food intake disorder on clinical comparisons with anorexia nervosa. International Journal of Eating Disorders, 52(3), 230-238. https://doi.org/10.1002/eat.22988
Burton Murray, H., Bailey, A. P., Keshishian, A. C., Silvernale, C. J., Staller, K., Eddy, K. T., & Thomas, J. J. (2020). Prevalence and characteristics of avoidant/restrictive food intake disorder in adult neurogastroenterology patients. Clinical Gastroenterology and Hepatology, 18(9), 1995-2002. https://doi.org/10.1016/j.cgh.2019.10.030
Burton Murray, H., Dreier, M. J., Zickgraf, H. F., Becker, K. R., Breithaupt, L., Eddy, K. T., & Thomas, J. J. (2021). Validation of the Nine Item ARFID Screen (NIAS) subscales for distinguishing ARFID presentations and screening for ARFID. International Journal of Eating Disorders, 54(10), 1782-1792. https://doi.org/10.1002/eat.23520
Canadian Paediatric Society. (2023). Avoidant/restrictive food intake disorder surveillance study. Canadian Paediatric Surveillance Program. https://cpsp.cps.ca/uploads/publications/RA-avoidant-restrictive-food-intake-disorder.pdf
Dumont, E., Jansen, A., Kroes, G., de Haan, E., & Mulkens, S. (2019). A new cognitive behavior therapy for adolescents with avoidant/restrictive food intake disorder in a day treatment setting: A clinical case series. International Journal of Eating Disorders, 52(4), 447-458. https://doi.org/10.1002/eat.23053
Eating Disorders Ontario. (2025). Understanding avoidant restrictive food intake disorder (ARFID) series. https://eatingdisordersontario.ca
Holland Bloorview Kids Rehabilitation Hospital. (2024). Neurodevelopmental disorders restrictive eating clinic. https://hollandbloorview.ca/services/programs-services/neurodevelopmental-disorders-restrictive-eating-clinic
Kambanis, P. E., Kuhnle, M. C., Wons, O. B., Jo, J. H., Keshishian, A. C., Hauser, K., Franko, D. L., Kass, A. E., Jenkins, P. E., Coniglio, K. A., Becker, K. R., Franzen, M. D., Eddy, K. T., & Thomas, J. J. (2023). Prevalence and correlates of psychiatric comorbidities in children and adolescents with avoidant/restrictive food intake disorder. European Eating Disorders Review, 31(1), 120-139. https://doi.org/10.1002/erv.2962
National Eating Disorders Association. (2024). Avoidant restrictive food intake disorder (ARFID). https://www.nationaleatingdisorders.org/avoidant-restrictive-food-intake-disorder-arfid/
NEDC. (2024). Avoidant/restrictive food intake disorder (ARFID). https://nedc.com.au/eating-disorders/types/arfid
Norris, M. L., Roscoe, C., Owen, C., & Cheng, M. (2021). Avoidant/Restrictive Food Intake Disorder (ARFID): Information for families. eMentalHealth.ca. https://primarycare.ementalhealth.ca/Canada/Avoidant-Restrictive-Food-Intake-Disorder-ARFID-Information-for-Families/index.php?m=article&ID=73419
Norris, M. L., Spettigue, W. J., & Katzman, D. K. (2016). Update on eating disorders: Current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatric Disease and Treatment, 12, 213-218. https://doi.org/10.2147/NDT.S82538
SickKids. (2015). More than just picky eating. https://www.sickkids.ca/en/news/archive/2015/ARFID/
Thomas, J. J., Becker, K. R., Kuhnle, M. C., Jo, J. H., Harshman, S. G., Wons, O. B., Keshishian, A. C., Liebman, R. E., Micali, N., Misra, M., Lawson, E. A., & Eddy, K. T. (2020). Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: Feasibility, acceptability, and proof-of-concept for the anxiety-based and sensory-based subtypes. International Journal of Eating Disorders, 53(10), 1516-1534. https://doi.org/10.1002/eat.23355
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
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