Avoidant restrictive food intake disorder

Overview & Definition

A ten-year-old will eat only beige crackers from one brand, drinks no milk, and has fallen two weight centiles in a year. He is not trying to lose weight. He panics if the packet changes. This is the face of avoidant/restrictive food intake disorder — and it was invisible in older classifications that recognised only anorexia and bulimia. ARFID was added to the DSM-5 in 2013 precisely to capture the large group of children whose restriction harms them but is not motivated by weight or shape, and ICD-11 followed. [14] [3]

ARFID is defined by four features taken together. The eating or feeding disturbance leads to a failure to meet nutritional or energy needs, shown by one or more of: significant weight loss or failure to gain expected growth; significant nutritional deficiency; dependence on oral nutritional supplements or enteral feeding; or marked interference with psychosocial function. The disturbance is not better explained by lack of available food or a cultural practice. Critically, there is no persistent disturbance in the way body weight or shape is experienced — the defining feature of anorexia nervosa is absent. The behaviour is also not better explained by another mental disorder or medical condition. [14] [2]

What makes ARFID a fellowship topic rather than a footnote is that it sits at the junction of four services that do not always talk to each other: general paediatrics, gastroenterology and nutrition, mental health, and developmental-behavioural paediatrics. The general paediatrician is usually the first port of call, owns the medical safety question, and must get the boundary with anorexia nervosa and the relationship to pediatric feeding disorder right — because wrong triage sends the child to the wrong team. [5] [3]

This page owns the ARFID diagnosis itself. Cross-link the feeding-problems page for the broader spectrum of selective eating and pediatric feeding disorder, the faltering-growth page for full growth-algorithm detail, and the autism page for the developmental context that so often surrounds ARFID. [23] [25]

References30Show ledgerHide ledger

1. [1]Katzman DK, Spettigue W, Agostino H, et al. Incidence and Age- and Sex-Specific Differences in the Clinical Presentation of Children and Adolescents With Avoidant Restrictive Food Intake Disorder. JAMA pediatrics, 2021.PMID 34633419
2. [2]Katzman DK, Guimond T, Spettigue W, et al. Classification of Children and Adolescents With Avoidant/Restrictive Food Intake Disorder. Pediatrics, 2022.PMID 35945342
3. [3]Kambanis PE, Thomas JJ Assessment and Treatment of Avoidant/Restrictive Food Intake Disorder. Current psychiatry reports, 2023.PMID 36640211
4. [4]Wronski ML, Kuja-Halkola R, Hedlund E, et al. Mental and Somatic Conditions in Children With the Broad Avoidant Restrictive Food Intake Disorder Phenotype. JAMA pediatrics, 2025.PMID 39960738
5. [5]Estrem HH, Pederson JL, Dodrill P, et al. A US-Based Consensus on Diagnostic Overlap and Distinction for Pediatric Feeding Disorder and Avoidant/Restrictive Food Intake Disorder. The International journal of eating disorders, 2025.PMID 39679744
6. [6]Kambanis PE, Tabri N, McPherson I, et al. Prospective 2-Year Course and Predictors of Outcome in Avoidant/Restrictive Food Intake Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 2025.PMID 38718975
7. [7]Kambanis PE, Mancuso CJ, Becker KR, et al. Course of avoidant/restrictive food intake disorder: Emergence of overvaluation of shape/weight. Journal of eating disorders, 2024.PMID 38702736
8. [8]Thomas JJ, Becker KR, Kuhnle MC, et al. Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: Feasibility, acceptability, and proof-of-concept for children and adolescents. The International journal of eating disorders, 2020.PMID 32776570
9. [9]Burton-Murray H, Becker KR, Breithaupt L, et al. Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: A proof-of-concept for mechanisms of change and target engagement. The International journal of eating disorders, 2024.PMID 38213085
10. [10]Spettigue W, Norris ML, Santos A, et al. Treatment of children and adolescents with avoidant/restrictive food intake disorder: a case series examining the feasibility of family therapy and adjunctive treatments. Journal of eating disorders, 2018.PMID 30123505
11. [11]Couturier J, Isserlin L, Norris M, et al. Canadian practice guidelines for the treatment of children and adolescents with eating disorders. Journal of eating disorders, 2020.PMID 32021688
12. [12]Norris ML, Obeid N, Santos A, et al. Treatment Needs and Rates of Mental Health Comorbidity in Adolescent Patients With ARFID. Frontiers in psychiatry, 2021.PMID 34349680
13. [13]Bryson AE, Scipioni AM, Essayli JH, et al. Outcomes of low-weight patients with avoidant/restrictive food intake disorder and anorexia nervosa at long-term follow-up after treatment in a partial hospitalization program for eating disorders. The International journal of eating disorders, 2018.PMID 29493804
14. [14]Eddy KT, Harshman SG, Becker KR, et al. Radcliffe ARFID Workgroup: Toward operationalization of research diagnostic criteria and directions for the field. The International journal of eating disorders, 2019.PMID 30758864
15. [15]Eddy KT, Negi S Avoidant/Restrictive Food Intake Disorder Plus Eating Disorder Comorbidity: Are Two Diagnoses Better Than One? The International journal of eating disorders, 2025.PMID 40099862
16. [16]Lange CRA, Claesdotter-Knutsson E, Gustafsson P, et al. Long-term follow-up study of low-weight avoidant/restrictive food intake disorder and childhood-onset anorexia nervosa: comparison of autistic eating behaviours. Journal of eating disorders, 2026.PMID 42421087
17. [17]Bourne L, Mandy W, Bryant-Waugh R Avoidant/restrictive food intake disorder and severe food selectivity in children and young people with autism: A scoping review. Developmental medicine and child neurology, 2022.PMID 35112345
18. [18]Sharp WG, Berry RC, Burrell L, et al. Scurvy as a Sequela of Avoidant-Restrictive Food Intake Disorder in Autism: A Systematic Review. Journal of developmental and behavioral pediatrics : JDBP, 2020.PMID 32044868
19. [19]Benezech S, Hartmann C, Morfin D, et al. Is it leukemia, doctor? No, it's scurvy induced by an ARFID! European journal of clinical nutrition, 2020.PMID 32313189
20. [20]Winten CG, Strodl E, Kambanis PE, et al. A Systematic Review and Meta-Analysis of Psychological Therapies for Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents and Adults. The International journal of eating disorders, 2026.PMID 41913341
21. [21]Matherne CE, Watson HJ, Schmidt R, et al. Avoidant/Restrictive Food Intake Disorder (ARFID) Symptoms in Adolescent Patients With Disorders of Gut-Brain Interaction. The International journal of eating disorders, 2025.PMID 39912431
22. [22]Rienecke RD, Drayton A, Richmond RL, et al. Adapting treatment in an eating disorder program to meet the needs of patients with ARFID: Three case reports. Clinical child psychology and psychiatry, 2020.PMID 31315462
23. [23]Kerzner B, Milano K, MacLean WC Jr, et al. A practical approach to classifying and managing feeding difficulties. Pediatrics, 2015.PMID 25560449
24. [24]Goday PS, Huh SY, Silverman A, et al. Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework. Journal of pediatric gastroenterology and nutrition, 2019.PMID 30358739
25. [25]Gonzalez-Viana E, Dworzynski K, Murphy MS, et al. Faltering growth in children: summary of NICE guidance. BMJ (Clinical research ed.), 2017.PMID 28963099
26. [26]WHO Multicentre Growth Reference Study Group WHO Child Growth Standards based on length/height, weight and age. Acta paediatrica (Oslo, Norway : 1992). Supplement, 2006.PMID 16817681
27. [27]Chatoor I, Begtrup R, Cheng IY, et al. Failure to thrive in toddlers with lack of interest in eating and food and their cognitive development during later childhood. Frontiers in pediatrics, 2023.PMID 37705600
28. [28]Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Journal of pediatric gastroenterology and nutrition, 2018.PMID 29470322
29. [29]Kovacic K, Rein LE, Szabo A, et al. Pediatric Feeding Disorder: A Nationwide Prevalence Study. The Journal of pediatrics, 2021.PMID 32702429
30. [30]Cardona Cano S, Tiemeier H, Van Hoeken D, et al. Trajectories of picky eating during childhood: A general population study. The International journal of eating disorders, 2015.PMID 25644130