When Is Picky Eating Actually ARFID? What Parents of Autistic Kids Need to Know

What is ARFID?

Understanding Avoidant/Restrictive Food Intake Disorder and How It Differs from Picky Eating

Table of Contents

1. Introduction: Our Family’s Experience with Extreme Picky Eating

2. What is ARFID?

3. ARFID vs. Picky Eating: Key Differences

4. How ARFID Shows Up in Autistic and Non-Autistic Children

5. Why ARFID Is Often Overlooked

6. When to Seek Help

7. Final Thoughts + Free Support Resource

Extreme Picky Eating

When I was first navigating extreme picky eating with my twins, the term ARFID (Avoidant/Restrictive Food Intake Disorder) never came up. Even now, I’m not sure whether any of my three boys would—or would have—qualified for a formal diagnosis of ARFID. But their eating was (and in some cases still is) extremely limited.

ARFID stands for Avoidant/Restrictive Food Intake Disorder.

I followed all the “right” advice—offering every color of the rainbow, modeling veggie-eating like it was my job, staying calm and pressure-free. Still, like clockwork, when my kids turned three food refusals began.

Now I hear the term ARFID much more often, especially in online groups, therapy discussions, and professional trainings. But what exactly is ARFID—and how can parents tell the difference between a child who’s just a picky eater and a child who needs more help?

What is ARFID?

ARFID stands for Avoidant/Restrictive Food Intake Disorder. It was officially added to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) in 2013, which means it’s still relatively new in terms of medical awareness.

Grab your free social story to encourage trying new foods.

Unlike other eating disorders like anorexia or bulimia, ARFID is not driven by body image concerns. Instead, it involves an extreme avoidance or restriction of food that leads to:

• Significant weight loss (or failure to gain weight as expected)

• Nutritional deficiencies

• Dependence on nutritional supplements or tube feeding

• Interference with social, emotional, or daily functioning

Children with ARFID may refuse foods due to:

• Sensory sensitivities (texture, taste, smell, appearance)

• Fear of choking, vomiting, or pain

• A lack of interest in food or eating

ARFID appears to affect between 1.5% and 5% of children and adolescents

According to recent studies, ARFID appears to affect between 1.5% and 5% of children and adolescents (Kurz et al., 2015; Nicely et al., 2014). Rates may be higher among autistic individuals.

ARFID vs. Picky Eating: Key Differences

Nearly all young children go through a picky phase—but ARFID is something more. Here are a few ways to tell the difference:

Typical Picky Eating:

• Child eats from each major food group, though limited

• Accepts new foods with time and exposure

• Growth and weight stay on track

• Mealtimes may be frustrating but not distressing

ARFID:

• Eats very few foods—sometimes fewer than 10

• Refuses entire categories of food (e.g., all meat or all vegetables)

• Often experiences strong distress around trying new foods

• Growth may stall or decline

• Can’t participate in social situations involving food (like birthday parties)

Some children with ARFID also have anxiety or sensory processing difficulties that make eating feel overwhelming.

How ARFID Shows Up in Autistic and Non-Autistic Children

Autism is associated with a higher rate of feeding challenges, and many autistic children are selective eaters. In fact, research shows that between 46% and 89% of autistic children experience some level of feeding difficulty (Bandini et al., 2010).

For autistic children, food selectivity may be linked to:

• Sensory processing differences

• Need for predictability or sameness

• Gastrointestinal issues

• Difficulty with interoception (awareness of hunger/fullness cues)

But even in non-autistic children, ARFID can develop for different reasons—including trauma, illness, or anxiety. This is why it’s so important not to assume all feeding difficulties are “just autism” or “just a phase.”

Why ARFID Is Often Overlooked

Unfortunately, ARFID is still underdiagnosed. Many pediatricians and therapists may not be trained to recognize the signs—and parents may not know how to describe what’s happening.

Growth charts may look okay even if diet is severely limited.

Some common reasons ARFID goes unnoticed:

• The child doesn’t appear underweight

• Growth charts look okay (even if diet is severely limited)

• Parents feel dismissed or told to "wait it out"

• The child’s behaviors are misattributed to autism or anxiety alone

If you’re concerned, it’s important to be specific when describing your child’s eating habits. Instead of saying “he’s a picky eater,” say things like:

• "He only eats five foods and cries if I offer something new."

• "She gagged when I put a new food on her plate."

• "He hasn’t tried a new food in over a year."

• "We can’t go to restaurants or family events because of his eating."

When to Seek Help

If your child’s eating habits are causing stress, interfering with growth, or impacting daily life, it’s time to get support.

Talk to your pediatrician, and consider asking for a referral to:

• A feeding therapist (speech-language pathologist or occupational therapist)

• A pediatric dietitian

• A psychologist with experience in ARFID and anxiety

Treatments may include sensory-based approaches, food chaining, anxiety support, and parent coaching.

A formal evaluation can help determine whether ARFID might be the cause—and what kind of support your child may need.

Treatments may include sensory-based approaches, food chaining, anxiety support, and parent coaching.

It’s also okay to trust your gut. You know your child best. If you feel something isn’t right, don’t wait.

Final Thoughts + Free Support Resource

It’s easy to second-guess yourself when your child is a picky eater. But ARFID is real—and serious—and it deserves to be taken seriously by professionals.

Not every child with picky eating has ARFID, but when mealtime challenges begin to affect your child’s health, emotional wellbeing, or quality of life, it’s worth exploring further. Early support can make a huge difference.

This social story is available for purchase on ETSY.

If you’re just beginning this journey, I created a gentle social story to help children understand why eating a variety of foods is important. It’s designed with real photos, simple text, and a non-pressuring tone that can help start conversations. You can learn more about it here.

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

• Bandini, L. G., Anderson, S. E., Curtin, C., Cermak, S., Evans, E. W., Scampini, R., ... & Must, A. (2010). Food selectivity in children with autism spectrum disorders and typically developing children. The Journal of Pediatrics, 157(2), 259-264.

• Kurz, S., van Dyck, Z., Dremmel, D., Munsch, S., & Hilbert, A. (2015). Early-onset restrictive eating disturbances in primary school boys and girls. European Child & Adolescent Psychiatry, 24(7), 779–785.

• Nicely, T. A., Lane-Loney, S., Masciulli, E., Hollenbeak, C. S., & Ornstein, R. M. (2014). Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. Journal of Eating Disorders, 2(1), 21.