ARFID & Selective Eating
When picky eating is more than a phase. Understanding ARFID, safety-first approaches, and when to seek professional help.
Picky eating vs ARFID
- Decreases with age (most children outgrow it)
- Will eat enough for adequate nutrition
- May try new foods with encouragement
- Doesn't significantly impact weight or health
- Eats a reasonable range of foods (20+)
- Can be managed with patience and strategies
- Persists and may worsen over time
- Leads to nutritional deficiencies
- Extreme distress around new foods
- Weight loss or failure to gain appropriately
- Very restricted range (often fewer than 20 foods)
- Requires professional intervention
ARFID presentations
Most common in autism. Strong preferences for specific sensory profiles.
- •Consistent sensory preferences
- •May gag or vomit with non-preferred textures
- •Limited food range based on sensory features
Often follows a negative experience. High anxiety around eating.
- •May have had a choking or vomiting incident
- •Generalised fear beyond original trigger
- •Avoidance of many foods "just in case"
Food simply isn't rewarding or interesting. May need reminders to eat.
- •Easily distracted from eating
- •Small portion sizes
- •No enjoyment of food
- •May not feel hunger normally
Maintaining intake is more important than expanding variety. Don't remove safe foods.
Pressure increases anxiety and makes eating worse, not better.
At least one safe food at every meal. They need to know they won't go hungry.
Hiding foods, tricking them, or forcing will backfire and damage trust.
Regular weight checks and nutritional monitoring with healthcare provider.
Helpful approaches
Connecting accepted foods to similar new foods through small steps.
Example: McDonald's nuggets → other brand nuggets → homemade nuggets → chicken strips
Gradual, anxiety-reducing exposure to feared foods without eating pressure.
Example: Food in room → on table → on plate → touched → smelled → licked → tiny bite
Playing with food and exploring sensory properties without eating expectation.
Example: Food art, sensory play, cooking together - no pressure to eat the result
Consistent routines, predictable mealtimes, reduced anxiety around eating.
Example: Same time, same place, same rules - predictability reduces anxiety
What doesn't help
Creates trauma and worsens avoidance
Destroys trust, may lose safe foods
Creates unhealthy relationship with food
Increases shame without changing ability
Dangerous and traumatic
Progress takes months to years
Important to know:
- •Weight loss or failure to gain weight
- •Signs of nutritional deficiency
- •Fewer than 10-15 foods accepted
- •Eating anxiety is severe
- •Family mealtime is significantly impacted
- •You're concerned about their health or growth
Professional help
Paediatrician/GP
Medical assessment, growth monitoring, referral
Dietitian
Nutritional assessment, supplement guidance, meal planning
Psychologist/Therapist
Anxiety treatment, CBT for food fears, family support
Feeding clinic/specialist
Comprehensive assessment and treatment for complex cases
Occupational therapist
Sensory-based feeding difficulties
ARFID is not a choice or a parenting failure. It's a recognised eating disorder that is highly co-morbid with autism and ADHD. Pressure and forcing make it worse. Progress is slow but possible with the right approach and often professional support.
- ARFID is a real eating disorder, not just fussy eating
- It's highly co-morbid with autism and ADHD
- Pressure and forcing make it worse, not better
- Safety-first: maintain intake while gradually expanding
- Professional help is often needed - this isn't a parenting failure