Understanding your child’s eating difficulties can be the first step towards change

If your child eats only a handful of foods, becomes extremely distressed around mealtimes, avoids eating because of a fear of choking or vomiting, or seems to have very little interest in food, you may have wondered:

“Is this more than picky eating?”

It is not easy to distinguish the difference between ‘typical picky eating’, and Avoidant/Restrictive Food Intake Disorder (ARFID), especially when everyone’s advice is ‘they will eat when they are hungry’. 

ARFID is a recognised eating disorder and serious mental health condition. It can involve significant restriction in the amount or variety of food a child eats and may lead to nutritional deficiencies, difficulties with growth, anxiety, and disruption to everyday life. ARFID is not driven by concerns about body weight or shape.

A comprehensive assessment can help families understand what is happening and, importantly, what to do next.

But first, What is ARFID?

Avoidant/Restrictive Food Intake Disorder is characterised by persistent difficulties meeting nutritional or energy needs through eating.

Children may restrict their eating for different reasons, including:

• Sensory sensitivity: restriction of foods due to the taste, texture, smell, appearance or temperature of food. 

• Fear of aversive consequences: including but not limited to a fear around eating because they are worried about choking, vomiting, experiencing pain, having an allergic reaction, or becoming unwell.
• A lack of interest in eating: low appetite or low interest in food

So, you may be considering an ARFID Diagnosis Assessment?

A formal assessment can provide much-needed clarity for families who have been trying to understand their child’s eating for years.

1. A diagnosis can help explain why your child is struggling

One of the most valuable parts of an assessment is developing an understanding of the underlying reasons for your child’s restricted eating.

Rather than simply describing a child as “fussy” or “picky”, an assessment looks at the factors contributing to their eating difficulties.

Is it sensory? Is your child afraid of choking or vomiting? Do they experience anxiety around eating? Do they have very little interest in food? Are there nutritional or medical concerns?

Understanding the “why” allows intervention to be much more targeted.

2. It can distinguish ARFID from typical picky eating

‘Picky eating’ is common during childhood. However, ARFID distinguishes itself from ‘picky eating’ where a child’s eating becomes significantly more restrictive and begins to affect their nutrition, health, development or participation in everyday life.

3. It can identify nutritional risk

A child does not necessarily need to be underweight to experience nutritional consequences from restricted eating.

A child may eat enough calories to maintain their weight while having a very limited range of foods and therefore being at risk of inadequate intake of particular vitamins, minerals or other nutrients.

A specialist dietetic assessment can examine dietary variety, nutritional adequacy, growth history, supplementation and other nutritional risk factors.

4. It can provide a clear pathway for treatment

One of the biggest benefits of diagnosis is that it can help move a family from “We know something isn’t right, but we don’t know what to do” to a clear plan.

ARFID treatment may involve psychological therapy, nutritional intervention and feeding therapy, depending on the child’s individual presentation and needs. 

Following assessment, children may be recommended for one of our multidisciplinary, evidence-based feeding therapy programmes involving: Occupational Therapy + Dietetics + Psychology

This allows the different factors contributing to feeding difficulties to be addressed together rather than treating nutrition, sensory needs and anxiety in isolation.

5. It can improve communication between professionals

Children with complex feeding difficulties may have several professionals involved in their care, including GPs, paediatricians, psychologists, dietitians, occupational therapists, speech-language therapists and school or early childhood teams.

A clear diagnostic report provides a shared language for communicating about a child’s needs.

This can be particularly valuable when a child has multiple developmental, medical or mental health needs alongside their feeding difficulties.

6. It can support earlier intervention

Early recognition and appropriate intervention are important when feeding difficulties are significantly affecting a child’s nutrition, health or wellbeing.

New Zealand’s national Eating Issues and Eating Disorders Strategy also places an increased focus on early intervention, specialist community support and greater involvement of families and whānau across the eating-disorder continuum.

An assessment can therefore be an important step in identifying concerns early and connecting families with appropriate support.

7. It can provide funding opportunities 

While this is not a guarantee, funding pathways can open up when a child receives an ARFID diagnosis. If you are already receiving Individualised Funding, this may support a review of support needs. In some cases a diagnosis supports accessing the child disability allowance. 

What Does an ARFID Assessment Look Like?

Our ARFID Assessment Pathway is Aotearoa’s first multidisciplinary ARFID Diagnosis Pathway.

Before the first appointment, families complete a Comprehensive Screening Assessment covering their child’s feeding, medical, developmental, nutritional and psychosocial history.

The assessment then includes:

Psychological Assessment
Our psychologist explores the child’s feeding history, emotional and psychological experiences around food, sensory sensitivities, fears, appetite, functional impact and relevant developmental or mental health factors.

Structured Diagnostic Interview
An age-appropriate PARDI structured diagnostic interview is completed to systematically assess the features and severity of ARFID.

Dietetic Assessment
Our specialist paediatric dietitian assesses dietary intake, food variety, nutritional adequacy, growth and nutritional risk.

Multidisciplinary Review
The psychologist and dietitian review the assessment findings together before determining the diagnostic outcome and recommendations.

Feedback and Diagnostic Report
Families receive a clear explanation of the findings, diagnostic outcome and recommended next steps.

If your child’s diet is becoming increasingly restricted, mealtimes are causing significant distress, or you are concerned about nutrition, growth or the impact of eating difficulties on everyday life, it is worth seeking professional advice.

ARFID can be complex, but recovery and meaningful progress are possible with the right support.

The first step is understanding your child. 

Nourish Therapy