ARFID: Avoidant Restrictive Food Intake Disorder IN CHILDREN AND ADOLESCENTS

Mar 10

Avoidant/Restrictive Food Intake Disorder (ARFID) can present in many ways — from extreme picky eating to intense fears around eating. While some children go through short-lived “picky” phases, ARFID goes beyond this and can significantly affect health, growth, and quality of life.

Common Signs in Kids and Teens

Very Limited Food Range: Relying on a few safe foods and avoiding entire food groups.
Fear of Negative Consequences: Anxiety about choking, vomiting, or stomach pain after eating.
Low Interest in Eating: Forgetting to eat, feeling full quickly, or seeming burdened by mealtimes.
Growth Concerns: Falling off growth curves, delayed puberty, or slow weight gain.
Distress Around Food and Mealtimes: Family stress, arguments, or avoidance of social events involving food.

Why ARFID Is a Concern

In children and teens, ARFID isn’t just about food — it can impact development in serious ways.

Health Risks

Nutritional Deficiencies: Lack of vitamins, minerals, and protein needed for growth.
Impaired Growth and Puberty: Insufficient calories can disrupt height, weight, and developmental milestones.
Weakened Immune System: Poor nutrition increases illness risk.
Medical Complications: Chronic undernutrition may affect heart, bone, and hormonal health.
Dental Issues: Limited diets can impact oral health.

Emotional and Social Risks

Cognitive Impairment: Malnutrition can affect focus, learning, and memory.
Emotional Distress: Anxiety, low mood, or frustration around food and eating.
Social Isolation: Avoidance of school lunches, parties, and outings with peers.
Risk of Other Eating Disorders: Restrictive patterns can persist into adolescence and beyond if untreated.

Evidence-Based ARFID Treatments for Children and Teens

Effective treatment often requires a combination of medical, nutritional, and psychological support.

Feeling and Body Investigators (FBI) for Young Children

Designed for ages 4–10, developed at Duke University.
Uses play, curiosity, and fun characters to reduce fear and encourage exploration.
Parents are active partners, supporting progress at home.

Family-Based Treatment for ARFID (FBT-AR)

Parents take a leading role in supporting nutritional rehabilitation.
Focuses first on weight restoration and growth, then gradual food expansion.
Builds family structure around mealtimes and exposures.

Cognitive-Behavioral Therapy for ARFID (CBT-AR)

For older children and teens (typically age 10+).
Targets fears, avoidance, and rigidity around food.
Includes structured exposures to new foods and coping strategies for anxiety.

Concrete Strategies for Parents

While treatment should be guided by a trained provider, parents can play an important role at home. Here are some practical, research-informed approaches:

Boost calories in familiar foods: Add butter, oil, cheese, or nut butter to foods your child already eats to support growth without changing taste too much.
Make exposures playful: Frame a new food as a “food experiment” or “mission.” Start small — smelling or touching counts as progress.
Adjust the environment: Lower mealtime pressure, keep sessions short, and create a calm, predictable setting.
Use gradual steps: Move from looking at the food → touching → licking → taking a bite. Celebrate small wins.
Mix novelty with comfort: Introduce a new food alongside one or two “safe” foods to reduce anxiety.
Shift preparation slowly: For a child who only eats one brand of chicken nuggets, start by changing the plate, shape, or seasoning before switching brands or types.
Model curiosity: Show your child how you taste, describe, and react to new foods — curiosity instead of pressure.
Stay consistent: Small, repeated exposures are more effective than one-off attempts.

Columbus Park aND ARFID

At Columbus Park, we specialize in treating ARFID in children and teens. Our process begins with a parent meeting to understand your child’s unique challenges and strengths. From there, we create a customized treatment plan — always grounded in evidence-based care and built around your family’s needs.

Treatment often starts with ensuring adequate nutrition and restoring healthy growth. Once your child is medically stable, we work with you to gradually expand food variety through playful, structured exposures and skill-building. Parents remain central to the process, supported every step of the way by our expert team.

Melissa Gerson

Melissa Gerson is the founder of Columbus Park. Over the last 20-plus years, she has trained in just about every evidence-based eating disorder treatment available to individuals with eating disorders: a dizzying list of acronyms including CBT-E, CBT-AR, DBT, FBT, IPT, SSCM, FBI and more.

Among her most important achievements has been a certification as a Family-Based Treatment provider; with her mastery of this potent and life-changing (and life-saving!) modality, she’s treated hundreds of young people successfully and continues to maintain a small caseload of FBT clients as she also focuses on leadership and management roles at Columbus Park.

Since founding Columbus Park in 2008, Melissa has trained multiple generations of eating disorder professionals and has dedicated her time to a combination of clinical practice, writing, and presenting.