Diagnostic features

• Persistent failure to meet appropriate nutritional/energy needs associated with one or more: significant weight loss (or failure to achieve expected weight gain), nutritional deficiency, dependence on enteral feeding or supplements, and marked interference with psychosocial functioning.
• Food avoidance/restriction related to sensory characteristics, lack of interest in eating, or concern about aversive consequences (choking, vomiting), not due to lack of food or cultural practices and not explained by body shape/weight concerns.
• Severity varies from mild picky eating to severe restriction requiring medical support.

Common presentations & subtypes

• Sensory‑based: avoidance due to texture, taste, smell or appearance (common in autism spectrum disorder).
• Lack of interest: low appetite or apparent indifference to eating; often insidious onset.
• Fear‑based: avoidance after a choking episode, vomiting or severe gastroenteritis leading to anxiety about eating.
• Mixed presentations are common; assess for developmental or psychiatric comorbidity.

Assessment checklist

1. Thorough feeding history: onset, foods accepted/refused, mealtime behaviours, peak intake, growth/weight trajectory and use of supplements or formula.
2. Medical review: signs of malnutrition, dehydration, micronutrient deficiencies, GI symptoms (dysphagia, pain), and medication effects.
3. Developmental & psychosocial screen: autism, intellectual disability, anxiety disorders, OCD, and family attitudes to feeding; assess school/peer functioning and caregiver burden.
4. Use validated tools where available: Pica, ARFID, Rumination Disorder Interview (PARDI), and screening questionnaires for ARFID traits and severity when appropriate.

Investigations & baseline monitoring

• Baseline measurements: weight, height, BMI percentile (children), growth charting, vitals and orthostatic observations if symptomatic.
• Laboratory tests guided by severity: CBC, electrolytes, iron studies, B12, folate, vitamin D, LFTs, TFTs and others as clinically indicated.
• Consider swallow study or ENT assessment for suspected dysphagia, and GI referral for persistent vomiting, abdominal pain or suspected organic disease.

Management principles

• Multidisciplinary approach: coordinate paediatrics/primary care, dietetics, speech and language therapy (oral motor/sensory), psychology/psychiatry and occupational therapy for sensory issues.
• Individualised goals: focus on restoring adequate intake, correcting deficiencies, expanding variety and reducing distress around eating while supporting psychosocial functioning.
• Stepped care: outpatient behavioural therapies for mild–moderate cases; day‑programmes or inpatient care for medical instability, severe weight loss, or failure of outpatient treatment.

Psychological & behavioural treatments

• Family‑based therapy (FBT) adaptations: for younger children involve caregivers in meal support and structured feeding plans.
• CGT/CBT‑AR (CBT for ARFID): evidence‑informed approaches targeting cognitive and behavioural maintaining factors — exposure to feared foods, interoceptive exposure for anxiety about choking, and cognitive restructuring.
• Feeding therapy & exposure: graded exposure hierarchies to increase acceptance of textures and tastes, combined with positive reinforcement and sensory desensitisation.
• Applied Behaviour Analysis (ABA): useful in developmental disorders—reward‑based shaping of eating behaviours and antecedent modification.

Nutritional & medical interventions

• Dietetic plans to ensure caloric sufficiency and micronutrient repletion — use high‑energy meal plans and oral supplements when needed.
• Enteral feeding (NG or gastrostomy) may be necessary short‑term for severe malnutrition while behavioural work proceeds; use as part of an integrated plan to transition to oral intake.
• Medication: no medications are specifically approved for ARFID; treat comorbid conditions (anxiety, OCD) with SSRIs or other appropriate agents, and consider appetite stimulants in specific cases under specialist oversight.

Special populations & comorbidity

• Autism spectrum disorder: higher prevalence of sensory ARFID—tailor interventions with OT, sensory strategies and structured routines.
• Trauma / anxiety disorders: fear‑based ARFID benefits from trauma‑informed care and anxiety management (exposure, CBT techniques).
• Adolescents & adults: address nutritional independence, social eating, body image concerns that may overlap with other eating disorders, and transition care from paediatrics to adult services.

Practical tips for clinicians

• Start with medical stabilisation and basic nutrition while arranging multidisciplinary care—avoid blaming language and work collaboratively with families.
• Use small, achievable exposure steps and reinforce even small increases in variety or quantity; involve school to support mealtime routines.
• Document baseline growth and labs; set measurable goals (weight trajectory, dietary variety) and review frequently.

When to refer

• Refer to specialist paediatric or adult eating‑disorder services, gastroenterology, or multidisciplinary feeding teams for medical instability, severe restriction, failure of outpatient treatment, or significant comorbidity (ASD, intellectual disability, severe anxiety).

Key takeaways

• ARFID is a clinically significant feeding disorder driven by sensory sensitivity, low interest in eating or fear of adverse consequences — not by body image concerns.
• Early multidisciplinary assessment (medical, dietetic, speech/OT, psychology) and tailored behavioural/nutritional interventions improve outcomes.
• Escalate care for medical instability or failed outpatient management; coordinate with schools and caregivers for consistent support.