The difference between fussy eating and ARFID - the eating disorder that's on the rise

Is your little one fussy about food, or could it be something more serious? Sometimes kids don't want to eat certain things, and that's normal.

But if your child is very picky, it might be a sign of a real eating problem called ARFID (avoidant/restrictive food intake disorder). This can make them poorly and needs to be sorted out quickly.

ARFID is when kids (and grown-ups too) don't eat some types of food or only eat a little bit. People are talking about it more this year during Eating Disorders Awareness Week (Monday, February 26 to Sunday, March 3). The charity Beat says they're getting lots more calls for help with ARFID seven times more than five years ago.

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This eating problem isn't about worrying over weight like anorexia. It might happen because of not liking how food feels, having a scary time with food before, or just not feeling hungry much.

Umairah Malik from Beat said: "ARFID is a condition where people restrict the foods they eat maybe the types of food or the amount. It's quite different from the eating disorders people might have commonly heard of, in that it's not driven by weight or shape."

"Instead, it can be driven by things like having a traumatic experience with food – for example a choking incident that's made them worry about the consequences of eating. People might have sensory challenges around food that makes them sensitive to things such as texture, smells and appearances of food, or it may be they've got a lack of interest in food or a low appetite."

Ms Malik says these factors aren't just one thing, so people can sometimes have a mix of them all. But how can mums and dads tell the difference between fussy eating and ARFID?

She said: "When we're growing up, we all go through a phase where we experiment with different foods, figuring out what we like and what we don't like. The difference between ARFID and picky eating is when it starts to have an impact on a child's life, through physical health and the psychosocial impact. For example, they might struggle with social situations and family life.

"Another difference with picky eating is that some people with ARFID might eat a reasonable range of foods, but they might not eat the right amount of foods, particularly if they fall into the ARFID category where people have a low interest in food and a lack of appetite.

"ARFID can have an effect on a child's physical and mental health, their growth might not be as expected, or they might need to rely on supplements to get the nutrients they need. It will also have a significant impact on their life in terms of education, school and family life. It's about figuring out what impact it's having on a child's life, which is when it would move from picky eating into ARFID."

Ms Malik points out that disliking one food, for example, doesn't necessarily mean a child has ARFID unless disliking that one food is affecting their physical or mental health. She said: "ARFID is an umbrella term, so it can look really different in different people. Some might eat food of a similar colour, they might eat certain textures, they might always have the same meal.

"Some might eat a reasonable range of foods, but they might feel full after a few mouthfuls and then struggle to eat any more. You can't tell immediately that someone has an eating disorder just by looking at them."

Ms Malik advises any parent who's worried their child might have this disorder to see their GP and ask for a referral for ARFID support. She said: "It might be that you want to take some information on ARFID with you, in case they're not aware of what it is."

If the child isn't referred for this support, Ms Malik suggests trying the local eating disorders service, or calling the Beat helpline for advice. She said: "It's a postcode lottery, but that doesn't mean it shouldn't be taken seriously. We often hear from parents who are really struggling to get help. There aren't currently any treatment guidelines for ARFID, which means people can experience challenges and barriers to getting the help they need."

For those that seek help, treatments like cognitive behavioural therapy (CBT) can help. Support from dieticians, paediatricians, and mental health services, can also be beneficial too.

Ms Malik said: "The specific treatment a child needs would depend on their presentation of ARFID. But it's possible for them to recover, so it no longer has an impact on them physically, their mental health or their social life.

"As with other eating disorders, parents can sometimes feel guilt, and we have to reassure them they're not to blame for their child developing an eating disorder, including ARFID. There's definitely more that needs to be done to raise awareness about ARFID for the public and also with healthcare professionals so they're able to recognise the signs."

As part of her advice, Ms Malik points out that there are many different signs of ARFID, and these depend on the type the child has. Some of these signs are:

1. Eating some types of food but not enough to stay healthy.
2. Not putting on weight as expected.
3. Getting nutritional problems like anaemia.
4. Only wanting to eat food of the same colour (like beige).
5. Not knowing when they are hungry.
6. Do you feel full after just a few bites and struggle to eat more?
7. Does eating feel like a chore and take a long time?
8. Do you often skip meals?
9. Are you overly sensitive to the texture, smell, or temperature of certain foods?
10. Are you a fussy eater?
11. Do you eat the same meals over and over again?
12. Do you always eat something different from everyone else?
13. Do you avoid social events where food is present?
14. Do you feel anxious at meal times, chew your food carefully, and take small bites?

If you need help, you can call the Beat helpline on: England: 0808 801 0677.