Is It Just Picky Eating or Something More? Understanding the Difference Between Picky Eaters and ARFID
- Jennifer Urich
- Jun 16
- 3 min read
Many children go through phases where they reject broccoli, protest at the sight of anything green, or insist on eating the same brand of macaroni and cheese every day. But how do you know if it’s just typical picky eating or something more serious, like Avoidant/Restrictive Food Intake Disorder (ARFID)?
In this post, we’ll break down the differences between picky eating and ARFID, outline red flags to look for, and stress the importance of ruling out underlying medical conditions that may contribute to feeding difficulties.
What is Picky Eating?
Picky eating is a common part of child development. It usually begins in toddlerhood and may include:
Limited food variety (especially vegetables or proteins)
Refusal to try new foods (neophobia)
Strong preferences for certain textures, brands, or preparation methods
Most picky eaters:
Eat enough calories to grow appropriately
Tolerate being around non-preferred foods
Gradually increase food acceptance over time
Experience minimal mealtime stress or interference with daily life
What is ARFID?
Avoidant/Restrictive Food Intake Disorder (ARFID) is a clinical diagnosis defined in the DSM-5. It goes beyond picky eating and includes significant nutritional, medical, or psychosocial consequences.
Children with ARFID may:
Eat an extremely limited range of foods
Avoid foods due to sensory sensitivity (texture, smell, appearance)
Show fear of choking, vomiting, or previous negative feeding experiences
Have noticeable weight loss or poor growth
Require nutritional supplements or feeding tubes
Experience anxiety or distress around meals
ARFID often requires a team approach to treatment, including feeding therapists, psychologists, dietitians, and medical providers.
Before You Label It: Rule Out Medical Causes
Feeding difficulties can be the result of medical issues that make eating uncomfortable or even painful. Before assuming a child has ARFID or behavioral feeding challenges, it’s critical to rule out the following conditions:
1. Gastroesophageal Reflux Disease (GERD): A chronic condition where stomach acid flows back into the esophagus, causing pain, gagging, refusal to eat, and mealtime aversion.
2. Eosinophilic Esophagitis (EoE): An allergic inflammatory condition where white blood cells build up in the esophagus, leading to pain, difficulty swallowing, food impaction, and refusal of solid foods.
3. EGID (Eosinophilic Gastrointestinal Disorders): A group of conditions, including EoE, that affect various parts of the gastrointestinal tract and can cause vomiting, abdominal pain, poor appetite, and failure to thrive.
4. Celiac Disease: An autoimmune disorder triggered by gluten that damages the small intestine, often leading to malabsorption, diarrhea, stomach pain, and poor growth. Children may develop food aversions after repeated discomfort.
5. Inflammatory Bowel Disease (IBD): Includes Crohn's disease and ulcerative colitis. These chronic inflammatory conditions can cause pain, diarrhea, fatigue, and decreased appetite, contributing to selective eating or refusal to eat.
Who Should Be Involved?
If your child is experiencing severe food selectivity, poor growth, mealtime distress, or food refusal, consider involving:
Pediatrician: To screen for growth concerns and initiate medical referrals
Gastroenterologist: To evaluate for reflux, EoE, EGID, celiac, or IBD
Allergist: To test for food allergies or intolerances
Feeding Therapist (OT or SLP): To assess oral motor skills, sensory responses, and behavioral patterns
Registered Dietitian: To evaluate nutritional intake and suggest dietary strategies
Psychologist or Psychiatrist: If anxiety, past trauma, or ARFID is suspected
Final Thoughts
Picky eating is frustrating, but often a normal part of development. ARFID, on the other hand, is a serious feeding disorder requiring skilled intervention. If you’re concerned about your child’s eating, don’t wait. The earlier you seek help and rule out medical causes, the sooner you can begin addressing your child’s needs and building a healthy relationship with food.
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