The rise of Arfid: is your child a fussy eater or do they have a disorder?

The table was piled high with crispy potatoes, roast chicken and pigs in blankets, yet last weekend nine-year-old Thomas* helped himself to a single Yorkshire pudding and nibbled it slowly while the rest of his family tucked in to their Sunday roast.
“I felt so sad for him,” his mother, Sarah, says. “And embarrassed because my parents had gone to so much effort. And a little ashamed when I saw his cousins tucking into all the delicious food.”
Thomas, who was diagnosed with ASD [autism spectrum disorder] when he was seven, has always been a picky eater, Sarah adds. “All toddlers can be fussy, but he was fussier than most and had a very strong reaction to food. If I gave him something he didn’t like, instead of simply leaving it he’d start to cry or insist I remove every last trace of it from his plate. He wouldn’t eat any vegetables — he still won’t — and before long we were down to about seven foods he would eat on rotation. Mainly things like bread rolls, no butter; fusilli pasta, no other shape and no sauce; and chips.”
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It wasn’t until his younger sister, who is now six, came alongand ate “normally” that Sarah realised something was amiss. After a referral from the family GP, Thomas was diagnosed with Arfid this year.
“Arfid stands for avoidant restrictive food intake disorder,” says Umairah Malik, a clinical advice co-ordinator at Beat, the eating disorder charity. “It’s an eating disorder where someone will only eat certain foods, limit how much they eat or a combination of both.” Malik says there’s often a misconception that all eating disorders are driven by weight, as is the case with bulimia or anorexia, but that this isn’t the case with Arfid.
“Weight doesn’t play any part in it,” Malik says. “For some it might be a sensory or taste issue, for others it might be due to a traumatic incident that has led to a fear around eating, such as choking. Another group might not recognise that they feel hungry in the way others would and have a low interest in eating. Research shows some people overlap with all three groups.”
Precise figures are difficult to come by, but Malik reports a steep rise in cases of Arfid since the pandemic: “Anecdotally, we’ve heard that many parents spotted the signs faster when they were locked down together. It could also be an increase in mental health awareness. There’s a long way to go before we understand why cases are increasing.”
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Research from Beat in 2024 shows cases of Arfid in the UK have risen fivefold in the past five years. In 2018, 2 per cent of the total number of calls the charity received were about Arfid. In 2023, they accounted for 10 per cent. Beat’s chief executive, Andrew Radford, called this “extremely worrying” due to the fact that awareness and care for the eating disorder — which already “rarely gets the attention it deserves” — isn’t always readily available. Many of the calls they received were from young people or their parents.
“Arfid is something that develops early on in life when a child is first weaned, and most parents initially put it down to fussy eating,” says Dr Stephen Linacre, a member of the British Psychological Society’s faculty for eating disorders. “It can be genetic and it’s more common in children who are neurodiverse [for example, children with autism spectrum disorder, ASD, or attention deficit hyperactivity disorder, ADHD]. But we do want to reiterate that you don’t need to be neurodiverse to have it.”
Vicky’s* 14-year-old daughter Mia* — who hasn’t been formally diagnosed with a neurodiversity but suffers from anxiety — has only eaten a limited number of foods since she was a toddler and is even particular about the way her food is served. “I have to peel the skin off cucumbers and scoop out the seeds. She can’t cope with wet foods like yoghurt, soup and mashed potato. And she can’t eat soft bread, only cracker bread. She also likes the different foods on her plate to be kept separate from one another.”
Vicky works as a teaching assistant in a junior school and has increasingly seen similar eating patterns among other children in recent years, especially neurodiverse students.
“I often hear judgmental comments from the teachers who will say, ‘Did you see what his mum has put in his lunchbox?’ It’s easy to judge, but I have three children who were raised on the same diet and it’s only Mia who struggles. There’s a lack of understanding among those with children who don’t have issues with food. It’s even taken my husband a long time to realise she’s not being difficult but has a genuine psychological block around certain foods.
“I’ve heard people say, ‘Kids won’t starve themselves’, but there was a time when she actually would have starved if we hadn’t given her certain foods. Parents dealing with this are pulling their hair out and are desperate for help yet they’re told they have fussy eaters when it’s actually a disorder.”
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Arfid can also appear at any age. Two years ago Olivia*, now 15 and diagnosed with ASD, developed a fear of food poisoning after her mother explained in passing why chicken needs to be cooked properly. “Soon afterwards she began cutting her chicken into tiny pieces to check for pink bits, and eventually stopped eating it altogether. She then became anxious whenever I cooked it for the rest of the family, because she thought she might ‘catch’ food poisoning. Family mealtimes became incredibly unhappy, arguments would flare up and one of us would often end up storming out.”
So, where is the line between Arfid and fussy eating? The dietitian Sarah Fuller says that we all have different food likes and dislikes and “as a result picky eating applies to almost all of us. It’s why we call it a spectrum.” Fuller says it’s normal for children to go through phases of selective eating, but clinically speaking, fussy eating moves into Arfid when nutrition or growth is compromised — for example, those not growing in height, being underweight or experiencing nutritional deficiencies. This can result in some parents relying on nutritional supplements to ensure their child has an adequate nutritional intake.
She notes that signs your child has Arfid might include a diet limited to fewer than ten foods based on sensory specificity, such as being similar in texture or taste, only eating one brand of a particular food, struggling to accept new foods, an extreme reaction to the sight or smell of certain foods and struggling to eat socially or flexibly. Avoidance of foods resulting from a choking or vomiting episode or due to concerns about contamination might also indicate Arfid.
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“I wouldn’t classify it as Arfid until it’s affecting somebody physically or psychologically,” Linacre agrees. As for cures, he says people sometimes grow out of it or bow to peer pressure to try new foods as they get older — although this is less likely among those with ASD. “CBT [cognitive behavioural therapy] can be helpful and enable a young person to explore their relationship with food and understand their fears around it. It can also help young people find foods that are similar to the ones they already eat and expand their repertoire.”
Linacre adds that another important goal is to help parents, who are often incredibly anxious about their child’s health and face a lack of awareness. “Not enough professionals around the country are experienced in Arfid and there often isn’t the staffing, resources or knowledge to treat it, even though it can cause a huge amount of stress for the entire family.”
“If you think your loved one has Arfid, speak to your GP,” Fuller advises. “There are also steps you can take to help and support them without needing a diagnosis and before accessing professional help, including visiting the Arfid information page on Beat’s website or ARFID Awareness UK.”
Lastly, go easy on yourself, she says: “Supporting someone with Arfid can feel overwhelming, restrictive and worrying. It is incredibly important that you practise self-compassion for the challenging situation you are in. Remember that you did not cause this, you are not to blame, you are not failing and that there is hope.”*Names have been changed