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Understanding ARFID and PFD: A Guide for Parents and Caregivers

May 9, 2023

As a parent or caregiver, it can be difficult to watch your child struggle with eating. While picky eating is common in young children, for some children picky eating doesn’t go away. Avoidant Restrictive Food Intake Disorder (ARFID) and Pediatric Feeding Disorder (PFD) are two diagnoses that your child’s pediatrician may have talked about. ARFID and PFD are both conditions that involve extreme picky eating and avoidance of certain foods. However, they differ from picky eating in that they can have serious consequences for a child’s health and well-being if left untreated.

What is ARFID?

ARFID is a relatively new mental health diagnosis that was added to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) in 2013. It is characterized by a persistent refusal to eat certain foods or a complete lack of interest in eating altogether. This can lead to significant weight loss, malnutrition, and other health problems.  ARFID is more common in boys and usually starts at a young age.

Signs to watch out for if you are concerned your child has ARFID:

  1. Your child has a significant negative reaction to smells, textures, colors of foods, and/or tastes.
  2. Your child lacks interest in eating, has a low appetite, finds eating unrewarding, or denies feeling hungry.
  3. Your child fears what might happen when they eat because they might be afraid of choking or vomiting.

What is PFD?

PFD is a broader term encompassing a range of feeding difficulties, including ARFID. PFD is a multidisciplinary diagnosis that occurs in one or more domains: medical, nutrition, feeding skills, or psychosocial.  Children with PFD may have difficulty with oral motor skills, such as chewing and swallowing, or may have sensory issues that make certain textures or flavors of food intolerable.  They may refuse to eat an appropriate amount of food, cough, choke, or gag while eating, and have problematic feeding behaviors (i.e., stress, crying, or irritability) that can make mealtimes stressful.

How are ARFID and PFD different from picky eating?

While picky eating is common in young children and often resolves on its own, ARFID and PFD are more severe and persistent. Picky eaters may have strong preferences, eat a limited variety of foods, avoid new foods, and may eat differently in different contexts. Picky eating becomes a problem when:

  • Food selectively becomes extreme, and child may eliminate entire food groups
  • Your child refuses food and begins gagging, vomiting, hitting, or crying
  • They have a limited appetite
  • Poor weight gain
  • Their eating skills are delayed
  • Mealtimes are stressful, and it negatively impacts the family

What can parents and caregivers do to help?

If you suspect that your child may have ARFID or PFD, it is important to seek help from a healthcare provider who specializes in feeding disorders such as an Occupational Therapist. They can help to determine the underlying cause of your child’s feeding difficulties and develop a treatment plan.  Treatment may involve gradually introducing new foods and textures and helping to improve oral motor skills. It may also involve addressing any underlying sensory issues or anxiety that may be contributing to the feeding difficulties.

As a parent or caregiver, being patient and supportive of your child as they work through their feeding difficulties is important. Avoid pressuring them to eat or using food as a reward or punishment. Instead, focus on creating a positive and relaxed mealtime environment, and offer a variety of healthy foods in a non-threatening way.


ARFID and PFD can be challenging conditions for parents and caregivers to navigate, but with the right support and treatment, children can overcome their feeding difficulties and develop a healthy relationship with food. If you suspect your child may have ARFID or PFD, don’t hesitate to seek help. With early intervention and the right treatment, your child can thrive and enjoy a variety of healthy foods.

At Connect Pediatric Therapy, we specialize in working with kids that are struggling with eating.  Feel free to reach out to us to schedule a FREE phone consultation to determine if your child could benefit from working with one of our occupational therapists.

Resources: – Avoidant/Restrictive Food Intake Disorder (ARFID)

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