Better Me

When to Worry About Your Child’s ‘Nuggets and Fries’ Diet

Just about every parent has dealt with a picky eating phase with their child. Whether it’s macaroni and cheese (only the orange kind!), yogurt that has to come in a squeezable tube or white-bread PB&J with the crusts cut off, it seems like there is a time when your child will eat one food, and one food only.

But most children outgrow this phase. They may not become the most adventuresome eaters, but they’re willing to taste unfamiliar things and eat a variety of foods.

Some children struggle to expand their food choices, though. They may have avoidant restrictive food intake disorder (ARFID). “They take in such a narrow spectrum of foods that they risk medical complications such as nutritional deficiencies, weight loss, menstrual irregularities, and impairment in overall functioning,” said Lesley Williams, MD, an eating disorder specialist at Banner Behavioral Health Hospital in Scottsdale, AZ. “They may avoid social situations because they fear being pushed to eat foods outside their comfort zone.”

If they don’t eat much fiber, they may have abdominal pain or constipation. Protein and vitamin deficiencies can lead to fatigue, dizziness, muscle weakness, and changes in their hair, skin, and nails.

They can develop mental health conditions like depression and anxiety as well, and as they get older, ARFID affects their ability to interact with their peers.

What makes ARFID more than just picky eating?

The difference between picky eaters and kids with ARFID is severity and duration. “When you have picky eaters there’s a window developmentally, then kids tend to grow out of it and expand their food choices,” Dr. Williams said.

Kids with ARFID tend to prefer bland foods with uniform texture—things like rice and toast that aren’t providing many nutrients. “They are avoidant of things that have a lot of flavor or variety in terms of taste and texture,” Dr. Williams said.

Children with some other conditions may be more prone to AFRID. “The majority of patients I have seen have struggled with autism spectrum disorder,” Dr. Williams said. There’s also overlap with:

  • Attention deficit hyperactivity disorder
  • Trauma, especially a history of trauma around food
  • Post-traumatic stress disorder
  • Anxiety disorders
  • Phobia of swallowing or vomiting

While ARFID typically starts in childhood, if untreated it can continue into adulthood. “Some adults are undiagnosed for years,” Williams said.

And while weight loss often goes hand-in-hand with ARFID, that’s not always the case. ARFID can occur regardless of the child’s size.

If you suspect your child might have ARFID, what should you do?

You need a thorough psychiatric and medical evaluation to determine if your child’s eating meets the criteria for ARFID. If so, a team approach can help. “You can work with a psychiatrist, psychologist, therapist, and dietitian to help your child expand their food choices,” Dr. Williams said.

Health care professionals may start by creating a hierarchy of foods that range from least scary to most scary. “It really depends on what their fears are and what their concerns are around,” she said.

To help decrease aversion, they might ask your child to look at the food, touch it, or put it in their mouth. They may also recommend a nutritional supplement until they expand the list of foods they will eat.

The bottom line

Most children grow out of their picky eating phase. But some children eat such a restricted diet that they can develop physical or mental health problems. If you suspect that your child has ARFID or another eating disorder, talk to your health care provider. For a referral, visit bannerhealth.com.

Behavioral Health Children's Health Nutrition Parenting

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