Extreme Picky Eating or ARFID? How to Know the Difference Picky eating is a normal part of childhood development. Around the ages of 2 to 3 years, many children begin asserting their independence, including expressing strong opinions about what they will and will not eat. This phase is a typical part of childhood development, is usually short-lived, and generally does not affect a child’s growth or nutritional status. This developmental phase, often referred to as food neophobia, is considered a normal part of childhood and typically peaks between 2 and 6 years of age before gradually improving with repeated exposure to foods (Dovey et al., 2008). Parents can often help their child through this stage by offering simple choices rather than forcing foods. For example, instead of insisting on one vegetable, you might ask, “Would you like corn, carrots, or peas?” Negotiation can also be helpful —for example, asking your child to finish one of the three foods left on their plate. Involving children in grocery shopping, meal preparation, and choosing recipes can also increase their interest in trying new foods and help them feel more empowered in making food choices. As children grow older, usually by the ages of 6 to 8 years, their diet naturally expands, and food variety generally increases. For most children, picky eating becomes much less of a concern. However, for some children, this natural progression does not occur. Instead, eating becomes increasingly restrictive, and the range of accepted foods becomes even more limited. This may be an early sign of Avoidant/Restrictive Food Intake Disorder (ARFID). ARFID is an eating disorder characterized by persistent restrictive eating that goes well beyond typical picky eating. ARFID was first formally recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013 and was retained in the DSM-5-TR (2022). Unlike other eating disorders such as anorexia nervosa, ARFID is not driven by concerns about body weight or body shape, but rather by limited food intake resulting from sensory sensitivities, fear of aversive consequences of eating (such as choking or vomiting), or an apparent lack of interest in eating (American Psychiatric Association, 2022). Children with ARFID often accept only a very limited number of foods and may completely avoid entire food groups, such as fruits or vegetables. Their food choices are often based on sensory characteristics such as taste, texture, smell, temperature, or appearance, or may stem from unpleasant experiences related to eating. Unlike typical picky eating, ARFID can affect a child’s growth, nutritional status, and overall quality of life. Mealtimes often become stressful for both the child and the family. Parents may find themselves preparing separate meals, purchasing only specific food brands, or avoiding restaurants, birthday parties, school events, and family gatherings because their child will not eat the available food. Out of concern that their child may not eat enough, many parents understandably begin accommodating their child’s eating patterns. While this may reduce stress in the short term, it often reinforces food avoidance and makes expanding the child’s diet more difficult over time. How Can a Dietitian Help? A dietitian experienced in ARFID begins by carefully assessing the child’s current dietary intake, nutritional status, and eating behaviors. Treatment is individualized and focuses on gradually increasing food variety while ensuring the child feels safe and supported throughout the process. Several evidence based strategies may be used. Addressing Sensory Sensitivities Many children with ARFID experience heightened sensitivity to taste, texture, smell, temperature, appearance, or even environmental factors such as noise. Small accommodations can sometimes reduce distress during meals. For example, a child who is highly sensitive to smells may benefit from using a small handheld fan, while a child who is overwhelmed by noise may feel more comfortable wearing noise-reducing headphones during meals. Food Chaining Food chaining is a commonly used strategy in ARFID intervention. It involves making very small, gradual changes from an accepted food to a new food that shares similar characteristics. For example: Plain crepe Crepe with a light sprinkle of cinnamon Crepe with cinnamon and a small slice of banana Crepe with cinnamon and several banana slices These tiny steps help build familiarity while reducing anxiety around trying new foods. Although individualized, this method has been shown to improve acceptance while minimizing anxiety associated with new foods (Fishbein et al., 2006). Building on Safe Foods Another strategy is to improve the nutritional quality of foods the child already accepts. For example, if plain pasta is considered a “safe food,” shredded mozzarella cheese or a drizzle of olive oil can be added to increase its nutritional value. Progress Takes Time Every child with ARFID is different. Each has unique food preferences, sensory challenges, and levels of anxiety around eating. For this reason, treatment is always individualized and developed collaboratively with parents. Together, the dietitian and family identify one food group to focus on based on the child’s current intake. A few realistic target foods are selected, and the child is gradually exposed to them through repeated, low-pressure experiences. The goal is not to force eating. Instead, progress follows a gradual sequence: Tolerating the food being nearby Touching the food Smelling the food Tasting a small bite Eating several bites Eventually eating a full portion comfortably Although progress can be slow, every positive exposure is a meaningful step forward. A Message to Parents One of the biggest challenges for parents is resisting the understandable urge to accommodate every food refusal. While serving only accepted foods may reduce anxiety in the moment, it does not help break the cycle of fear and avoidance. Although well intentioned, research suggests that excessive accommodation may inadvertently reinforce avoidance behaviours and maintain anxiety around eating, making long-term progress more difficult (Thomas, Eddy & colleagues). It is equally important not to become convinced that your child can only cope if offered their preferred foods. Over time, this belief can become reinforced for both the child and the parent, making it even harder to expand the child’s diet. Remember: Avoidance tends to increase anxiety, while gradual, supported exposure helps reduce it. Listen to your child’s concerns, acknowledge their fears, and offer reassurance. With patience, consistency, and the right professional support, children with ARFID can gradually build confidence, increase food variety, and develop a healthier relationship with food. When should I seek professional help? Your child consistently eats only a very limited number of foods, and that number continues to decrease. Entire food groups are avoided. Meals cause significant distress or anxiety. Growth or weight gain is affected. Your child avoids school meals, parties, or restaurants because of food. Mealtimes consistently become stressful for the whole family. If you are concerned about your child’s eating habits, early assessment by a dietitian and multidisciplinary team can make a significant difference. Although ARFID can be challenging for both children and their families, early intervention and a supportive, individualized approach can lead to meaningful progress. Every small step—whether it’s touching, tasting, or accepting a new food—helps build confidence, improved nutrition and moves the child toward a healthier, more varied diet. References: American Psychiatric (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Association Publishing. Dovey, M., Staples, P. A., Gibson, E. L., & Halford, J. C. G. (2008). Food neophobia and “picky/fussy” eating in children: A review. Appetite, 50(2–3), 181–193. Fishbein, M., Cox, S., & Swenny, C. (2006). Food Chaining: A systematic approach for the treatment of children with feeding aversion. Nutrition in Clinical Practice, 21(2), 182–184. Norris, L., Robinson, A., Obeid, N., et al. (2021). Exploring Avoidant/Restrictive Food Intake Disorder in children and adolescents: A review of the literature. Journal of Eating Disorders. Thomas, J. J., Lawson, E. A., Micali, N., et al. (2017). Avoidant/Restrictive Food Intake Disorder: A three-dimensional model of neurobiology with implications for etiology and treatment. Current Psychiatry Reports, 19(8), 54. About the author: Hala Tajrine is a Clinical Dietitian with 15 years of experience specializing in diabetes, eating disorders & ARFID, obesity and weight management, gut health & IBS, women’s health & PMOS, and pediatric and sports nutrition. She holds a degree in Dietetics and Human Nutrition from McGill University and has advanced training as a Diabetes Educator (International Diabetes Federation Europe), along with certifications in Medical Nutrition Therapy, Physical Activity, and ARFID treatment. Hala’s approach is rooted in compassion, collaboration, and personalization. She listens deeply to each patient’s story, aligns on realistic goals, and supports them in building sustainable, long-term habits. She strives to create a safe, supportive environment where clients feel heard, understood, and motivated toward better health.