My nine-year-old granddaughter is a picky eater. At almost every one of our Sunday evening family dinners, I watch as she turns her nose up at whatever her father or my husband has prepared. These two men are the main cooks in our family. Her disdain of our food is often followed by some whining and complaining that she does not like what we are eating. Her mother, my daughter, usually scurries around the kitchen and fixes her chicken fingers, a hot dog, some instant quick mac and cheese, or a quesadilla. Her mother is very sympathetic, because she was once herself a picky eater.
My granddaughter ate well as a toddler and younger child – meats, vegetables and almost every fruit. But as she has entered school age, she has grown pickier and pickier about her food. Often, she refuses to try something new. Her parents’ old approach of one “thank-you bite” does not seem to work any longer.
Most children go through a picky eating stage. As a pediatrician, I understand this.
Many toddlers and preschoolers reject vegetables, insist on eating the same foods repeatedly, or refuse to try something new. In most cases, they continue to grow well and gradually expand their diets over time.
Recently, my younger daughter, my granddaughter’s aunt, worried out loud about her niece (not within her sister’s earshot). Since she has a degree in Psychology and “knows a few things,” she wondered whether she might have Avoidant/Restrictive Food Intake Disorder (ARFID).
So, to satisfy my own curiosity, I went to look up some papers and read about this condition. Here are some of the interesting facts I uncovered.
Children with ARFID don’t simply “choose” to be picky - they experience intense anxiety about eating, extreme sensitivity to food textures or smells, or little interest in food at all. As a result, these kids can show poor nutrition, slowed growth, and significant stress for the child and family (worse than just picky eating).
Your child probably has “normal” picky eating if most of these statements are true:
☐ Eats foods from several food groups, even if choices are limited
☐ Is growing normally and maintaining an appropriate weight (gain)
☐ Occasionally is willing to try a new food after repeated exposure
☐ Eats enough to satisfy their hunger
☐ Participates in family meals without major distress
☐ Can eat at birthday parties, in restaurants, or at school around friends when they are hungry
☐ Doesn’t become anxious or fearful around new foods
☐ Mealtimes are occasionally frustrating but not a daily battle fopr parents
If you check three or more of the following, please discuss your concerns with your child’s pediatrician.
☐ My child has lost weight or isn’t growing as expected.
☐ My child eats only a very small number of foods (often fewer than 20).
☐ Entire food groups are avoided (for example, no fruits, vegetables, proteins, or dairy).
☐ Family meals cause significant anxiety, panic, crying, or meltdowns.
☐ My child refuses food because of its texture, smell, color, or temperature.
☐ My child fears choking, vomiting, gagging, or getting sick after eating.
☐ My child often says they simply aren’t hungry or they forget to eat.
☐ Eating at school, birthday parties, restaurants, or friends’ homes is very difficult.
☐ My child needs nutritional supplements or special drinks because they won’t eat enough food.
☐ Blood tests show low iron, vitamin D, or other nutritional deficiencies.
☐ Mealtimes have become a major source of stress for our entire family.
☐ My child’s eating habits interfere with normal daily activities or social events.
Children with these conditions are more likely to develop ARFID:
Autism spectrum disorder
ADHD
Anxiety disorders
Obsessive-compulsive disorder (OCD)
Sensory processing differences
History of reflux, choking, or painful swallowing
Previous traumatic feeding experiences
Severe developmental delays
Sensory sensitivity:
Child refuses foods because of texture, smell, taste, color, or temperature.
He eats fewer than 20 foods.
She often prefers processed foods with predictable textures.
Fear of adverse consequences:
Restrictive eating begins after an episode of choking, vomiting, painful swallowing, severe reflux, or food poisoning.
Child becomes frightened that eating will cause another unpleasant event.
Low appetite or lack of interest in eating:
Child rarely feels hungry.
She becomes distracted during meals.
He may forget to eat altogether.
Many children have overlapping features.
Please do not wait to seek help if your child:
Is losing weight or falling off their growth curve
Appears tired, weak, or pale
Becomes dehydrated
Eats fewer and fewer foods over time
Avoids social situations because of eating
Experiences severe distress during meals
ARFID is more serious than picky eating, with clear diagnostic criteria and significant medical and psychosocial consequences.
Better understanding of the three major ARFID presentations (sensory sensitivity, fear of aversive consequences, and low interest in eating), allows for more tailored treatment.
Early treatment is highly effective. Most children improve with a team approach that includes a pediatrician, dietitian, psychologist, and feeding therapist.
Similar to other eating disorders, the earlier ARFID is recognized, the easier it is to restore healthy eating habits before nutritional problems become more serious.
My granddaughter is most likely just a picky eater.
Please remember: These checklists are screening tools, not a diagnosis. If you’re concerned about your child’s eating habits, growth, or nutrition, please schedule an appointment with your pediatrician. Early evaluation can make a significant difference.
Thomas JJ, Becker KR, Eddy KT. Avoidant/restrictive food intake disorder in children and young people: an update for clinicians. BJPsych Advances. 2023;29(1):38–50. doi:10.1192/bja.2022.52
American Academy of Pediatrics Committee on Practice and Ambulatory Medicine. Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics. 2025;155(2):e2025075764. doi:10.1542/peds.2025-075764
Norris ML, Robinson A, Obeid N, et al. Family-based treatment for avoidant/restrictive food intake disorder: a systematic review. Current Opinion in Pediatrics. 2024;36(4):548–556.
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