Is It ARFID or Picky Eating? What we miss when we call everything picky eating

If you’ve ever Googled “Is this normal picky eating?” at 10 pm after another tough eating moment with your child, you are in the right place.

Picky eating is common in childhood and can be surprisingly complex. As someone who works with this every day, both as a dietitian and as a parent, I can tell you there’s a huge range in how it shows up in families. That’s why this topic can feel so confusing.

One parent might describe their child as “fussy” because they don’t like green vegetables. Another might use the same word to describe a child who only eats Goldfish crackers and milk. The same label. Very different picture. And a very different level of support is needed.

Food refusal and selective eating behaviours typically appear around age one and peak around age two. For many children, these behaviours gradually decline by early primary school, and by the teenage years, they’re mostly eating a varied diet. This is why picky eating is often viewed as a normal developmental stage, particularly in toddlers.

But developmentally appropriate picky eating is not what many of the families I work with are experiencing. And when we call all of this “picky eating,” we risk missing when a child is struggling, when eating is driven by distress and sensory overwhelm rather than preference, and when waiting can actually make things harder over time.

When “picky eating” doesn’t quite fit

Picky eating is often described as a phase in which a child suddenly refuses certain foods, has a limited range of accepted foods, is hesitant around new foods, or eats less enthusiastically than other children.

For many children, selective eating tends to ease over time.

But for some families, it doesn’t.

Sometimes feeding has felt challenging from the very beginning, including breast- and/or bottle-feeding. Other times, restrictive or selective eating patterns remain mostly the same for years, or the list of foods a child accepts gradually shrinks.

If you’re reading this, there’s a good chance you’ve been told "not to worry". That “it's just a phase all kids go through”. That children "will eat when they’re hungry". So you try to pretend it's all fine — even as mealtimes become tense, exhausting, or emotionally charged. Feeding your kids starts to take up far more mental space than you ever expected.

Often, it’s not until you travel or spend significant time with other families that the difference becomes clear. What you’ve been managing quietly suddenly stands out, and you realise how different and much effort your child’s eating requires.

You read the blogs. You reduce pressure. You give them the same five foods over and over. You wait. But instead of expanding, eating feels harder. Your child eats less, not more, and between social media's obsession with "healthy lunchboxes" and the sideways looks or well-meaning comments from others, it can slowly chip away at your confidence as a parent, and even strain your relationship with your child.

That is a lot for parents to carry.

This is often the point at which “wait and see” stops feeling supportive, not because you haven’t tried hard enough, but because something more may be going on.

This is where pausing and asking different questions about what might be driving the difficulty, and what kind of support could help, can be a meaningful next step.

In some cases, this pattern of eating has a name: avoidant/restrictive food intake disorder, or ARFID. Before we go any further, I want to clarify the goal of this article.

This isn’t about labels — it’s about understanding

This isn’t about diagnosing your child or rushing to labels. It’s about recognising when eating signals distress or a nutritional risk, and responding in ways that reduce harm and support both the child and the family.

My hope is that this blog will give you a moment to reflect, or perhaps provide an opportunity to initiate a conversation with a partner, family member, teacher, or health professional, and to better describe what you’re seeing in your child.

Because while many children do move through picky phases on their own, for some families, that simply doesn’t happen. And those children often need a very different kind of support, where earlier understanding can make a meaningful difference.

Whether or not a child ever meets formal criteria for something like ARFID, what matters most is how eating feels for them, how it’s affecting daily life, and whether our response reduces — rather than increases — distress.

A note on language

If you’ve been here a while, you might notice that I’m not a fan of using words like picky or fussy. Probably because I was considered a “picky eater” myself (and I’m now raising one too).

The only reason I use these terms at all is that they’re the words most people reach for when trying to describe what they’re seeing. In my work, I prefer language that feels more neutral, accurate, and respectful of a child’s experience, such as "selective eating," "feeding differences," or "sensory-based eating differences."

These terms help shift the focus away from behaviour or blame, and towards understanding what might be going on for the child. Because the behaviours we observe as adults are different to what a child might be experiencing on the inside.

So what is ARFID?

ARFID (pronounced ar-fid) stands for Avoidant/Restrictive Food Intake Disorder. It has been formally recognised as an eating disorder since 2013.

Unlike many other eating disorders, ARFID is not driven by body image, weight, or a desire to be smaller.

That said, we live in a world saturated with diet culture. Some people with ARFID may still develop body image concerns over time or experience overlap with other forms of disordered eating. That overlap is real and complex, and it’s one of the reasons careful, thoughtful assessment matters.

At its core, ARFID involves avoidance or restriction of food that is driven by:

• Sensory distress related to texture, smell, taste, temperature, or appearance.

• Fear-based responses following experiences such as choking, vomiting, allergic reactions, or illness.

• A very low drive to eat, where food feels effortful or unmotivating.

• Differences in how internal body signals like hunger, fullness, or discomfort are experienced.

  
  

The following description from one of my 14-year-old clients can sound extreme for some, but it reflects how real and intense sensory distress can be for some children with ARFID. 

“What you see as rice, I see as worms. Even when I know logically that it isn’t, my body doesn’t agree. And I can’t get myself to eat it.”

This quote captures something important.

ARFID isn’t about stubbornness, defiance, or lack of effort. It’s about the nervous system and sensory processing system responding in ways that make eating genuinely hard or impossible, even when a child wants to eat.

A note for clinicians (and curious parents)

ARFID makes up a significant proportion of eating disorder presentations in childhood, and it often co-occurs with neurodivergent profiles such as anxiety, autism, ADHD, or OCD.

At the same time, not all neurodivergent people experience eating difficulties, and not everyone with ARFID is neurodivergent.

As health professionals, taking time to understand the broader picture — including genetics, family context, and co-occurring factors such as sensory processing differences, neurodivergence, or anxiety — helps ensure support is matched to the child, rather than defaulting to a one-size-fits-all approach.

How ARFID shows up in real life

Even with validated screening tools for ARFID, it’s important to remember that ARFID can look very different from one child to the next.

For some families, eating has always felt hard. For others, difficulties emerge after illness or a frightening experience. And for many, it comes and goes, easier in some phases, heavier in others.

In everyday life, this can look like a child who:

• Frequently says they are “not hungry,” particularly when feeling overwhelmed, overstimulated, or anxious.

• Struggles to eat in busy, unpredictable, or unfamiliar environments such as school canteens, restaurants, birthday parties, friends’ homes, or while travelling.

• Needs large quantities of familiar foods packed when away from home.

• Needs repeated reassurance that food is safe, clean, uncontaminated, and/or won’t cause choking or vomiting.

• Shows significant distress around mealtimes, including difficulty coming to the table or staying there, shutting down, losing posture, hiding, or attempting to “escape”.

• Eats a very small quantity and/or range of foods.

• Relies heavily on the same familiar or “safe” options.

• At times, can eat large amounts of safe foods, or appear to lose control when access finally feels predictable and safe.

• Notices even small changes in brand, product, or preparation and refuses the food as a result.

• Finds it impossible to eat foods that look, smell, or taste different from what was expected, even if they are usually accepted.

• Eats very slowly, takes very small bites, and chews for a long time, with meals often stretching close to an hour and rarely progressing without active adult support.

• Gags or vomits when forced to eat foods they find aversive, or will not eat at all, regardless of pressure or consequences.

  
  

For these children, the issue isn’t preference alone. It’s the sensory mismatch, fear response, or overload that makes eating feel impossible in that moment.

If you’d like to hear directly from someone with lived experience, this blog post by Dani Shapira (he/they) on the RDs for Neurodiversity blog offers a thoughtful and generous account of living with ARFID, shaped by their Singaporean heritage.

Is this picky eating, ARFID, or something in between?

If some of the patterns above sound familiar, it may be worth speaking with a health professional who understands feeding differences to explore what’s going on and whether a diagnosis such as ARFID is appropriate.

And if it doesn’t quite fit? Support can still help.

When eating doesn’t get easier with time, becomes increasingly restrictive, or is driven by significant sensory distress, fear, or very low interest in food, something important is being missed if we simply call it picky eating. In these situations, eating often interferes with daily life, relies on rigid routines or preparation, and may require further medical screenings and nutritional supplementation to meet needs.

These patterns tend not to respond to pressure, rewards, or “they’ll eat when they’re hungry” approaches — and can worsen with them.

And when we call it picky eating, we miss so much of what parents are telling us.

We miss the distress behind the behaviour.

We miss how much effort it takes for that child to eat.

We miss the impact on family life, relationships, and a child’s sense of safety around food.

We may miss underlying medical conditions that cause pain and discomfort around eating. And we miss opportunities for earlier, gentler support that could reduce stress for everyone involved.

Many families don’t meet the diagnostic criteria for an eating disorder like ARFID, but eating is still fragile, sensory-driven, highly context-dependent, and hard to sustain without significant effort.

In those in-between spaces, waiting and hoping often isn’t neutral. It can cause harm.

Without guidance, families may unintentionally increase pressure, reinforce rigid patterns, miss nutritional gaps or medical concerns, or carry far more worry than they should have to.

What matters most isn’t the label. It’s whether families have a framework for understanding what they’re seeing — and permission to seek support when they don't know how to approach their child's eating behaviours.

At this point, it is important to mention that many people with ARFID go on to live happy, meaningful, and fulfilling lives.

The goal of support is not to “fix” or cure ARFID. For many, it’s about reducing distress, supporting adequate nourishment, and finding ways to live well — with food, and with themselves.

My child hasn't lost weight or isn’t underweight — can they still have ARFID?

This is one of the most common questions parents ask me.

Yes, weight loss or poor growth is included in the diagnostic criteria for ARFID, and it should always be considered as part of a careful clinical assessment.

But in real-life practice, it’s not the most common presentation we see.

Many children, teens, and even adults with ARFID track along their growth curve, maintain their weight, or live in higher-weight bodies. What stands out far more often isn’t weight change — it’s how much effort, distress, and restriction sit around eating.

This is one of the reasons ARFID can be missed or minimised for so long. When weight appears “fine,” families are often reassured that there’s nothing to worry about, even as eating becomes increasingly hard to manage day to day.

It’s also important to say that nutritional risk is not a given.

Research findings are mixed. Some studies show nutrient inadequacies in highly restricted diets, while others find no clinically meaningful differences. This reinforces the importance of individualised nutritional assessment rather than relying solely on one measurement.

The point isn’t that weight or nutrition don’t matter. It’s that weight and checklists alone don’t tell the whole story.

When support is delayed until a child is “sick enough”, we risk missing earlier opportunities to reduce distress, ensure nutritional adequacy, and support a child’s relationship with food — long before things reach crisis point.

If this sounds familiar

If this article has left you thinking, “Something here feels familiar,” that doesn’t mean something is wrong with your child, or that they suddenly need a diagnosis.

Often, it simply means you’ve found language for something you’ve been living with for a long time.

My hope is that this piece has offered space to reflect and a new vocabulary to work with. Words you might use when talking with a partner, family member, teacher, or health professional. Words that help you describe what you’re noticing in your child more clearly.

You’re very welcome to share it if it helps explain your experience.

You don’t have to wait until eating becomes a crisis to ask questions or seek support. Early, thoughtful guidance can reduce stress, protect your child’s relationship with food, and support the parent–child relationship along the way.

And if you’d like to talk things through — without alarm, labels, or pressure — you’re welcome to book an initial assessment. We can gently explore whether what you’re noticing fits within typical picky eating, ARFID, or that very real in-between space where support can make things feel lighter. And clarify what your next steps could be.

Noticing, questioning, and seeking understanding is not overreacting — it’s being a parent.

Thank you for being here.