Avoidant/Restrictive Food Intake Disorder

On the basis of consensus, avoidant/restrictive food intake disorder (ARFID) is an eating disorder diagnosis introduced in 2013 in the Feeding and Eating Disorders section of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. (1) • On the basis of consensus, children and adolescents with a diagnosis of ARFID have a disturbance in eating or feeding pattern without a fear of weight gain or body dysmorphia, which are characteristic of other eating disorders, such as anorexia nervosa, that leads to decreased food intake and persistent failure to meet appropriate energy/nutritional needs and/or psychosocial impairment. (1) • On the basis of consensus, the feeding and eating disturbances in ARFID are not related to religious or cultural practices or lack of availability of food. (1) The feeding disturbance is not due to another eating disorder such as anorexia nervosa and is not due to other psychiatric or medical conditions. (1)(17) • On the basis of evidence, children and adolescents with ARFID have a feeding disturbance that could be due to avoidant restrictive eating related to fear of consequences (such as choking, vomiting, and nausea), sensory issues (eg, related to smell, taste, texture), or low appetite/disinterest in food. (1)(8)(9)(26) • On the basis of evidence, patients with ARFID are more likely to be male, to be in a younger age group (4-11 years), and to have a longer duration of illness compared with those with other eating disorders, such as anorexia nervosa or bulimia nervosa. (8)(9)(14)(15)(16) • On the basis of evidence, children and adolescents with a diagnosis of ARFID can have associated comorbid neurocognitive disorders, particularly autism spectrum disorder, anxiety disorder, and attention-deficit/ hyperactivity disorder. (8)(9) • On the basis of recent case reports, patients diagnosed as having ARFID benefit from a multidisciplinary team approach (if available), including physicians, psychologists, dietitians, speech-language pathologists, and occupational therapists. (21) • On the basis of recent case reports, children and adolescents with a diagnosis of ARFID can benefit from psychotherapy such as family-based treatment, cognitive behavior therapy, and individual therapy. (27)(31)(33) • On the basis of evidence, children and adolescents with a diagnosis of ARFID may be medically compromised similar to patients with other eating disorders, requiring medical stabilization, enteral feeding, and nutritional supplements. (16) • Research on pharmacotherapy for patients with ARFID is currently lacking. Based on recent case reports, patients diagnosed as having ARFID may benefit from pharmacotherapy such as antianxiety medicines such as selective serotonin reuptake inhibitors and/or low-dose antipsychotics such as olanzapine, which has shown to improve weight gain in patients with ARFID. © 2020 American Academy of Pediatrics. All rights reserved.