Kids Eat in Color is committed to providing informative articles based on scientific evidence.
This article is fact-checked by our team of experts.
Our team strives to be objective, unbiased, honest about the information provided.
This article contains scientific references. Please view them below.
Created by experts, Kids Eat in Color is the leading resource for families seeking evidence-based information and strategies on child nutrition and feeding.
Author:
Samantha Garrido, MSNS
Coauthors:
Jennifer Anderson, MSPH, RDN
Share
+
Avoidant/Restrictive Food Intake Disorder (ARFID) is a feeding disorder that causes a child to eat a very limited range or amount of food. When a child eats a very limited diet, they may miss out on important nutrients that their body needs or not get enough energy. Over time, this limited intake can lead to malnutrition, an imbalance or deficiency in nutrients which can affect growth, energy levels and overall health.
How can ARFID lead to malnutrition?
ARFID involves a severe restriction in the amount or variety of food someone eats. When a child eats a very small amount of food, it becomes much harder for them to get the nutrients their body needs to grow and stay healthy.
In some cases of ARFID, children are eating so little food or not getting enough variety of foods, and it can affect what nutrients they are getting in their diet. Without the proper nutrients to keep the body healthy and running smoothly, severe cases of ARFID can lead to malnutrition, which should be treated appropriately and immediately.
Weight loss and poor growth in children with ARFID
Children need a certain amount of calories a day to grow and support normal development. When children don’t eat enough, they fall short of meeting their needs. This can cause them to experience weight loss as well as delays in expected growth or brain development.
Here are some signs that a child might not be eating enough:
Unintentional weight loss.
Falling off growth curves.
Failure to gain expected weight. (1)
Children may not gain weight or grow exactly as expected at every doctor’s visit; occasional changes are common. However, if your child’s weight or growth continues to remain below expected patterns over several visits, it may be helpful to talk with your pediatrician or another health professional. They can help determine whether your child may need extra support or treatment.
Common vitamin and mineral deficiencies in ARFID (2,3)
A limited diet in children with ARFID can increase the risk of vitamin and mineral deficiencies because important nutrients come from a variety of foods. When a child only eats a small group of “safe foods,” they may miss key nutrients that come from foods they do not eat such as fruits, vegetables or protein foods. Over time, these nutritional gaps can affect energy, immune health, growth and overall development.
Here are some common deficiencies and their effects seen in children with ARFID:
Iron: can lead to iron-deficiency anemia, slowed brain development.
Vitamin D & calcium: can lead to rickets, decreased bone strength.
Vitamin B12: can lead to fatigue, weakness, neurological dysfunction.
Zinc: can lead to poor skin & hair health, poor wound healing.
Protein intake: can lead to overall low energy and low muscle strength.
Along with the concerns mentioned above, here are some more general symptoms that you may notice with nutritional deficiencies:
Fatigue.
Pale skin.
Frequent illness.
Brittle hair or nails.
Delayed growth.
As these symptoms are very generic and can vary, it is important to keep track of any changes you may see in your child’s growth along with getting tested for any deficiencies to get a formal diagnosis for ARFID.
Nutritional supplements for ARFID
If you are concerned that your child may not be getting enough calories or nutrients that they need to support their growth, a nutritional supplement may be beneficial.
Supplements may be appropriate when food from a regular diet is not enough and/or to help resolve nutrient deficiencies.
Types of nutritional supplements commonly used are:
Keep in mind that while nutritional supplements can be beneficial to support any nutritional gaps found in children with ARFID, they should not replace food. Ideally they would only supplement your child’s diet.
Before starting any supplement, even a multivitamin, please make sure to consult with a pediatrician or health care provider to ensure it is an appropriate fit for your child. Some may have possible side effects or can even be dangerous to some children.
It is important to work with a health care provider to determine what nutrition supplements are appropriate for your child to take as they know the right doses that can be used safely to correct deficiencies.
High-calorie and nutrient dense foods
To help resolve nutritional deficiencies and support weight gain, serving higher calorie and nutrient-dense foods is recommended.
Some ways to increase calories without increasing volume is to add full-fat dairy or oils to meals and fortifying your child’s safe foods.
While malnutrition can be a serious concern for children with ARFID, early support can make a meaningful difference on preventing negative growth and health outcomes. If you’re concerned with your child’s growth, nutrient intake or eating habits, seeking guidance can help ensure they get the support they need to grow, develop and build a healthier relationship with food.
References
Kambanis, P. E., Kuhnle, M. C., Wons, O. B., Jo, J. H., Keshishian, A. C., Hauser, K., Becker, K. R., Franko, D. L., Misra, M., Micali, N., Lawson, E. A., Eddy, K. T., & Thomas, J. J. (2020). Prevalence and correlates of psychiatric comorbidities in children and adolescents with full and subthreshold avoidant/restrictive food intake disorder. The International journal of eating disorders, 53(2), 256–265. https://doi.org/10.1002/eat.23191
Del Campo C, Bouzas C, Tur JA. Risk Factors and Consequences of Food Neophobia and Pickiness in Children and Adolescents: A Systematic Review. Foods. 2024;14(1):69. Published 2024 Dec 30. doi:10.3390/foods14010069
James RM, O’Shea J, Micali N, Russell SJ, Hudson LD. Physical health complications in children and young people with avoidant restrictive food intake disorder (ARFID): a systematic review and meta-analysis. BMJ Paediatrics Open. 2024;8:e002595. https://doi.org/10.1136/bmjpo-2024-002595
About Kids Eat in Color
Created by experts, Kids Eat in Color is the leading resource for families seeking evidence-based information and strategies on child nutrition and feeding.
Samantha is a dietetic intern at Be Well Solutions with a masters in nutritional sciences from the University of Hawaii at Mano’a. Before that, she received her bachelor of science at San Jose State University for athletic training with a minor in nutrition. As a future Registered Dietitian, Samantha hopes to help people learn more about basic nutrition and how to lead a healthier but balanced lifestyle.
Related articles
Does ARFID Go Away? Understanding ARFID Recovery in Children
Avoidant/Restrictive Food Intake Disorder (ARFID) is a feeding disorder that causes a child to eat a very limited range or amount of food. When a child eats a very limited diet, they may miss out on important nutrients that their body needs or not get enough energy. Over time, this limited intake can lead to malnutrition, an imbalance or deficiency in nutrients which can affect growth, energy levels and overall health.
How can ARFID lead to malnutrition?
ARFID involves a severe restriction in the amount or variety of food someone eats. When a child eats a very small amount of food, it becomes much harder for them to get the nutrients their body needs to grow and stay healthy.
In some cases of ARFID, children are eating so little food or not getting enough variety of foods, and it can affect what nutrients they are getting in their diet. Without the proper nutrients to keep the body healthy and running smoothly, severe cases of ARFID can lead to malnutrition, which should be treated appropriately and immediately.
Weight loss and poor growth in children with ARFID
Children need a certain amount of calories a day to grow and support normal development. When children don’t eat enough, they fall short of meeting their needs. This can cause them to experience weight loss as well as delays in expected growth or brain development.
Here are some signs that a child might not be eating enough:
Children may not gain weight or grow exactly as expected at every doctor’s visit; occasional changes are common. However, if your child’s weight or growth continues to remain below expected patterns over several visits, it may be helpful to talk with your pediatrician or another health professional. They can help determine whether your child may need extra support or treatment.
Read more: Does My Child have ARFID?
Common vitamin and mineral deficiencies in ARFID (2,3)
A limited diet in children with ARFID can increase the risk of vitamin and mineral deficiencies because important nutrients come from a variety of foods. When a child only eats a small group of “safe foods,” they may miss key nutrients that come from foods they do not eat such as fruits, vegetables or protein foods. Over time, these nutritional gaps can affect energy, immune health, growth and overall development.
Here are some common deficiencies and their effects seen in children with ARFID:
Along with the concerns mentioned above, here are some more general symptoms that you may notice with nutritional deficiencies:
As these symptoms are very generic and can vary, it is important to keep track of any changes you may see in your child’s growth along with getting tested for any deficiencies to get a formal diagnosis for ARFID.
Nutritional supplements for ARFID
If you are concerned that your child may not be getting enough calories or nutrients that they need to support their growth, a nutritional supplement may be beneficial.
Supplements may be appropriate when food from a regular diet is not enough and/or to help resolve nutrient deficiencies.
Types of nutritional supplements commonly used are:
Keep in mind that while nutritional supplements can be beneficial to support any nutritional gaps found in children with ARFID, they should not replace food. Ideally they would only supplement your child’s diet.
Before starting any supplement, even a multivitamin, please make sure to consult with a pediatrician or health care provider to ensure it is an appropriate fit for your child. Some may have possible side effects or can even be dangerous to some children.
It is important to work with a health care provider to determine what nutrition supplements are appropriate for your child to take as they know the right doses that can be used safely to correct deficiencies.
High-calorie and nutrient dense foods
To help resolve nutritional deficiencies and support weight gain, serving higher calorie and nutrient-dense foods is recommended.
Some ways to increase calories without increasing volume is to add full-fat dairy or oils to meals and fortifying your child’s safe foods.
Learn more about how to feed your child with ARFID here.
While malnutrition can be a serious concern for children with ARFID, early support can make a meaningful difference on preventing negative growth and health outcomes. If you’re concerned with your child’s growth, nutrient intake or eating habits, seeking guidance can help ensure they get the support they need to grow, develop and build a healthier relationship with food.
References