Could it be more than just “fussy eating”?

“My child is so picky! We’ve tried bribing, consequences, rewards. Even if we don’t let them leave the table for hours, they still refuse to eat what I have cooked. I don’t know what to do.”

It can be exhausting, frustrating, and worrying as a parent.

If your child refuses foods that seem common to others you may have brushed it off as picky eating - that they are ‘fussy’ and being ‘difficult’. But sometimes picky eating is not a phase - it could be a sign of something called ARFID which stands for Avoidant/Restrictive Food Intake Disorder.

ARFID is a relatively newly recognized eating disorder characterised by avoidance, aversions or restriction to foods and eating. It is not about fear of weight gain (although it can co-occur with anorexia/body image concerns or other eating disorder behaviours). It is not about being difficult or stubborn it is about genuine challenges with physical and psychological responses that your child experiences around food and mealtimes.

ARFID can present in three main ways.

1. Avoidant ARFID is when children avoid certain foods or eating environments due to sensory sensitivities e.g. texture, taste, smell, appearance or even sounds.

2. Aversive ARFID is driven by fear of adverse outcomes like choking vomiting allergic reactions or gastrointestinal discomfort, from previous experiences or anticipated as a result of similar foods/textures creating the same challenge previously.

3. Restrictive ARFID is when a child shows low interest in eating due to poor appetite, hunger cues, early fullness or even simply forgetting to eat.

Some children may show characteristics of more than one subtype and every experience is unique. ARFID can affect people of all ages from children to adults and often occurs alongside conditions such as Autism, ADHD, OCD, emetophobia, sensory processing differences, PTSD, anxiety and depression.

If your child consistently refuses entire categories of food avoids foods due to sensory sensitivities, becomes highly anxious around mealtimes, experiences physical or emotional stress when pressured to eat, or shows signs of nutritional deficiencies - it is worth exploring the possibility of ARFID with a qualified healthcare professional. It is important to work with a neurodiversity affirming healthcare professional who bases interventions on understanding and supporting the child’s needs rather than using behaviorist strategies focused on controlling behavior.

It is important to be mindful of people who suggest using rewards and consequences to get your child to eat or who push exposure therapy without considering your child’s experience. For children with ARFID, this approach can, and most likely will, backfire. It often encourages fawning where the child gives in to adult demands to avoid conflict or punishment, ignoring their own body signals and needs in the process. Over time this teaches them that compliance is more important than listening to themselves, increasing anxiety around food and mealtimes rather than reducing it.

ARFID is not about willpower.

Forcing or punishing a child into eating only reinforces fear and stress instead of creating safety and trust.

Imagine this you are at dinner and someone is insisting you eat something you have tried once before and had a negative experience with - for the sake of this let’s say it’s fresh oysters (something I absolutely cannot stomach). Maybe you gagged the first time or hated the texture so much that you physically recoiled. Now imagine that - every time that food is in front of you there is pressure, consequences or shame to just try it again.

Would you feel safe?

Would you want to eat it?

Would you feel trusting in the people around you?

Most likely no.

Chances are, your body and your brain would be telling you not to eat it. This is not defiance, this is a survival instinct, and the same reason we do not eat poisonous things. Our body recognises unsafe foods and gagging is a part of our body rejecting it. The same goes for an individual with ARFID, in their mind - the food has been deemed unsafe - whether it is from negative previous experiences or perhaps it just looks like something they will not like to eat (texture, smell, sight). We must learn to trust our child’s voice, they are the experts in their brain and body, because only they know what it is like to live in their body with their particular brain.

Language such as “don’t worry! just try it! you WILL like it” is telling a child how they will or should feel, which creates mistrust in listening to their own body cues and instead they are now basing how they feel on what an external person has said to them. With this mindset encouraged constantly, the child grows into an adult who trusts other’s voices more than their own. This can lead to higher risk of things like domestic violence, being the victims of assault and so on - because in their mind, even if something feels wrong, they have been taught to ignore the unsafe feeling and prioritise the wants or needs of someone else.

Let’s get back to the fresh oysters. I remember trying it and immediately regretting putting it in my mouth. The texture was what I imagine a raw egg mixed with seawater would be like, it also smelt like the ocean and not in a good way. I gagged and felt sick, swearing I would not go near that food again. Now imagine I live somewhere that fresh oysters is on the menu every second day and that I would be punished if I don’t eat it. This isn’t to say that all food aversions can be compared to fresh oysters, but it is to highlight that my body had a physical response to a food, it wasn’t ‘being dramatic’ or ‘being fussy’ - my brain and body responded in the best way that it could. Creating a physical and psychological response to ensure I would not eat it again.

That is exactly how children with ARFID feel every time they face a food that triggers sensory distress or fear. I have heard lived-experience individuals describe sensory processing being received into their brain and body in the same way that pain is. This means that non-preferred flavours and textures aren’t just yucky and uncomfortable, but can be physically painful to tolerate.

Pressuring a child or offering bribes may seem helpful in the short term but often leads to masking and fawning behaviours where the child complies outwardly but is extremely stressed internally.

This can create long term anxiety around food and a sense that their feelings do not matter. We do not want our children to think that compliance is more important than listening to their needs and self-advocacy.

Supporting a child with ARFID starts with validating their experience. Let them know that how they are feeling is real, that foods can feel overwhelming, scary or unpleasant and that although you might not relate - you are trying understand.

So what can you do?

Encourage your child to use words to describe textures and flavours so they can communicate what they like and dislike. Terms like crunchy, soft, salty, sweet, smooth or lumpy give them a way to express their experience with food, and this information allows you as a parent to adapt meals to match their sensory preferences. For example if they prefer crunchy and salty foods rather than soggy and salty, you can create meals that fit within those categories, making eating less stressful and more predictable.

Oral sensory input is not just about taste - it is closely linked to the brain’s regulation systems. Chewing, crunching, and exploring textures provide proprioceptive and tactile feedback that helps the nervous system feel grounded, supports emotional regulation, and can reduce anxiety. Avoid power struggles. Rewards, punishments or pressure often increase stress and reduce trust. Focus on creating safety, predictability and calm around mealtimes. Gradually introducing new foods in small voluntary ways where they are autonomous in this decision, without forcing or shaming - helps them feel safe.

Even being in the same room as a new food without eating it can be meaningful progress. Can they be part of the meal selection, preparation and cooking process? Can you watch food videos together to get excited about different foods they might want to try? This is also a great way to connect and re-wire their brain to learn that food can be enjoyable, not stressful.

Some children just want predictability, even a tiny change in your daily routine such as letting them know in the morning what dinner will be - has made a significant improvement to many of my clients. Sensory children thrive on predictability, they want to mentally prepare for their sensory experiences. Sometimes, a little bit of warning can make a huge difference in how the dinner turns out.

Access to safe foods is critical. Making sure children can always eat something they can tolerate whether at home or when out prevents malnutrition and reduces anxiety. Trying new foods should be a collaborative process, where the child feels autonomous and in control. This process should occur when they are not experiencing any external stressors, not during any contextual or situational factors such as changing classroom in the new year or moving house. For the best success, the child must be regulated and ready to trial new foods (within their safety confines - and please do not go straight to oysters!).

Accommodations to support the environment such as preparing foods in ways that reduce sensory stress or helping with grocery shopping can make a big difference. Building trusting relationships is also important children eat more comfortably when they are around people they feel safe with and when food is prepared by someone they trust.

Exploring coping skills such as fidgets, ice packs, deep breathing or other sensory supports can help regulate their body and make eating more accessible.

Distraction techniques can also be extremely useful for sensory aversions. Have you ever turned down the radio to focus better on reversing your car? That works both ways - if a child is focused on a screen or book (multi-sensory approach) they are not going to be as focused on the food they are eating, as their brain is welcoming multiple different forms of sensory stimuli into their processing system. Another example of this would be squeezing a stress ball or looking at a painting while getting an injection - when your brain is busy taking in another type of sensory input (stress ball/painting), the one you are avoiding is much more tolerable (injection).

Autonomy is key allowing children to make choices around what and when they eat helps restore control and reduces anxiety.

ARFID is not just about eating - it is about how the brain and body respond to fear and sensory input. I can assure you, this is not simply picky eating and children do not just grow out of ARFID. Some will struggle even if safe foods are available. Without affirming support - the impact on quality of life and nutrition can be significant.

Compassion patience and collaboration are critical. Focus on progress not perfection. Celebrate small wins such as tolerating new textures, sitting at the table calmly, or trying a single bite. If they are feeling brave enough to try one bite, do not push for two.

Don’t tell them you will buy them a new toy if they finish what is on their plate. Bribery and consequences only allow for short term wins and long term challenges. Collaboration and connection allow for sustainable success and improve body autonomy. Progress is about reducing fear and building confidence around food - not forcing children to eat every food on their plate.

Children with ARFID are doing the best they can in a world where eating feels unpredictable, threatening and a lot of the time overwhelming.

The goal is not compliance - it is safety, trust and gradual (sustainable!) progress.

By empathising validating and collaborating we help children rebuild a healthy relationship with food without fear, shame or pressure. With patience understanding access to safe foods and ARFID informed support, children can learn to feel safe around food and mealtimes again and develop more confidence and control over their eating.

Tracey-Leigh Edwards

Occupational Therapist

This resource is based on a combination of clinical research, neurodiversity-affirming approaches, and lived experience perspectives. Key sources include the work of Lauren Safari, ARFID Dietician (ARFID Basics), Dr. Vanessa Lapointe on co-regulation and child development, Dr. Ross Greene’s Collaborative and Proactive Solutions model, and current evidence on sensory processing, anxiety, and feeding challenges in neurodivergent children.