This page is for families and carers who have children struggling with their eating. This may be more simple fussy eating behaviours or it may be more complex feeding difficulties and ARFID (Avoidant Restrictive Food Intake Disorder)
These are two entirely separate conditions. The table below will help you understand where your child is currently sitting.
How we manage fussy and complex eating is different too. Strategies we use for fussy eating don’t work for more complex feeding problems.
Fussy Eating Behaviors | Complex Feeding Difficulties |
| Generally able to maintain weight | May have sudden &/or significant weight loss. Could be due to sensory issues &/or aversions to food |
Usually maintain their growth | Often fail to thrive and drop through the centiles |
Usually eat enough variety and volume of foods to meet their requirements | May be reliant on feeding tubes or supplements to meet nutrition requirements |
Feel little or no distress about food in social situations | May interfere with social interactions and may feel intense anxiety around food and meals |
Do not limit intake due to fears | Can be triggered by a specific event or fear, such as a fear of vomiting or choking. |
Often feel hungry, are interested in eating the foods they enjoy and do not have an overall lack of interest in food and eating. Won’t starve themselves | Often show a lack of interest in food or eating. Will starve themselves. |
Eat more than 30 different foods | Eat less than 20 foods – potentially a lot less |
Fussy eating behaviours are often something that has developed over a period of time and families can feel very stuck. For many children fussy eating is a normal developmental stage that they pass through. Some children can get stuck in this stage. It can often develop around 18months but can also happen later in life.
Sometimes fussy eating is associated with other medical conditions, such as constipation and anaemia. These need to be assessed and managed by your GP or Paediatrician before you will be able to make any significant changes to their diet.
The following resources offer lots of practical advice and tips on addressing your child's eating and moving them forward:
Complex feeding difficulties and avoidant/restrictive food intake disorder (ARFID) are characterised by the person:
- Avoiding certain foods, whole food groups or types of food
- Having restricted intake in terms of overall amount eaten
- Or both.
Someone might be avoiding and/or restricting their intake for a number of different reasons. The most common are the following:
- Sensitivity relating to the taste, texture, smell, colour, temperature or appearance of certain foods. This can lead to sensory-based avoidance or restriction of intake.
- They may have had a distressing experience with food, such as choking, vomiting, symptoms from food allergies or abdominal pain. This leads to feelings of fear and anxiety around food or eating, resulting in them avoiding certain foods or textures. Some people may experience more general worries about eating that they find hard to put into words and restrict their intake to what they regard as ‘safe’ foods.
- In some cases, the person may not recognise that they are hungry, or they may generally have a poor appetite. For them, eating might seem a chore and not something that is enjoyed, resulting in them struggling to eat enough. Such people may have restricted intake because of low interest in eating.
It is very important to recognise that you can have one or more of these reasons behind avoidance or restriction of food at any one time. This means that complex feeding and ARFID might look quite different from one person to the next.
The information below should help you understand the complex feeding situation you are managing and give strategies and practical advice to help manage this.
Online Courses, Self-Help Programmes & Webinars
- NHS Be body Positive - Self lead modules to improve your understanding of eating behaviours.
- South Yorkshire Eating Disorders Association (SYEDA) self-help guide
- BEAT ARFID Workshops
- Surrey Occupational Therapy Online Workshops from Children and Family Health Surrey
- Eating for Children with Sensory Difficulties - Webinars on Fussy Eating in Children
- The Feeding Trust Treatment & Training - *Please note there are costs involved with their services
Support Groups
- BEAT carer support group – 8 week programme
- BEAT Hummingbird patient support group (Online ARFID support group)
Assessment Tools
- ARFID self assessment tools - click on the link which takes you to the Maudsley Centre for Child and Adolescent Eating Disorders website, then scroll down to assessments, Short ARFID Screen – Self (SAS-S)
Sensory Support
- Sensory play toolkit – De Montfort University
- The National Autistic Society information on sensory differences
Nutritional Information
- British Dietetic Association fact sheet on Autism and Diet
- ARFID Awareness – Vitamin & Mineral Supplements
- Improving Your Childs Nutrition - Webinar on Fussy Eating in Children
- Improving nutrition for fussy eaters
- Helping children take vitamins and mineral supplements
- Simply Veg
Written Information
- The National Autistic Society guide for eating difficulties
- ARFID Awareness resources
- SLAM (South London & Maudsley) Eating Disorders Service
- PEACE (Pathway for Eating disorders and Autism developed from Clinical Experience
Books
- The Fussy Eater’s Guide to Exploring Food: a book for children, by Alison Butterworth OT and Samantha Sargent Dietitian and Kay Toomey Psychologist
- ARFID Avoidant Restrictive Food Intake Disorder: A guide for parents & carers, by Rachel Bryant-Waugh
- Food refusal and avoidant eating in children, including those with autistic spectrum conditions: a practical guide for parents and professionals by Gillian Harris
- Helping your child with extreme picky eating, by Katja Rowell & Jenny McGlothlin
- The picky eaters recovery book, by Jennifer Thomas
- Can't eat, won't eat, by Brenda Legge
Charity and Non-profit Organisations
- BEAT - The UK's Eating Disorder Charity
- National Autistic Society
- Be Body Positive