ARFID: Why Nutrition May Need to Come Before Food Variety

When parents come to see me about ARFID, one of their biggest concerns is often food variety.

“My child only eats a handful of foods.”

“They won't eat vegetables.”

“They've dropped another food they used to eat.”

“How can we get them to try something new?”

These are completely understandable concerns. Variety is important, and helping a child or young person gradually feel more comfortable with different foods can certainly be part of ARFID treatment.

But sometimes, variety isn't where we need to start.

Sometimes the first question needs to be:

Are they getting enough nutrition from the foods they can currently manage?

Adequacy before variety

ARFID (Avoidant/Restrictive Food Intake Disorder) can affect both the amount and range of food someone eats.

Some children and young people may have a reasonable number of foods but struggle to eat enough of them. Others may eat enough overall but have a very limited range. And some struggle with both.

This means ARFID treatment needs to be individualised.

Before focusing heavily on introducing new foods, I often want to understand:

• Is the child or young person eating regularly throughout the day?

• Are they getting enough energy to support growth, development, learning and activity?

• Are there nutritional gaps, such as iron, calcium, vitamin D, protein, fibre or essential fats?

• Are they losing weight or not growing as expected?

• Are meals taking a very long time?

• Is anxiety making it difficult for them to eat enough?

• Are sensory sensitivities, fear of choking or vomiting, or low interest in food contributing to their intake?

If nutritional intake is inadequate, supporting the body may need to be the first priority.

Safe foods are still food

Parents can understandably worry that continuing to offer preferred or “safe” foods will reinforce limited eating.

But for someone with ARFID, safe foods can be incredibly important.

If a child is already struggling to eat enough, taking away accepted foods in the hope that hunger will encourage them to eat something new can increase anxiety and may result in them simply eating less.

Instead, we may initially look at how we can get more nutrition from foods they already feel comfortable eating.

For example, this might mean increasing the portion of an accepted food, adding an accepted side or drink, choosing a more energy-dense version, or using fortified foods or nutritional supplements when appropriate.

A child doesn't necessarily need to eat a completely different diet before we can start improving their nutrition.

What about trying new foods?

This doesn't mean we forget about variety.

It means we consider when and how we work on it.

Imagine a child who is already finding every meal exhausting. They may be anxious, overwhelmed by smells or textures, struggling to recognise hunger, or frightened that they might choke or vomit. If every meal also becomes an opportunity to push a new food, eating can become even more stressful.

Sometimes we need to establish more safety and predictability around eating first.

Once nutritional intake is more stable, food exploration can happen gradually and without unnecessary pressure.

Progress might initially look like:

• having an unfamiliar food on the table

• tolerating it on their plate

• touching or smelling it

• helping prepare it

• trying a slightly different version of a familiar food

• eventually tasting it when they feel ready.

For a child with ARFID, these seemingly small steps can represent significant progress.

Nutrition doesn't have to be perfect

Parents are often carrying enormous worry about whether their child is eating a “healthy” diet.

If your child's accepted foods are currently crackers, cereal, yoghurt, pasta or a particular brand of chicken nuggets, you may understandably be thinking about everything they're not eating.

But sometimes we need to shift the focus from:

“How do I get them to eat a healthier variety?”

to:

“How can we make sure they're adequately nourished while we help them build confidence with food?”

We can work towards variety over time.

In the meantime, nutrition can often be supported creatively using accepted foods, fortification, appropriate supplements and a meal/snack structure that works for that child.

There is no single ARFID treatment plan

ARFID can look very different from one person to another.

A child with sensory sensitivities may need a different approach from a teenager who is frightened of choking. Someone who rarely experiences hunger may need different strategies again.

That's why treatment isn't simply about creating a list of foods a child “should” eat.

It's about understanding what is making eating difficult, ensuring nutritional needs are being supported, and gradually helping the person feel safer and more confident around food.

With ARFID, we don't have to choose between adequate nutrition and greater food variety. We may simply need to work on them in the right order.

Helen Dean is an Accredited Practising Dietitian, Registered Counsellor and Eating Disorder Clinician at Stepping Stones. Helen works with children, adolescents and adults experiencing ARFID, feeding difficulties, neurodivergent eating differences and eating disorders, with support available for parents and families.