Avoidant Restrictive Food Intake Disorder (ARFID)

As part of our Comprehensive Eating Disorders Program at Stanford Medicine Children’s Health, we provide specialized treatment for children, adolescents, and young adults ages 9 to 24 with avoidant restrictive food intake disorder (ARFID). Youth with ARFID struggle to eat the amount or variety of foods they need to grow and develop. Our program recognizes the unique needs of young people with ARFID and is one of the few programs in the country that have developed a care program specifically designed to care for individuals with ARFID who are medically unstable.

When your child or young adult comes to us for care, they will be seen by a multispecialty team of caregivers, including an adolescent medicine provider, a psychiatrist or psychologist, a dietitian, and possibly an occupational therapist. This team works together to compassionately tailor care to fit your child’s unique needs, empowering them to develop improved eating habits and overcome ARFID.

About ARFID

With ARFID, the overriding question is, “Why is my child not eating enough?” Understanding how ARFID comes about is key to treating it. While ARFID is similar to anorexia, it has marked differences. Both involve limiting food—amount and types—but for different reasons. With ARFID, there is no worry about body shape or size. Rather, there could be a lack of interest or appetite, sensory issues impacting food choices, or fear of discomfort or something bad happening if they eat. Anyone can be at risk for ARFID, but certain children are more susceptible to developing ARFID. The limiting of food can lead to weight loss, growth problems, and nutritional deficits. When extreme, your child may have serious health concerns that require hospital care.

ARFID subtypes

The latest research, and our own expertise, point to three subtypes of ARFID. We have developed a specific treatment approach for each:

Children and young adults who experience low-interest ARFID tend to have symptoms of a chronic low appetite and low hunger cues. These children can also have problems with the physical act of eating, developing habits of taking small bites or taking a long time to finish meals. Certain medications can contribute to a low interest in eating.

Individuals with this subtype may experience unpleasant sensations (taste, texture, smell, or appearance) with food while eating. They may also exhibit selective eating (only eating certain foods, such as a specific brand of chicken nuggets). These individuals may be labeled as picky eaters—those who are reluctant to try new foods or eat a variety of foods.

This subtype of children and young adults develops ARFID due to a specific anxiety or fear, which may have developed on its own or have been triggered by a traumatic event such as choking, vomiting, or an allergic reaction to food. Individuals with GI issues can also develop an aversion to eating due to nausea, and children with other health issues, such as sore throat, can develop a fear of swallowing.

What to expect when coming to us for care

At Stanford Children’s, we understand that eating disorders are both a medical and psychological concern that can greatly affect your child’s health and well-being. In fact, we are one of a few medically based eating disorders programs in the nation to treat both at once. When you bring your child, teen, or young adult to us, you can expect:

  • A multispecialty, in-depth evaluation. We bring together an adolescent medicine provider, a psychiatrist or psychologist, and a dietitian who specializes in ARFID to provide a thorough medical and psychological evaluation of your child. The evaluation includes tests to determine if their health is compromised, which helps us decide whether to enroll them in inpatient or outpatient care within our leading-edge Comprehensive Eating Disorders Program. The inpatient program comes with added medical support for your child, with dietitians ensuring nutritional and caloric support and occupational therapists with expertise in treating children with ARFID.
  • Individualized care plan. Once we understand your child’s type of ARFID, we create a customized plan for your child. We use innovative and research-driven therapy to achieve success. This includes parent- and family-based care that’s tailored to your child and your family’s needs. For example, our occupational therapist may eat with your child during an inpatient stay to develop strategies that work for them, our medical doctor creates a plan for improved health, and our psychiatrist or psychologist provides emotional support and specific coping skills. Our inpatient program also includes recreation therapy, relaxation groups, nutrition groups, process groups, and an in-hospital school to keep children on track with their school’s learning requirements. 
  • Occupational therapy. Having an occupational therapist (OT) working directly with your child is an exceptional benefit of our inpatient program. Our OT identifies barriers to eating and creates a step-by-step plan for improved eating that’s just right for your child.

About inpatient and outpatient care. Our inpatient care is provided at the Comprehensive Care Program, a Stanford Medicine Children’s Health unit located within El Camino Hospital, where we designed an entire unit exclusively for medically unstable adolescents and young adults with eating disorders—the only one of its kind in the Bay Area. It includes several spaces for various healing activities, such as individual and group therapy, recreation and relaxation groups, and a schoolroom and large outdoor patio. Rooms are equipped with pull-out beds for parents.

Our outpatient clinic is located in Sunnyvale, adjacent to El Camino Hospital. Inpatients may be followed by care in our outpatient clinic after discharge or continue care with a provider in their community. Our care approach centers around the family as the crucial support for their child’s recovery.