Children with ARFID may present with:

• Limited dietary variety or volume

• Nutritional deficiencies (e.g. iron, zinc, vitamins A and D)

• Growth faltering, weight loss or overweight or obesity

• Psychosocial impairment (e.g. anxiety around meals, social withdrawal)

Importantly, ARFID is not defined by weight status. Many children with ARFID are not underweight; some may even be overweight.1 This emphasises the need for comprehensive assessment beyond BMI alone.

Common dietary patterns include a preference for dry, beige foods (e.g. toast, crisps, biscuits), often brand specific, and strong aversions to mixed or “wet” foods like fruits and vegetables.2

Ideally, ARFID should be managed within a multi-disciplinary team. Involving the following professionals, if possible:

• Specialist dietitian

• Psychologist/therapist

• Paediatrician

• Occupational/ speech Therapist

Unfortunately, this is often not the case due to pressures on NHS services.

Specialist dietitians are central to assessment, diagnosis, and treatment. Their involvement improves outcomes, reduces treatment duration, and prevents deterioration. Dietitians must be embedded in multidisciplinary teams (MDTs) and adequately resourced.

A nutritional assessment should include:

• Growth history and anthropometric data (including centile tracking)

• Dietary intake analysis (e.g. food diaries, 24-hour recalls)

• Micronutrient screening (iron, vitamin D, zinc)

• Feeding behaviour history (sensory sensitivities, fear-based avoidance)

• Consideration of co-occurring conditions (e.g. autism, ADHD)

Effective management of ARFID requires dietitians to possess a unique blend of skills spanning both paediatric nutrition and mental health. Given the complexity of the disorder, dietitians working within CAMHS must be equipped with paediatric training to understand growth, development, and nutritional requirements, while paediatric dietitians must receive mental health training to navigate the psychological drivers of restrictive eating.

In addition, all dietitians involved in ARFID care should undertake specific training focused on the disorder itself, including its diagnostic criteria, behavioural presentations, and evidence-based interventions. This cross-speciality competence is essential for delivering safe, holistic care and for ensuring dietitians can contribute meaningfully within multidisciplinary teams. Investment in structured training pathways and ongoing professional development is critical to meet the growing demand and complexity of ARFID presentations.

Early nutritional assessment:

• Dietitians play a critical role in identifying nutritional deficiencies, growth concerns, and feeding risks early in the care pathway.

Individualised nutritional care plans:

• Plans should be tailored to the child’s specific presentation - whether sensory-based aversion, fear-based restriction, or low appetite.

• Consideration of safe foods, preferred textures, and gradual exposure is essential.

• Food exposure hierarchies.

  • Tools like the “Always, Sometimes, Never” list help categorise foods by comfort level. Gradual exposure to “Never” foods can be supported through desensitisation and behavioural techniques.

• Vitamins and minerals can be added to reverse deficiencies. In cases of severe restriction, oral nutritional supplements or enteral feeding may be necessary. These should be used judiciously to avoid reinforcing avoidance behaviours.2

• Children with sensory sensitivities may benefit from:

  • Texture modification

  • Visual presentation adjustments

  • Collaboration with occupational therapists for sensory integration

Multidisciplinary collaboration:

• Dietitians must work closely with psychologists, paediatricians, and speech and language therapists to ensure holistic care.

• Joint goal-setting and shared understanding of feeding challenges are key.

Support for families:

• Dietitians provide practical advice to parents/carers on managing mealtimes, reducing pressure, and improving food variety.

• Education around nutritional adequacy and safe supplementation may be needed.

• Family-Based Treatment (FBT) empowers parents to take control of feeding in early phases, gradually returning autonomy to the child. This approach is particularly effective when combined with dietetic and psychological input.3

Monitoring and review:

• Regular follow-up is essential to track progress, adjust interventions, and prevent nutritional deterioration.

• Growth monitoring and dietary intake analysis are part of ongoing care.

Cognitive Behavioural Therapy for ARFID (CBT-AR) and Family-Based Treatment for ARFID (FBT-ARFID) are increasingly supported in UK clinical settings. A recent UK-based paper from the Maudsley Centre outlines how CBT can be adapted for children with ARFID, especially those with fear-based avoidance3. While NICE guidelines for ARFID in children are still in development, multidisciplinary care remains the gold standard.

CBT-AR is a structured, evidence-based psychological intervention designed specifically for individuals with Avoidant/Restrictive Food Intake Disorder. Unlike traditional CBT for eating disorders, CBT-AR targets the unique drivers of ARFID -such as sensory sensitivities, fear of aversive consequences (e.g. choking or vomiting), and low interest in eating.

The therapy is typically delivered in stages, beginning with psychoeducation and nutritional rehabilitation, followed by gradual exposure to feared or avoided foods using personalised hierarchies. In the UK, CBT-AR is increasingly being integrated into multidisciplinary care pathways, particularly in specialist eating disorder services and CAMHS teams. Early evidence suggests it can significantly improve dietary variety, reduce anxiety around food, and support healthy growth and development in children and adolescents.

FBT-ARFID is a structured therapeutic approach adapted from the well-established FBT model for anorexia nervosa. It empowers parents to take an active role in re-establishing healthy eating patterns, particularly during the early phases of treatment. In the context of ARFID, FBT focuses on addressing the specific drivers of food avoidance - such as sensory sensitivities, fear of aversive consequences, or low appetite - while also managing nutritional and psychosocial risks.

The treatment is delivered in stages, beginning with parental control over food intake and progressing toward increased autonomy for the child as eating behaviours improve. UK clinicians are increasingly integrating FBT-ARFID into multidisciplinary care pathways, especially within CAMHS and specialist eating disorder services. Early evidence suggests that FBT-ARFID can lead to improvements in dietary variety, reduced anxiety around food, and healthier growth outcomes.

Despite increasing recognition of ARFID as a serious and complex eating disorder, many healthcare services across the UK lack dedicated pathways to support affected children and young people. This gap often results in fragmented care, delayed diagnosis, and inconsistent management. To address this, it is essential that local services develop robust multidisciplinary team (MDT) pathways that include specialist dietitians with expertise in both paediatrics and mental health. These pathways should be clearly defined, adequately resourced, and integrated within existing CAMHS and paediatric frameworks. Commissioners and service leads must prioritise funding for dietetic time to ensure timely access to nutritional assessment and intervention, which is critical for preventing deterioration and improving outcomes. Without this investment, families may be left navigating unsupported systems, and children risk long-term physical and psychological harm due to untreated nutritional deficiencies and feeding difficulties.

1. FREQUENTLY ASKED QUESTIONS | ARFID Awareness UK

2. Avoidant and Restrictive Food Intake Disorder (ARFID) in hildren and ...

3. Cognitive behaviour therapy (CBT) as a psychological intervention in ...

4. Family-based treatment for Avoidant/Restrictive Food Intake Disorder.

5. BDA ARFID Position Statement