ARFID: Avoidant Restrictive Food Intake Disorder Staff Guide

Avoidant restrictive food intake disorder, usually shortened to ARFID, is an eating disorder that many care staff have never been trained to recognise. It was previously known as feeding disorder or selective eating disorder, and it is easily mistaken for fussy eating, a sensory preference or a behaviour problem. Because the person may be eating far too little, or too narrow a range of foods, to stay well, spotting it early matters. This guide, based on NHS information, explains what ARFID is, how it differs from other eating disorders, and what practical steps care and support staff can take. If you support people with a learning disability or autism, our guide to Oliver McGowan mandatory training covers the wider communication and reasonable-adjustment skills that apply here too.

What is ARFID?

NHS child and adolescent mental health service information describes ARFID as an eating disorder in which a person avoids certain foods, limits how much they eat, or both. The key difference from anorexia nervosa or bulimia nervosa is that the restriction is not driven mainly by concern about body weight or shape. Instead, the person may avoid food for other reasons, and those reasons can look very different from one person to the next.

That distinction matters in practice. A person with ARFID may say clearly that they want to eat more, or that they are not worried about their weight at all, and still be unable to eat enough. Telling them to "just try it" or to "think about their health" rarely helps and can increase distress around mealtimes.

Common ways ARFID shows up

The NHS describes several common presentations, and a person may have more than one:

• Sensory sensitivity: avoiding foods because of their texture, smell, taste, temperature or appearance, so that the range of accepted foods becomes very small.
• Fear of a bad consequence: avoiding food because of a fear of choking or vomiting, often after an unpleasant experience with eating.
• Low appetite or little interest in food: forgetting to eat, feeling full very quickly or simply not seeming interested in meals.

Because the fear of choking can be a real driver, it is worth knowing how it overlaps with swallowing problems. Our guide to dysphagia and choking risk explains when difficulty eating may have a physical cause that needs a speech and language therapy assessment rather than, or as well as, mental health support.

Who is more likely to be affected?

NHS information notes that ARFID is more common in children who have a learning difficulty, ADHD or autism. Many people with these conditions are supported by care staff for years, so you may be well placed to notice a pattern. Our guide to ADHD in adults and NICE NG87 explains how attention and sensory differences can affect daily routines, including eating. Most of the NHS material available on ARFID is written with children and young people in mind, so if you support an adult, the person's GP is the right starting point for working out who should coordinate their care.

Signs that staff may notice

ARFID is not always obvious, particularly where a person has always been described as a "picky eater". Signs that may be worth recording and raising include:

• a very limited list of foods that the person will accept, which may be getting shorter over time
• refusing whole food groups, or foods of a particular texture, colour or brand
• distress, gagging or panic at mealtimes or when new food is offered
• eating very slowly or very small amounts, or regularly leaving meals unfinished
• weight loss, tiredness, dizziness, feeling cold or other signs of poor nutrition
• avoiding meals with other people, or becoming anxious about eating away from familiar places

None of these signs on their own proves that someone has ARFID. They are reasons to look more closely and to ask a clinician to assess.

Practical support for care staff

The following steps are general good practice rather than a treatment plan, and they should always be agreed with the person's clinical team.

• Record what is eaten and drunk. A simple, factual food and fluid record gives clinicians much better information than a general impression. Record refusals and distress as well as what was eaten.
• Keep mealtimes calm and predictable. Avoid pressure, bribery, force or comments on how much has been eaten. Pressure can make fear of food worse.
• Respect sensory needs. Find out which foods, textures and presentations the person can manage, and make sure those are available. Ask the person, or those who know them well, what helps.
• Use communication that suits the person. Visual choices, simple language and consistent routines can reduce anxiety for people with a learning disability or autism.
• Do not make changes alone. Introducing new foods, or removing familiar ones, should be planned with the person and their dietitian or clinician.

When to get help

NHS information advises seeking urgent help if a child or young person is losing weight quickly over more than a few weeks. In a care setting, a sensible approach is to ask the GP for a prompt review whenever food intake is clearly falling, weight is dropping, or the person seems physically unwell. Call NHS 111 for urgent advice, and 999 in an emergency such as collapse, severe breathlessness or signs of choking. Follow your organisation's policy on escalation and make sure any concern is recorded and handed over to the next shift.

How ARFID is supported

NHS CAMHS information explains that support for children and young people with ARFID comes through the child and adolescent mental health service, and that dietitians have an important part to play. The British Dietetic Association and the eating disorders charity Beat are both signposted as sources of further information. For adults, support is usually arranged through the GP, a community mental health team or an eating disorder service, depending on local arrangements. Care staff are not expected to diagnose or treat ARFID, but their observations can make a real difference to how quickly someone is seen.

Frequently asked questions

Is ARFID the same as fussy eating?

No. Many children are fussy eaters and grow out of it. ARFID involves restriction that is significant enough to affect health, growth, nutrition or daily life.

Is ARFID the same as anorexia?

No. People with ARFID are generally less concerned about body weight or shape. The two conditions can look similar from the outside, which is why a proper assessment is important.

Can I make someone eat?

No. Forcing or pressuring a person to eat is not appropriate and can make things worse. If you are worried about someone's intake, escalate to their clinical team and follow the care plan.

Where can staff and families find more information?

The NHS website, the British Dietetic Association and Beat all have information on eating difficulties. Staff can also build their knowledge through the health and social care learning available through Learnsignal CPD.

This article is general information for care staff, based on NHS information, and does not replace the advice of a person's own clinicians. If you are worried about someone's health right now, contact their GP, NHS 111 or, in an emergency, call 999.