Implications of Avoidant/Restrictive Food Intake Disorder (ARFID) on Children with Feeding Problems

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) diagnosis, avoidant/restrictive food intake disorder (ARFID), has replaced the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnosis of feeding disorder of infancy and early childhood. The prevalence of 3 diagnostic criteria—significant weight loss or insufficient growth, dependence on enteral feeding or oral nutritional supplements, and nutritional deficiency—was examined in a sample of 422 children referred for feeding problems. Insufficient growth was found in 19.7% of the sample. Dependence on supplements included both children who were tube fed (16.8% of the sample) and who received oral supplements (37.7% of the sample). The nutritional deficiency, defined in this study as eating 10 or fewer foods monthly, was found in 21.5% of children. For the total sample, 63% met one or more of the 3 diagnostic criteria for ARFID examined. One exclusion for the diagnosis is that the eating disturbance not be attributed to a concurrent medical condition, which, in this sample, were present in 149 children. If all of these children were excluded, 133 children or 32% of the sample would meet the criteria for the diagnosis of ARFID. Implications of the diagnostic criteria for ARFID and the 3 exclusions were discussed for children with feeding problems.