This page is for families and carers who have children struggling with their eating. This may be more simple fussy eating behaviours or it may be more complex feeding difficulties and ARFID (Avoidant Restrictive Food Intake Disorder)

child scrunching her nose

These are two entirely separate conditions. The table below will help you understand where your child is currently sitting.

How we manage fussy and complex eating is different too. Strategies we use for fussy eating don't work for more complex feeding problems.

Eating Behaviors

Fussy Eating Behaviors

 Complex Feeding Difficulties
Generally able to maintain weight

May have sudden &/or significant weight loss. Could be due to sensory issues &/or aversions to food

Usually maintain their growth

Often fail to thrive and drop through the centiles 

Usually eat enough variety and volume of foods to meet their requirements

May be reliant on feeding tubes or supplements to meet nutrition requirements

Feel little or no distress about food in social situations

May interfere with social interactions and may feel intense anxiety around food and meals 

Do not limit intake due to fears

Can be triggered by a specific event or fear, such as a fear of vomiting or choking. 

Often feel hungry, are interested in eating the foods they enjoy and do not have an overall lack of interest in food and eating.  Won't starve themselves

Often show a lack of interest in food or eating. Will starve themselves.

Eat more than 30 different foods

Eat less than 20 foods - potentially a lot less

Fussy eating

Fussy eating behaviours are often something that has developed over a period of time and families can feel very stuck. For many children fussy eating is a normal developmental stage that they pass through. Some children can get stuck in this stage. It can often develop around 18months but can also happen later in life.

Sometimes fussy eating is associated with other medical conditions, such as constipation and anaemia. These need to be assessed and managed by your GP or Paediatrician before you will be able to make any significant changes to their diet.

The following resources offer lots of practical advice and tips on addressing your child's eating and moving them forward:

Complex feeding

Complex feeding difficulties and avoidant/restrictive food intake disorder (ARFID) are characterised by the person:

  • Avoiding certain foods, whole food groups or types of food
  • Having restricted intake in terms of overall amount eaten
  • Or both.

Someone might be avoiding and/or restricting their intake for a number of different reasons. The most common are the following: 

  • Sensitivity relating to the taste, texture, smell, colour, temperature or appearance of certain  foods. This can lead to sensory-based avoidance or restriction of intake.
  • They may have had a distressing experience with food, such as choking, vomiting, symptoms from food allergies or abdominal pain. This leads to feelings of fear and anxiety around food or eating, resulting in them avoiding certain foods or textures. Some people may experience more general worries about eating that they find hard to put into words and restrict their intake to what they regard as 'safe' foods. 
  • In some cases, the person may not recognise that they are hungry, or they may generally have a poor appetite. For them, eating might seem a chore and not something that is enjoyed, resulting in them struggling to eat enough. Such people may have restricted intake because of low interest in eating. 

It is very important to recognise that you can have one or more of these reasons behind avoidance or restriction of food at any one time. This means that complex feeding and ARFID might look quite different from one person to the next.

The information below should help you understand the complex feeding situation you are managing and give strategies and practical advice to help manage this.

Online Courses, Self-Help Programmes & Webinars

 

Support Groups

Assessment Tools

  • ARFID self assessment tools - click on the link which takes you to the Maudsley Centre for Child and Adolescent Eating Disorders website, then scroll down to assessments, Short ARFID Screen - Self (SAS-S) and Short ARFID Screen - Parent/carer (SAS-P).

Sensory Support

Nutritional Information

PFD_TS088 Encouraging Your Child to Explore New Foods V1

Written Information

Books

  • The Fussy Eater's Guide to Exploring Food: a book for children, by Alison Butterworth OT and Samantha Sargent Dietitian and Kay Toomey Psychologist
  • ARFID Avoidant Restrictive Food Intake Disorder: A guide for parents & carers, by Rachel Bryant-Waugh 
  • Food refusal and avoidant eating in children, including those with autistic spectrum conditions: a practical guide for parents and professionals  by Gillian Harris
  • Helping your child with extreme picky eating, by Katja Rowell & Jenny McGlothlin 
  • The picky eaters recovery book, by Jennifer Thomas 
  • Can't eat, won't eat, by Brenda Legge.

Charity and Non-profit Organisations