Avoidant Restrictive Food Intake Disorder (ARFID)

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Read the full CAHS clinical disclaimer.

Introduction

Avoidant Restrictive Food Intake Disorder (ARFID) is characterised by restrictive eating patterns that are not associated with concerns about body shape or size. ARFID can lead to significant nutritional deficiencies, weight loss, dependence on enteral feeding or oral nutritional supplements, and psychosocial impairment.

ARFID is defined by an eating disturbance leading to one or more of the following:

Significant weight loss or failure to achieve expected weight gain
Significant nutritional deficiency
Dependence on enteral feeding or oral nutritional supplements
Marked interference with psychosocial functioning

Pre-referral investigations

Blood tests to consider:

Full blood picture and film
Iron studies
Blood glucose
UEC
LFT
Calcium
Magnesium
Phosphate
Vitamin D
Active Vitamin B12
Folate
TFT’s
Coeliac serology

Additional tests to consider if food repertoire is limited:

Zinc
Vitamin A
Vitamin C
Vitamin K (coagulants)
Selenium
Copper
Vitamin E, Vitamin B1

Pre-referral management

Most children and young people with restrictive eating patterns can be managed safely in the community with a multidisciplinary approach, including:

General Practitioner (GP): Regular reviews to monitor physical and biochemical status.
Psychologist: Mental health support for the child and family
Dietitian: Advice on dietary intake and nutritional requirements

For children with concerning restrictive eating patterns about body shape or size:

Refer to the Eating Disorders pre-referral guidelines

For children without concerns about body shape or size:

If on an NDIS plan (including children with ASD), the plan should include dietetic and psychological support. If not included, families should contact their support co-ordinator or Local Area Coordinator (LAC) for reassessment
If not on an NDIS plan, a GP should arrange a Mental Health Care Plan for psychology access and a Chronic Disease Management Plan for a community-based dietitian and/or occupational therapist (OT)
Note: Cognitive Behavioural Therapy for Avoidant/Restrictive Food Intake Disorder (CBT-AR) is not recommended for children under 12 years.

When to refer

Refer to Perth Children’s Hospital General Paediatrics Department (or Adolescent Medicine Department if ≥12 years of age) if meet ARFID definition (p1) and:

The child has severe weight loss, nutritional deficiencies not responding to management in general practice, or dependence on enteral feeding.
Physiological instability (postural hypotension, bradycardia etc)
Community-based interventions have been unsuccessful.
Specialised paediatric dietetic services are needed.

How to refer

Routine non-urgent referrals from a GP or a Consultant are made via the Central Referral Service
Routine non-urgent referrals from private hospitals are made via the PCH Referral Office (Fax: 6456 0097 or email PCH.Referrals@health.wa.gov.au)
Urgent referrals (less than seven days) are made via the PCH Referral Office. Please call Perth Children’s Hospital Switch on 6456 2222 to discuss referral with the Paediatrician on-call if child is <12 years old. If ≥12 years please discuss with the Adolescent Medicine Consultant on-call.

Essential information to include in your referral

Serial growth measurements (plotted on growth chart for triage purposes) and nutritional assessment findings
Medical history, including any previous interventions.
Summary of pre-referral management efforts
Relevant blood test results as above
Reason for referral and urgency level

Additional supports

Some secondary hospitals such as Fiona Stanley and Midland Hospital have feeding team services. PCH dietetics and the Feeding Assessment and Support Team (FAST team) can support secondary hospital dieticians upon request.
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Private services specialising in ARFID:
1. The Swan Centre (Claremont, Busselton)
2. The Westerly Youth Clinic (Claremont, ages 10-24)
3. Esus (Subiaco)

Approved by:	General Paediatrics Department	Date:	July 2025
Endorsed by:	General Paediatrics Department	Date:	July 2025
		Review date:	July 2028

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