A guide for healthcare professionals and families
Understanding the complexities of pediatric feeding disorder (PFD) and avoidant/restrictive food intake disorder (ARFID) can be challenging for both healthcare professionals and families. At Feeding Matters, we are dedicated to helping you navigate these overlapping diagnoses with clarity and confidence. Our latest system-change initiative, “PFD and ARFID: Navigating the Overlap,” aims to bridge the gap between these two fields, improving health outcomes and better supporting patients, families, and professionals.
What Are PFD and ARFID?
Avoidant/restrictive food intake disorder (ARFID) was first recognized in 2013 as an expansion of the mental health diagnosis “Feeding Disorder of Infancy and Early Childhood” found in the DSM-IV. It is a feeding and eating disorder and mental health diagnosis that describes children and adults with feeding problems and related nutritional risks without medical issues or body image concerns. ARFID significantly overlaps with the diagnosis pediatric feeding disorder (PFD).
Pediatric feeding disorder (PFD) is a multidisciplinary diagnosis that is defined as impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. Both diagnoses exclude body image issues as a criterion.
The overlap between these two diagnoses, combined with the siloed fields of treatment and research, has caused confusion among healthcare professionals and families alike. Feeding Matters is committed to uniting the fields of eating disorders and feeding disorders to provide clearer guidance and support.
Latest Recommendations
When ARFID is diagnosed in young children, the standard of care should involve a detailed workup that considers the four domains of PFD to ensure that skill and/or medical factors are not contributing to the child’s feeding struggles. In this sense, it is possible, that a child may qualify for both diagnoses.
“If a patient has a diagnosis of ARFID, it may be worth reassessing from the pediatric feeding disorder (PFD) perspective to see if the cause of feeding difficulties might include a medical or skill dysfunction, and not be purely behavioral.”
-Dr. Richard Noel, Feeding Matters Volunteer Medical Director
Building Consensus and Advancing the Field
Feeding Matters was founded on the principle that families and professionals must work together to advance the field of pediatric feeding disorders. We have a long history of facilitating expert consensus and continuously assess the barriers affecting families and children with feeding and eating differences. While our efforts to create a shared identity through the PFD diagnosis have been successful, more work is needed to unite and advance the field, particularly where PFD and ARFID overlap.
- The Research Initiatives Task Force (RITF) launched in 2021 to begin looking into research challenges in the PFD field. The biggest barrier to care became the confusion and overlap of PFD and ARFID.
- The RITF authored and published the diagnostic criteria comparison infographic in January of 2022.
- In 2023, the RITF partnered with Emory University and Children’s Healthcare of Atlanta to bring together experts in ARFID and PFD to clarify the diagnostic criteria.
- Following the 2023 Consensus gathering, we assert that both the PFD and ARFID diagnoses can be assigned to children in the feeding developmental window. Experts in attendance agreed on the need for more support, better education, and an opportunity for both fields to collaborate.
- In 2024, we launched the inaugural 2024 Feeding and Eating Psychology Summit, a 3-hour educational event open to the public. This interactive webinar will not only provide valuable knowledge but also serve as a foundation for our next consensus effort. Participants will also engage in active discussions that will shape future initiatives.
- Following the Summit, the 2023 Consensus Committee, along with new experts, will reconvene to delve deeper into the overlapping needs of the ARFID and PFD communities, aiming to provide greater clarity and support for the field.
- Follow along for updates as we continue our consensus work.
Frequently asked questions about PFD and ARFID
Will PFD eventually replace ARFID?
No. Both diagnoses are necessary, especially since there is an ARFID presentation distinct from PFD. However, ongoing collaboration and research will help us distinguish each disorder as well as better understand the causes, accurate diagnoses, and treatment.
Who can treat each diagnosis?
Treatment for each diagnosis requires specialized education. Because of the overlap, providers in either field may encounter a child who qualifies for both diagnoses. If psychosocial dysfunction is the primary driver of feeding struggles, and feeding skill and medical issues seem resolved, treatment may focus on ARFID, but with an awareness of all PFD domains, especially during the feeding development window.
What happens when a child turns 18 and has not outgrown their PFD?
PFD that began in childhood can continue into adulthood, often leaving a psychosocial impact. At this point, the individual may qualify for an ARFID diagnosis.
Treatment will depend on the patient’s needs and preferences and whether they wish to address all domains of their PFD and ARFID.
The question of adult “Feeding Disorder” remains and needs more research.
If an older child or young adult presents with ARFID but has a history of feeding problems since birth, how should that be approached?
It is important to maintain an awareness of both diagnoses and frameworks, ensuring that all domains—feeding skill, medical, nutrition, and psychosocial—are considered. Providers and family members should discuss the patient’s feeding skills and medical issues, along with their goals, to determine the most appropriate treatment approach.
Is it appropriate to say that PFD can lead to ARFID?
Yes, PFD can contribute to the development of ARFID, which is why early identification of PFD is critical. However, ARFID can also develop independently. Ongoing research will continue to improve our understanding of the long-term impact of feeding difficulties in early childhood.
What do I do when I have no access to psychology or nutrition providers?
Unfortunately, access to specialized care remains a significant challenge for many families and healthcare professionals and we still have a long way to go to build a better educational pathway. It is crucial for providers to be transparent about their skillsets. Parents should ask questions to better understand what your provider’s education has been and what treatment is needed. Telehealth consultations and consultations with established programs can also be valuable alternatives.
Can a child have ARFID without PFD?
In young children, it is most likely PFD. However, if not identified early, it could develop into ARFID. In older children, it is possible to have ARFID without having PFD, but it is important to consider the feeding history of the child and all four domains of the PFD framework.
Follow Our Progress
Stay tuned for updates as we continue our consensus work and explore new avenues for supporting families and healthcare professionals navigating the overlap between PFD and ARFID.
International individuals and partners
While this work is starting in the United States, we would like to expand it internationally and support others who are trying to navigate the overlap of PFD & ARFID. We are actively working with others and reaching out to partners but if you are interested in this work with us, please email programs@feedingmatters.org.