Picky Eaters vs. PFD vs. ARFID: Differential Diagnosis Decision Tree

April 29, 2021 4:00 pm

A challenge faced by all pediatric practitioners is in determining when a family can be reassured about their child's feeding, eating and/or growth issues versus when a child should be flagged for close monitoring, and when a child needs to be sent on for more in-depth evaluation and intervention. It is imperative that physicians, mental health providers and rehabilitation therapists, as well as other professionals working with children, have tools that can help them to identify early, which child and family would most benefit from a Feeding and/or Eating Assessment. This talk will review the most recent research that has now allowed us to operationally define what a Picky Eater is, as well as review the diagnostic criteria for Pediatric Feeding Disorder and Avoidant Restrictive Food Intake Disorder, laying a foundation for a Differential Diagnosis Decision Tree. The questions within the Decision Tree will be examined with regard to how those questions guide the Clinician to a differential diagnosis. The Differential Diagnosis Decision Tree will then be applied to Case Studies to achieve accurate diagnosis. Global recommendations for intervention will be given for each type of diagnosis.

Learning Objectives:

By the end of this session, attendees will be able to:

  • Define the characteristics of a “picky eater” as different from either PFD or ARFID
  • Evaluate the validity of the criteria for ARFID
  • Identify critical components of a Differential Diagnosis Decision Tree for Picky Eaters vs PFD vs ARFID


  • Kay A. Toomey, Ph.D.

    Dr. Kay A. Toomey is a Pediatric Psychologist who has worked with children who don’t eat for almost 35 years. She has developed the SOS Approach to Feeding as a family centered program for assessing and treating children with feeding problems. Dr. Toomey speaks nationally and internationally about her approach. She also acts as a consultant to Gerber Products. Dr. Toomey helped to form The Children’s Hospital – Denver’s Pediatric Oral Feeding Clinic, as well as the Rose Medical Center’s Pediatric Feeding Center. Dr. Toomey co-chaired the Pediatric Therapy Services Department at Rose Medical Center prior to entering private practice. Dr. Toomey acted as the Clinical Director for Toomey & Associates, Inc.’s Feeding Clinic for six years and SOS Feeding Solutions @ STAR for eight years. Dr. Toomey is currently the President of Toomey & Associates, Inc., and acts as a Clinical Consultant to the Feeding Clinic at STAR Institute.

    Financial Disclosures: Receives a salary from Toomey & Associates, Inc.; is receiving an honorarium from Feeding Matters for CE session at the 2021 International Pediatric Feeding Disorder Conference; receives a consulting fee from Nestec

    Non-financial Disclosures: Serves as a founding medical professional council member with Feeding Matters; serves as a member of the PFD Alliance with Feeding Matters.

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