Avoidant/Restrictive Food Intake Disorder in Children and Adolescents: Nutritional Risk, Diagnostic Boundaries, and Multidisciplinary Care—A Narrative Review

Abstract

Background/Objectives: Avoidant/restrictive food intake disorder (ARFID) involves restrictive or avoidant eating causing clinically significant nutritional, medical, developmental, or psychosocial consequences without being primarily driven by weight- or shape-related psychopathology. This review synthesizes evidence on diagnosis, risk assessment, and treatment of ARFID in children and adolescents aged 0–18 years. Methods: We conducted a clinically oriented narrative review informed by a targeted search of English-language publications (1 January 2015–30 June 2026) in PubMed/MEDLINE, Embase, and the Cochrane Library. Results: Nutritional deficiencies, growth faltering, pubertal disruption, and psychosocial impairment may occur across the weight spectrum. ARFID presents through overlapping patterns of limited interest in eating, sensory-based avoidance, and fear of aversive consequences. Assessment should integrate maintaining mechanisms, consequences, and alternative diagnoses. Nutritional rehabilitation and psychological intervention form the foundation of care, although controlled evidence remains limited. One randomized trial reported greater weight gain with family-based treatment than with individual psychoeducational motivational therapy in underweight children, without an overall between-group difference in ARFID symptom severity. Pharmacotherapy has no established efficacy and remains adjunctive. Conclusions: ARFID requires developmentally informed, multidisciplinary assessment and individualized treatment informed by clinical formulation. Prospective comparative studies are needed to clarify long-term outcomes and treatment selection.