Picky Eating, Sensory Aversion, or Something More? Understanding ARFID

Brenda Banks, OTR/L

Picky eating is a common concern for many parents. Most children go through phases of refusing certain foods or insisting on familiar favorites. But what happens when picky eating becomes extreme, persistent, or starts affecting a child’s health and daily life?

Pediatric occupational therapists often work with families navigating the complex world of feeding challenges. In some cases, what appears to be ”picky eating” may actually be rooted in sensory processing difficulties — and in others, it may meet the criteria for Avoidant/Restrictive Food Intake Disorder (ARFID).

Understanding the difference is key to getting your child the support they need.

Picky Eating vs. Feeding Challenges with a Sensory Basis

Typical picky eating is a normal part of development, especially in toddlers and preschoolers. It often includes:

• Preference for familiar foods

• Occasional refusal to try new things

• Phases of food jags (eating the same food repeatedly, then suddenly refusing it)

While this can be frustrating, most children eventually expand their diets with gentle exposure and time.

However, when picky eating is extreme, long-lasting, or causes distress, it may signal something more — particularly if it’s related to sensory aversion or ARFID.

What Is Sensory Aversion?

Some children have heightened or atypical sensory processing, which affects how they experience the world — including food.

They may react strongly to:

• Certain textures (e.g. mushy, crunchy, gritty)

• Specific smells or tastes

• Food temperatures

• The way food looks or feels in their mouths or on their hands

For these children, eating certain foods can feel physically unpleasant or even overwhelming — not just “icky” but actually aversive. This can lead to food refusal, anxiety at meals, or rigid food preferences.

Understanding ARFID

According to the National Eating Disorders Association, ARFID (Avoidant/Restrictive Food Intake Disorder) is an eating disorder that goes beyond typical picky eating. It’s characterized by an extreme avoidance or restriction of food intake that leads to:

• Significant weight loss, failure to gain weight appropriately, and stalled growth

• Nutritional deficiencies leading to increased medical issues

• Dependence on supplements or tube feeding

• Psychosocial Problems (e.g. interference with relationships, schooling, work, etc.)

Unlike other eating disorders, ARFID is not driven by body image concerns. Instead, it may stem from sensory sensitivities, a fear of choking or vomiting, or simply a lack of interest in eating.

Children with ARFID may:

• Eat fewer than 10–15 total foods

• Eliminate entire food groups

• Experience high anxiety around new foods or mealtimes

• Avoid social situations that involve food

ARFID can appear in young children, but it also affects school-age kids and teens —and often flies under the radar because it doesn’t always look like a “typical” eating disorder.

Red Flags for Parents to Watch For

So how do you know when picky eating is something more? Here are some red flags that may indicate a sensory-based feeding challenge or ARFID:

• Persistently eating a very limited number of foods (often fewer than 20)

• Strong reactions (gagging, crying, vomiting) to new or non-preferred foods

• Avoidance of entire food categories, like fruits, vegetables, or proteins

• Anxiety, distress, or meltdowns at mealtimes

• Refusal to eat in social settings or embarrassment about food choices

• Difficulty maintaining weight, growth, or nutritional status

• Family stress around meals and food preparation

• Signs of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy

• Reports of vague gastrointestinal issues (“upset stomach”, feels full, etc.) around mealtimes that have no known cause.

If these signs sound familiar, you’re not alone — and there are effective, supportive interventions that can help.

How Occupational Therapy Can Help

Occupational therapists play a key role in addressing pediatric feeding challenges. An

OT trained in feeding therapy will look at:

• Your child’s sensory processing patterns

• Oral motor skills (e.g. chewing, tongue movement)

• The mealtime environment

• Family routines and emotional dynamics around eating

Treatment is individualized and collaborative. OTs often work alongside speech- language pathologists, dietitians, physicians, and mental health professionals (i.e., psychiatrist, psychotherapist, licensed clinical social worker, etc.) to provide comprehensive care.

In therapy, we use play-based strategies to slowly and gently expand a child’s comfort with food through sensory exploration, graded exposure, and positive experiences — never pressure or force-feeding.

When to Seek Help

You don’t have to wait until things become a crisis to reach out. If you’re feeling concerned about your child’s eating — even if others have told you it’s “just a phase” — trust your instincts.

Consider seeking an occupational therapy evaluation if:

• Mealtimes are consistently stressful or emotional

• Your child has a restricted diet and is not expanding over time

• You’re worried about growth, nutrition, or social impacts

• You feel stuck and unsure how to help

Final Thoughts: You’re Not Alone

Feeding difficulties can be isolating, overwhelming, and full of conflicting advice. But with the right support, children can build a more positive and functional relationship with food — and families can find relief from daily mealtime battles. If you’re noticing persistent feeding challenges in your child, consider reaching out to an occupational therapist with experience in pediatric feeding. Early support can make a world of difference — for your child’s health and for your family’s peace of mind.