NCLIP

Avoidant Restrictive Food Intake Disorder

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Avoidant Restrictive Food Intake Disorder

Key Points

  • ARFID is restrictive intake without primary fear of weight gain or body-shape distortion.
  • Common drivers include sensory sensitivity, anxiety, autism spectrum traits, and food-related adverse experiences.
  • Severe malnutrition can produce bradycardia, hypothermia, hypotension, and growth compromise.
  • Family-based and developmentally tailored interventions improve outcomes.

Pathophysiology

ARFID arises from disrupted intake patterns related to food avoidance, sensory aversion, or fear of adverse consequences of eating. Persistent restriction produces calorie and micronutrient deficits, then systemic compromise if untreated.

Unlike anorexia nervosa, ARFID is not primarily driven by weight-shape psychopathology. Symptom persistence is often reinforced by anxiety reduction after avoidance.

Classification

  • Sensory-based restriction: Avoidance due to texture, taste, smell, or visual features.
  • Fear-based avoidance: Restriction after choking, vomiting, pain, or traumatic food event.
  • Low-interest pattern: Marked lack of appetite or low drive to eat.

Nursing Assessment

NCLEX Focus

Differentiate ARFID from anorexia by assessing motivation for restriction and body-image beliefs.

  • Assess restricted-food patterns, aversions, and precipitating food-related events.
  • Assess growth/weight trends, hydration status, and vital-sign instability.
  • Assess for nutrition deficiencies and associated symptoms.
  • Assess comorbid anxiety, autism-spectrum traits, obsessive features, and ADHD symptoms.
  • Assess family stressors and caregiver capacity for structured support.

Nursing Interventions

  • Initiate nutrition rehabilitation and monitor for medical instability in severe cases.
  • Support exposure-based feeding plans and gradual food expansion.
  • Use age-appropriate behavioral interventions and caregiver coaching.
  • Coordinate collaborative care with dietitian, therapist, and behavioral specialists.
  • Reinforce family-based treatment participation and home-structure planning.

Pediatric Deterioration Risk

Children can decompensate quickly from sustained restriction; monitor growth, hydration, and hemodynamics closely.

Pharmacology

There are no FDA-approved medications specific to ARFID. In selected pediatric contexts, off-label medications may be used to support appetite or anxiety reduction while behavioral treatment proceeds.

Nurses monitor effect, adverse events, and interaction with nutrition goals, and ensure medication is adjunctive to structured feeding therapy.

Clinical Judgment Application

Clinical Scenario

A child with severe texture aversion and choking fear presents with low intake, weight decline, and orthostatic symptoms.

Recognize Cues: Restrictive intake with physiologic compromise and anxiety-driven avoidance. Analyze Cues: Pattern is consistent with ARFID rather than weight-shape driven restriction. Prioritize Hypotheses: Immediate priority is nutritional and hemodynamic stabilization. Generate Solutions: Start monitored nutrition support and behavioral feeding plan. Take Action: Coordinate family-centered, multidisciplinary ARFID treatment. Evaluate Outcomes: Track intake diversity, weight stabilization, and reduced avoidance.

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