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Avoidant/Restrictive Food Intake Disorder (ARFID)

DSM-5 criteria - eating disturbance without body-image disturbance.

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1 What is the Avoidant/Restrictive Food Intake Disorder (ARFID)?

The Avoidant/Restrictive Food Intake Disorder (ARFID) is a psychosocial scoring tool used in paediatric practice. DSM-5 criteria - eating disturbance without body-image disturbance. It scores 4 criteria and interprets the total across 2 bands, so the number always arrives with the severity it implies rather than on its own. In PediAid each criterion is shown as a labelled option with the weight it carries, so the total can be checked rather than taken on trust.

2 When to use it

  • Grading severity at the bedside in psychosocial
  • Recording an objective severity band in the case notes
  • Deciding when a total crosses the threshold for escalation
  • Re-scoring to track whether a child is improving or deteriorating
  • Checking the exact criteria of a score used infrequently

3 Formula & method

The score sums 4 criteria: Significant weight loss or failure to achieve expected weight gain / faltering growth; Significant nutritional deficiency; Dependence on enteral feeding or oral nutritional supplements; Marked interference with psychosocial functioning. Totals are then banded: any score - Below threshold: no listed consequence - ARFID requires at least one; 1 criteria met or more - Threshold met: ≥1 consequence present with an eating/feeding disturbance - consistent with ARFID, provided there is no body-image disturbance and no lack of available food or culturally sanctioned practice.
  • DSM-5 threshold: 1 or more of the 4 criteria listed.
  • A diagnosis also requires clinically significant distress or impairment, the required duration, and exclusion of substance use or another condition. Screening aid only - not a diagnosis.
  • Must NOT be explained by anorexia/bulimia (no disturbance in body weight or shape experience).

4 Frequently asked questions

How many criteria does the Avoidant/Restrictive Food Intake Disorder (ARFID) use?

4. They are Significant weight loss or failure to achieve expected weight gain / faltering growth; Significant nutritional deficiency; Dependence on enteral feeding or oral nutritional supplements; Marked interference with psychosocial functioning.

What do the bands of the Avoidant/Restrictive Food Intake Disorder (ARFID) mean?

The total is interpreted as: any score - Below threshold: no listed consequence - ARFID requires at least one; 1 criteria met or more - Threshold met: ≥1 consequence present with an eating/feeding disturbance - consistent with ARFID, provided there is no body-image disturbance and no lack of available food or culturally sanctioned practice.

Does the score replace clinical judgement?

No. It is a structured way to record and communicate severity. A clinician concerned about a child should act on that concern regardless of the total.

Where does this score come from?

DSM-5 threshold: 1 or more of the 4 criteria listed.

Does it work offline?

Yes. Score definitions are bundled with the PediAid app, so the score computes without a connection.

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ESPGHAN 2022
For qualified clinicians. This page and the PediAid app are a clinical aid only. Calculations and reference data must be verified against the patient's clinical context, the source guideline and your local protocols before any treatment decision is made.