Picky Eating, Pediatric Feeding Disorder, or ARFID? How to Tell the Difference

If mealtimes feel like a battle in your home, you’re not alone. As a Certified Pediatric Feeding Therapist, I often meet families who aren’t sure if their child’s eating habits are “just picky eating” or if something more is going on. The truth is, there’s a spectrum — from typical developmental phases to clinical feeding disorders that need specialized support.

Let’s break it down together :) 

1. Picky Eating

• What it is: A common phase, especially between ages 2–5, when kids may decline certain foods or prefer familiar favorites.

• Why it happens: Developmental independence, changes in taste perception, and even a little power-testing at the dinner table.

• Signs it’s typical picky eating:

  • Child eats from all major food groups (even if the variety is limited)

  • Growth is on track

  • They try new foods occasionally — even if reluctantly

  • Mealtimes aren’t causing significant stress or anxiety for the child

• To help improvement: With patience, repeated exposure, and positive mealtime routines, most kids grow out of it. This is when picky eating is typical!

2. Pediatric Feeding Disorder (PFD)

• What it is: A Pediatric Feeding Disorder (PFD) is defined as a medical, nutritional, feeding skill, or psychosocial challenge that impacts a child’s ability to eat safely, effectively, or comfortably.

• How it’s different from picky eating: It’s not just preference — it’s a disruption in ability.

• Possible causes: Premature birth, medical conditions, sensory-motor delays, structural differences (e.g., cleft palate), or negative feeding experiences.

• Signs of PFD:

  • Coughing, choking, gagging during meals

  • Trouble chewing or swallowing

  • Limited diet that’s causing growth or nutrition concerns

  • Prolonged mealtimes (over 30–40 minutes)

  • High stress for child and caregivers around eating

• Why early help matters: PFD can affect growth, development, and the child’s relationship with food. Support from a feeding specialist, dietitian, and/or medical team can make a big difference.

3. ARFID (Avoidant/Restrictive Food Intake Disorder)

• What it is: A diagnosis in the DSM-5 (the manual that mental health professionals use) describing extreme food avoidance or restriction that’s not about body image or weight concerns. It is commonly associated with extreme anxiety around new foods or food in general.

• What drives it:

  • Sensory sensitivity (taste, texture, smell)

  • Fear-based avoidance after a negative event (like choking or vomiting)

  • Lack of interest in eating altogether

• Signs of ARFID:

  • Very limited list of accepted foods (sometimes fewer than 10)

  • Significant weight loss or failure to gain expected weight

  • Nutritional deficiencies

  • Intense distress or anxiety at the idea of trying new foods

• Why it needs specialized support: ARFID overlaps with both medical and psychological factors, so treatment often involves a team — including, but not limited to: feeding specialist, registered dietician, psychologist, and physician

The Takeaway for Parents

• Picky eating is usually temporary.

• PFD involves skill, medical, nutritional, or physiological challenges.

• ARFID is a mental health diagnosis with serious nutritional and emotional impacts.

As a Certified Pediatric Feeding Therapist, my goal is to help children feel safe, confident, and curious about trying new foods. Seeing both children and families enjoy a meal time together is the driving force behind why I love what I do.

If you're unsure where your child falls, or if you want support surrounding meal times, contact us here!