A group of leading clinical psychologists has reached a consensus that two previously separate childhood feeding conditions should be treated using the same core psychological approach, a finding that could simplify care for thousands of families struggling with children who severely restrict what they eat. The findings were published on The International Journal of Eating Disorders.
Paediatric feeding disorder (PFD) and avoidant/restrictive food intake disorder (ARFID) have long been treated as distinct diagnoses managed by different clinical communities. Despite sharing similar symptoms, including food avoidance, restricted diets, and serious impacts on growth and nutrition, the two conditions developed separate treatment traditions that have sometimes left families and referring clinicians confused about where to turn.
The new consensus, published in the International Journal of Eating Disorders, emerged from the 2024 PFD-ARFID Psychology Summit, a meeting of nine specialist clinical psychologists convened by the Feeding Matters Research Initiative Task Force. Participants reviewed existing treatment evidence and reached agreement through a structured facilitated process involving pre-reading, case submissions, and voting.
The central finding is that exposure therapy, where children are gradually introduced to avoided foods and eating situations in a controlled way, represents the common core of effective treatment across both conditions. Alongside exposure, the experts agreed on three additional shared elements: collaborative goal setting between clinicians, patients, and families; techniques to enhance motivation; and meaningful involvement of parents or caregivers throughout the process.
Rather than the specific diagnosis driving treatment choices, the panel concluded that three practical factors should shape how therapy is delivered. These are the severity of the child’s symptoms, their age and developmental level, and the precise nature of their feeding difficulties, whether rooted in sensory aversion, low appetite, or fear of choking or vomiting.
ARFID is estimated to affect up to 4.5% of the general population, and PFD occurs in roughly 1 in 23 children under the age of five. Many children meet criteria for both conditions simultaneously, and a significant number shift from a PFD diagnosis to an ARFID diagnosis once underlying medical issues are resolved but food avoidance persists.
The consensus panel noted that before psychological treatment begins, a multidisciplinary assessment is recommended to identify any medical or skill-based contributors to feeding difficulties. Pre-treatment preparation may also include building distress tolerance in children and families, and addressing parenting strategies that could conflict with an exposure-based approach.
The panel acknowledged that most existing feeding programmes are designed for either younger children with high support needs or older, more psychiatrically complex patients, and that not every child is suited to every programme. They therefore advised referrers to consider the ages, developmental levels, and presenting problems a programme typically treats, rather than focusing solely on whether it labels itself as ARFID or PFD focused.
The authors noted that the consensus was not based on a systematic review, and that clinical trials and further mechanistic research are needed in coming years.
