Journal Article

Comparison of clinical presentation and management of children and adolescents with ARFID between paediatrics and child and adolescent psychiatry: a prospective surveillance study

Sanchez-Cerezo, Javier, Hudson, Lee D, Lynn, Richard M, Haidar, Ellaha, Julius, Nikita, Nicholls, Dasha, Neale, Josephine

2025

Overview

ObjectiveTo compare the clinical presentations, management and outcomes of avoidant/restrictive food intake disorder (ARFID) across paediatric and child and adolescent (C&A) psychiatric settings.Study designProspective surveillance study.MethodsData were collected during a 13-month prospective surveillance study of children and adolescents with ARFID in the UK and Republic of Ireland. Paediatricians reported cases via the British Paediatric Surveillance Unit and psychiatrists through the Child and Adolescent Psychiatry Surveillance System. A follow-up questionnaire was sent at 12 months after a case of ARFID was reported.Results319 cases were included, 189 from paediatricians and 130 from C&A psychiatrists. Patients presenting to paediatricians were younger (9.8 years vs 13.7 years), more often male (62.4% vs 43.1%), and had more chronic symptoms (80.4% vs 67.0%), selective eating (63.7% vs 46.6%) and comorbid autism (67.6% vs 50.0%) than to psychiatrists. Psychiatrists saw patients with more fear of aversive consequences from eating (13.1% vs 3.2%), weight loss (76.7% vs 65.0%) and comorbid anxiety (78.2% vs 47.4%). Patients presenting to paediatricians more often received medical monitoring (74.6% vs 53.1%), dietetic advice (83.1% vs 70.0%) and nutritional supplements (49.2% vs 30.0%). At follow-up, both cohorts improved in nutritional status. However, the psychiatric cohort improved more regarding disordered eating behaviours.ConclusionsThe presentation and management of ARFID differs across clinical settings. Findings suggest the need to develop clinical pathways for ARFID assessment and management across paediatrics and mental health. Our findings highlight the potential benefits of psychiatric input for some patients with ARFID.

• Publisher: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adolescent / Adolescent Health / Adolescent Psychiatry / Adolescents / Age / Anorexia / Anxiety Disorders / Autism / Autism Spectrum Disorders / Avoidant Restrictive Food Intake Disorder - diagnosis / Avoidant Restrictive Food Intake Disorder - epidemiology / Avoidant Restrictive Food Intake Disorder - psychology / Avoidant Restrictive Food Intake Disorder - therapy / Body Composition / Body mass index / Child / Child & adolescent mental health / Child & adolescent psychiatry / Child Psychiatry / Children / Children & youth / Comorbidity / Cutting Scores / Demographics / Dietary supplements / Eating behavior / Eating disorders / Epidemiology / Ethnicity / Evidence Based Practice / Fear / Feeding and Eating Disorders - diagnosis / Feeding and Eating Disorders - epidemiology / Feeding and Eating Disorders - psychology / Feeding and Eating Disorders - therapy / Female / Food / Food intake / Humans / Interdisciplinary Approach / Ireland - epidemiology / Male / Mental Disorders / Mental health / Nutrition / Nutritional status / Obesity / Original Research / Overweight / Paediatrics / Patients / Pediatrics / Prospective Studies / Psychiatric Services / Psychiatrists / Questionnaires / School Demography / Scientific Concepts / Statistical Data / Statistical Significance / Surveillance / Teenagers / Test Anxiety / United Kingdom - epidemiology