How Does ARFID Show Up at School?

Avoidant/Restrictive Food Intake Disorder (ARFID) is not just picky eating. We say this a lot—mostly because it seems to need a lot of repetition for those who are not living with or treating someone with ARFID.

A parent recently told me how tired she is of the judgment she experiences from others and how much she wishes she had a community around her of people who truly understand ARFID.

So, let’s try to be—or help create—that community by spreading the word and educating others about ARFID. Let’s learn more about how ARFID can show up in different settings.

Today, I’d like to focus on how ARFID can show up at school and how kids, parents, educators, and administrators can work together to find systems that provide support.

Understanding What ARFID Looks Like at School

ARFID is not simply about weight or size. It is about an individual's relationship with food and may involve fear, anxiety, sensory sensitivities, disgust, or a lack of interest in eating.

Someone with ARFID may be underweight, at an average weight, or above average weight. They may have always struggled with eating, or their relationship with food may have changed after an experience such as choking, gagging, vomiting, an allergic reaction, or gastrointestinal issues made eating feel threatening or unsafe.

Because ARFID can look so different from person to person, it can show up in many different ways at school.

It might look like the kiddo who sits with their lunchbox in front of them but doesn't open it.

It might look like the teen who has five different "snack" foods in their lunch but no "real" food. Those words are in quotes intentionally because it can be helpful to think about food in terms of nutrition and food groups rather than labeling certain foods as "real" or "junk."

If it's a grain, it's a grain. If it's providing energy, it serves a nutritional purpose. While someone may be working toward adding more variety and additional food groups, sometimes grains or other familiar foods may be what they are currently able to eat.

ARFID could also look like an anxious or shut-down student, a cranky or irritable student who isn't getting enough energy, or a kiddo who eats fairly comfortably as long as their safe foods aren't challenged—but has a very limited range of foods they can tolerate.

Sometimes ARFID may not be obvious at all.

What Can We Do to Help at School?

Ideally, parents, teachers, administrators, counselors, nurses, teacher's aides, and other school staff are having conversations about how to support a student with ARFID.

When people don't understand ARFID, they may unintentionally say things that are hurtful or increase anxiety around food:

• "You need to eat healthier."

• "If you eat all that junk, you're going to get fat."

• "Why don't you just eat?"

These comments may seem simple to someone who doesn't understand ARFID, but for a student struggling with eating, they can add shame and make an already difficult situation even harder.

Here are some ideas for families and schools to discuss and consider:

1. Allow alternative snacks and foods when needed

   For example, if a class is having a food-related celebration, consider allowing a parent to send in a similar but safe food for their child.

   
   

   The goal isn't to give the child a "special pass" from participating. It's to make participation possible without requiring them to eat a food they are currently unable to tolerate.

   
   

2. Consider flexible snack opportunities

   Some students may need snacks mid-morning or mid-afternoon to meet their nutritional needs.

   
   

   Depending on the student and their accommodations, this could mean allowing them to eat in the classroom or providing an alternative environment, such as the nurse's or counselor's office.

   
   

   Another option is to normalize snacks for everyone in the classroom when appropriate, which can reduce the feeling that a student is being singled out.

   
   

3. Consider supervised lunches when medically necessary

   For some students, eating at school may be particularly challenging. A supervised lunch in a supportive environment may help ensure that a student has an appropriate opportunity to eat their available safe foods.

   
   

   The goal should be to create a calm, supportive environment—not one where the student feels watched, pressured, or judged.

   
   

4. Make nutrition supplements accessible when needed

   For some students, oral nutrition supplements may be part of their nutrition plan.

   
   

   If a supplement has been recommended by the student's healthcare team, consider how the school can make it readily accessible during the school day.

   
   

5. Educate school staff about ARFID

   One of the most helpful things we can do is increase understanding.

   
   

   ARFID is a legitimate eating disorder, and understanding the disorder can help staff recognize that a student's eating behaviors are not simply defiance, laziness, or "being picky."

   
   

   Many organizations have educational resources available, and local eating disorder professionals may also be able to provide education or in-services for schools.

   For example, in Indiana, the Eating Disorder Task Force of Indiana has task force members throughout the state who provide education on ARFID and other eating disorders.

6. Consider the whole student

   ARFID frequently occurs alongside other challenges, including anxiety, ADHD, OCD, and autism spectrum disorder.

   
   

   This means that accommodations that support a student's other needs may also make it easier for them to use the coping strategies they are learning to manage ARFID.

   For example, sensory sensitivities to lighting, sound, movement, smells, or crowded environments can make mealtimes particularly difficult.

   
   
   
   

   Helping a student who is anxious or overstimulated find ways to regulate themselves won't "fix" ARFID—but it may help create the conditions they need to use the skills they are developing in treatment.

   
   

7. Most of all, be kind first

   Stop. Ask questions. Listen.

   
   

   Consider that most individuals—and their parents—are doing the absolute best they can, even when you can't see the effort or when things aren't going as well as you think they should.

   
   

   Think about ducks gliding across the water. From above, they look calm and effortless. What we don't see is how hard they are kicking beneath the surface.

   ARFID can be like that.

   
   

   A child may look like they are "refusing lunch," when underneath the surface there may be anxiety, fear, sensory discomfort, nausea, or an overwhelming feeling that makes eating incredibly difficult.

   
   

   Let's give these kids and their families some grace.

   
   

   Let's replace judgment with curiosity, pressure with support, and assumptions with questions.

   
   

   And most importantly, let's work together to create school environments where kids with ARFID can feel safe, understood, and supported while they continue working toward recovery.