Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar;58(3):489-499.
doi: 10.1002/eat.24349. Epub 2024 Dec 16.

A US-Based Consensus on Diagnostic Overlap and Distinction for Pediatric Feeding Disorder and Avoidant/Restrictive Food Intake Disorder

Hayley H Estrem  1 , Jaclyn L Pederson  2 , Pamela Dodrill  3 , Cuyler Romeo  4 , Kelsey Thompson  5 , Jennifer J Thomas  6 , Nancy Zucker  7 , Richard Noel  8 , Hana Zickgraf  9 , Jessie Menzel  10 , Colleen T Lukens  11 , Praveen S Goday  12 , Sarah MacLaughlin  13 , William G Sharp  14
Affiliations

A US-Based Consensus on Diagnostic Overlap and Distinction for Pediatric Feeding Disorder and Avoidant/Restrictive Food Intake Disorder

Hayley H Estrem et al. Int J Eat Disord. 2025 Mar.

Abstract

Objective: As diagnoses covering dysfunctional feeding and eating in pediatrics, avoidant/restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD) contain inherent areas of overlap in their diagnostic criteria. Areas of overlap include criteria regarding nutritional consequences associated with feeding/eating dysfunction and shared emphasis on possible psychosocial impairment associated with restricted food intake. Complicating the differential diagnosis process is a lack of guidance regarding when the two conditions occur independently, co-qualify, and/or transition into the other. Feeding Matters' Research Initiatives Task Force planned and hosted a PFD-ARFID consensus meeting, with the aim of reaching a consensus regarding diagnostic clarity on PFD and ARFID.

Method: Criteria for participation focused on US residents who either: (a) served as an author on the ARFID workgroup or PFD consensus papers, or (b) provided community representation via board or committee roles. The consensus process followed three stages: prework, the meeting, and post-work/writing. Twelve participants were present for the meeting, with 14 involved in pre- and post-work/writing.

Results: The final panel included four psychologists representing the ARFID community and seven multidisciplinary members representing PFD's four domains (medical, nutrition, skill, and psychosocial) plus a Zero-to-Three community representative and two representatives from Feeding Matters. Results yielded 10 consensus statements and visuals to support the consensus statements.

Discussion: The consensus process and results underscore an ongoing need to improve diagnostic systems and reinforce calls for strengthening healthcare expertise for both PFD and ARFID. Community-based participatory research is recommended to advance both diagnoses and reduce ambiguity in practice settings.

Keywords: ARFID; DSM‐5; ICF; PFD; diagnosis; feeding and eating disorder; research diagnostic criteria.

PubMed Disclaimer

Conflict of interest statement

Authors that attended the August 2023 consensus meeting had the option to accept a travel stipend covered by Marcus Foundation funding.

Figures

FIGURE 1
FIGURE 1
ARFID and PFD diagnostic overlap. Made available with permission from feeding matters organization.
FIGURE 2
FIGURE 2
Proposed ARFID and PFD influential relationship.
FIGURE 3
FIGURE 3
Feeding development window.
FIGURE 4
FIGURE 4
Reference list of 10 consensus summit statements.
See this image and copyright information in PMC

References

    1. Alford, E. N. , Hopson B. D., Safyanov F., et al. 2019. “Care Management and Contemporary Challenges in Spina Bifida: A Practice Preference Survey of the American Society of Pediatric Neurosurgeons.” Journal of Neurosurgery. Pediatrics 1‐10: 539–548. 10.3171/2019.5.Peds18738. - DOI - PubMed
    1. Alvar, A. , Hahn Arkenberg R., McGowan B., Cheng H., and Malandraki G. A.. 2021. “The Role of White Matter in the Neural Control of Swallowing: A Systematic Review.” Frontiers in Human Neuroscience 15: 628424. 10.3389/fnhum.2021.628424. - DOI - PMC - PubMed
    1. American Speech‐Language‐Hearing Association (ASHA) . 2010. “News in Brief.” ASHA Leader 15, no. 12: 3.
    1. APA . 1994. Diagnostic and Stastical Manual of Mental Disorders 4th Edition. New York: American Psychiatric Association. 10.1176/appi.books.9780890420614.dsm-iv. - DOI
    1. APA . 2013. Diagnostic and Statistical Manual of Mental Disorders: DSM‐5. Arlington, VA: American Psychiatric Association. http://VB3LK7EB4T.search.serialssolutions.com/?V=1.0&L=VB3LK7EB4T&S=JCs&....

Publication types

MeSH terms

Grants and funding