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

Kelsey Thompson, Pamela Dodrill, Sarah MacLaughlin, Praveen S Goday, Nancy Zucker, William G Sharp, Jennifer J Thomas, Hayley H Estrem, Jaclyn L Pederson, Cuyler Romeo, Richard Noel, Hana Zickgraf, Jessie Menzel, Colleen T Lukens

Journal: The International journal of eating disorders 2025;58(3):489-499

PMID: 39679744

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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.

Address: School of Nursing, University of North Carolina at Wilmington, Wilmington, North Carolina, USA.; Feeding Matters, Phoenix, Arizona, USA.; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.; Banner-University Medical Center South, Tucson, Arizona, USA.; The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; Massachusetts General Hospital, Boston, Massachusetts, USA.; Duke University Health Center, Durham, North Carolina, USA.; Duke Children's Hospital and Health Center, Durham, North Carolina, USA.; Rogers Behavioral Health Oconomowoc Main Campus, Atlanta, Georgia, USA.; Equip, California, USA.; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.; Nationwide Children's Hospital, Columbus, Ohio, USA.; Zero to Three, Washington, Columbia, USA.; Emory Medical School, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.

DOI: 10.1002/eat.24349

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MeSH Terms: Humans, Child, Consensus, Avoidant Restrictive Food Intake Disorder, United States, Diagnosis, Differential, Feeding and Eating Disorders of Childhood, Feeding and Eating Disorders