Selective eating and 'beige food': when to ask about ARFID

Why does my autistic child only eat certain foods?

Selective eating is very common in autistic children. A review of 17 studies found autistic children had about five times the odds of feeding problems compared with other children, and tended to get less calcium and protein. There is usually a real reason behind it, and more than one can apply:

• Taste, smell and texture. The NHS lists "negative feelings over the smell, taste or texture of certain foods" as one reason for restricted eating, and the National Autistic Society lists food textures, cooking smells and certain flavours among common sensory triggers. A review of 56 studies found sensory sensitivity was the most commonly described driver of very restricted eating in autistic children, and an earlier review also linked sensory sensitivity with selective eating.
• Predictability. Many autistic people find routine and predictability calming (National Autistic Society). Plain, packaged or "beige" foods such as bread, crackers, pasta and chips tend to look, taste and feel the same every time, which may be why they so often become safe foods.
• A bad experience. Some children avoid foods after choking or being sick (NHS).
• Low interest or hunger signals. Some children feel little hunger or interest in eating (NHS). Noticing hunger is part of interoception, the sense of what is happening inside the body, which can be more or less sensitive in autistic people (National Autistic Society).
• Physical problems. Constipation and reflux can affect appetite (NHS Lanarkshire), and constipation is much more common in autistic children (McElhanon et al. 2014).

Selective eating is not naughtiness. Knowing the likely reason helps you choose what to try.

Is a limited diet OK, or should I get help?

A small but steady list of foods can often be supported at home for a while, if your child is growing well, has energy and is otherwise well. But a very restricted diet can harm health. NICE says feeding problems, "including restricted diets can result in nutritional deficiencies that may have serious consequences", and asks professionals to assess feeding, growth and nutrition, monitor, and refer if needed, with blood tests if required (NICE CG170).

What is ARFID?

ARFID stands for avoidant/restrictive food intake disorder. The NHS says it is "when someone avoids certain foods, limits how much they eat or does both", and that "beliefs about weight or body shape are not reasons why people develop ARFID". The eating disorder charity Beat says ARFID occurs in children, teenagers and adults, and that autism is one of the conditions most commonly found alongside it.

The NHS gives three kinds of reason: negative feelings about the smell, taste or texture of foods; an upsetting past experience, such as choking or being sick; and not feeling hungry or having little interest in eating.

A review of 56 studies found ARFID-like eating is "common" in autistic children and young people, "with severe consequences for physical and mental health". But nobody yet knows how many autistic children have ARFID. When parents of 486 children described their child's eating in another study, children with ARFID, autistic children and picky eaters overlapped a lot, including in sensory sensitivity. So there is no neat dividing line. What matters most is whether your child's eating is affecting their health and growth, and how much it limits everyday life for them and your family.

How is ARFID assessed?

Start with your GP: both the NHS and Beat advise this if you think someone might have ARFID. A professional is likely to ask what your child eats and drinks, what happens at mealtimes and why foods are avoided, and to check growth and health. NICE says a full nutritional assessment may include blood tests.

Depending on where you live, your child may then be referred to a paediatrician, a paediatric dietitian or a specialist feeding team. Beat says young people with ARFID may be treated by their local community eating disorders service for children and young people. What is available varies from area to area.

How can I help my child eat a wider range of foods?

Start with the lowest-pressure ideas and go slowly. Most of this advice comes from NHS dietitians and has not been tested in large trials, so keep what works for your child.

Keep safe foods on the plate

Include at least one food your child already eats at every meal. The NHS Lanarkshire leaflet advises offering "the full range of foods that your child does eat". If foods must not touch, use a divided plate or separate plates.

Let new foods sit nearby, with no pressure

Put a small amount of a new food near your child, or on a separate plate, and let them look at, touch or smell it with no expectation to eat. Eat it yourself if your child is happy for you to. Say nothing about what is left: the leaflet advises "Do not comment about uneaten food". It can take many calm tries before a child touches or tastes something new.

Try food chaining

Food chaining means moving in small steps from a food your child accepts to others like it. Researchers describe it as a gentle, home-based approach that builds on the features a new food shares with foods your child already eats; the evidence comes from one review of clinic records. The NHS leaflet gives a bread example: white medium sliced, then white thick sliced, then 50:50, then wholegrain, then toast, then crackers, then oatcakes. Change one thing at a time, such as the brand, shape or colour.

Make mealtimes predictable

The leaflet suggests "3 meals and 3 snacks daily", "Visual aids such as a meal plan using pictures", and finishing main meals within about 20 to 30 minutes. A picture plan works like a visual timetable for food. Keep the same seat and plate, and a calm room, if that helps your child.

Explore food away from the table

Messy play can help with textures. The leaflet says: "The aim is to have fun and for your child to get messy with NO expectation to eat". You can also let your child help choose, wash or put away food, again with no expectation to eat it.

Specialist programmes

If home strategies are not enough, specialist feeding teams may offer a structured programme with parent coaching. The research is small: a review of 23 papers found every study had five or fewer children, all using prompting and rewards. Children often ate more, but not necessarily a wider range of foods. A 2023 review of programmes that train parents found further signs of benefit, with open questions about how best to involve parents. Ask any service how it keeps mealtimes low-stress and what happens if your child refuses.

What should I avoid?

Pressure can backfire. Avoid:

• Forcing. "Never force your child to eat, this can make problems worse" (NHS Lanarkshire).
• Bribes and food rewards. The leaflet advises against using pudding, or other foods, as a reward.
• Hiding new foods inside safe foods. If your child notices, they may stop trusting a food they used to eat.
• Comments and battles. Don't remark on what is left, and keep mealtimes calm even when little is eaten.
• Cutting out food groups without advice. NICE says not to use exclusion diets, such as gluten-free or casein-free diets, to manage the core features of autism. Our guide to autism therapies covers other claims you may see.

Who can help with eating in the UK?

• Your GP is the first step if you think your child might have ARFID. They can check growth, arrange blood tests and refer on.
• Your health visitor, for children under 5, can check growth and give advice.
• A paediatrician, if your child already sees one, should hear about eating worries too.
• A paediatric dietitian can look at your child's whole diet. Ask your GP, health visitor or paediatrician for a referral if you are worried about weight or nutrition (NHS Lanarkshire).
• Feeding teams and eating disorder services exist in some areas; ask your GP what is available locally.
• An occupational therapist can assess sensory differences that affect everyday life, which the National Autistic Society suggests if they are having a negative impact.
• Beat, the eating disorder charity, has information on ARFID and support for families, including a helpline and peer support for family members. See Beat.

The NICE guideline quoted here is for England, and the NHS leaflet is from Scotland, but wherever you live in the UK, your GP or health visitor is the place to start. For sensory ideas that help at mealtimes, see our guide to sensory differences, and for constipation, see toilet training.