An avoidant restrictive food intake disorder in a 7-year-old male came with nutritional deficiencies: a case report

Avoidant Restrictive Food Intake Disorder (ARFID) is a recently recognized feeding and eating disorder characterized by restricted or avoidance of food intake due to the sensory characteristics of the food or fear of the unpleasant consequences of eating without concerns about body image. It commonly presents in childhood and can lead to serious nutritional and developmental outcomes. While reports from high-income countries are increasing, data from low-resource settings remain scarce. In such settings, malnutrition is often attributed to food insecurity or infection, making ARFID an under-recognized cause of severe nutritional deficiency.

A seven-year-old male patient presented with generalized edema, night blindness, and growth failure. He had a highly restricted diet, mainly consisting of injera and bread, with complete avoidance of fruits, vegetables, and animal products due to fear. Physical examination and investigations diagnosed both macronutrient (edematous malnutrition) and micronutrient deficiencies (hypoalbuminemia, mixed anemia including iron and megaloblastic anemia, and vitamin A deficiency). Based on the feeding history and clinical features, he was diagnosed with ARFID. Although Hymenolepis nana infection was present and likely contributed to acute clinical deterioration, the child's restrictive eating behavior had been present for several years prior to the infection and represented the primary underlying cause of nutritional deficiency. Nutritional rehabilitation through nasogastric tube feeding and behavioral cognitive therapy led to significant clinical and dietary improvements.

Food selectivity may be a common problem in children, especially in pre-school age groups, but it doesn't lead to nutritional deficiency. ARFID is one of the avoidant food disorders commonly found in the childhood age group, which may lead to different nutritional deficiencies in both developed and developing countries. To prevent the acute and long-term complications of ARFID, it's important to have a high index of diagnostic suspicion in varied clinical settings.

This case highlights that ARFID can occur even in low-resource settings, where nutritional deficiencies are often presumed to result solely from poverty or infection. Taking a detailed dietary history and exploring reasons for food avoidance are crucial for differentiating ARFID from other causes of malnutrition. Early recognition and multidisciplinary care can prevent severe complications and improve outcomes.