Fear and picky eating-related ARFID behaviors in children with food allergy

Food allergy is a chronic condition with psychosocial consequences for both children and their families. Strict elimination diets and fear of adverse reactions may contribute to maladaptive coping including behaviors avoidant/restrictive food intake disorder (ARFID)-related eating patterns. Therefore, this study aimed to compare ARFID-related eating behavior scores between children with food allergy and healthy controls and to identify the affected domains.

In this prospective controlled study, 234 children aged 2-9 years were enrolled, including 117 children with physician-diagnosed food allergy and 117 age- and sex-matched healthy controls. Eating behaviors were assessed using the Nine Item Avoidant/Restrictive Food Intake Disorder Screen-Parent Report (NIAS-PR). Total and subscale scores (picky eating, fear, and appetite) were compared between groups. Within the food allergy group, associations between clinical characteristics and NIAS-PR scores were analyzed.

Children with food allergy demonstrated significantly higher NIAS-PR total scores compared with controls. The median total NIAS score was higher in the patient group than in the control group (17 [11-24] vs. 12 [7-18], p < .001). This difference was primarily driven by higher fear- and picky-eating-related scores, whereas appetite scores did not differ significantly. Fear subscale scores were significantly higher in children with a history of urticaria or anaphylaxis.

Pediatric food allergy is associated with increased ARFID-related eating behaviors, particularly fear- and picky-eating patterns. In addition, fear-related scores were higher among children with a history of immediate-type reactions, such as urticaria and anaphylaxis. These findings suggest that ARFID-related eating behaviors should be considered in the assessment of children with food allergy.