Identifying early feeding and growth patterns of infants who later develop Avoidant Restrictive Food Intake Disorder (ARFID) symptoms: findings from a prospective birth cohort

Background: Avoidant Restrictive Food Intake Disorder (ARFID) is a feeding/eating disorder characterised by intake of an insufficient quantity or variety of food. ARFID symptoms often emerge early, yet there is limited research on possible early life feeding and growth factors associated with the disorder. Methods: We used data from Gemini, a British prospective birth cohort study with parent-reported ARFID symptoms measured at 12-13 years (n=968). Exposures of interest (measured in the first year of life) included appetite, infant milk-feeding, parental concern about their child’s weight, parental feeding practices (pressure and restriction) and infant growth (e.g., weight-for age z scores, weight gain trajectories). Logistic regressions (adjusted for clustering of twins in families) examined associations with later ARFID symptoms and linear mixed models compared weight gain trajectories between the suspected ARFID and non-ARFID participants. Results: Appetite, specifically early slower feeding (OR=1.47, 95%CI= 1.13, 1.90) and sensitivity to satiety (OR = 1.35, 95%CI= 1.03, 1.77) were associated with increased odds of later ARFID symptoms. Infants whose parents were concerned about their child’s weight had higher odds of ARFID symptoms (OR= 1.76, 95%CI = 1.15, 2.70). Having a higher weight at birth, three, six, nine and twelve months was associated with 12-20% lower odds of ARFID symptoms and trajectory analyses suggest that children with ARFID symptoms may have a slower weight gain trajectory compared to children without ARFID symptoms. Conclusion: Findings indicate that poor appetite (especially slower feeding and getting full more quickly) and weight stagnancy in infancy may be potential risk factors for later ARFID symptoms, some of which (e.g. poor appetite) may play a role in the disorder’s development.